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is given by injection into a vein to ease the pain.

The part of the heart muscle starved of blood does not die immediately. If blood flow is restored within a few hours, much of the heart muscle that would have been damaged and die will survive. This is why a heart attack is a medical emergency and treatment is given urgently. The quicker the blood flow is restored, the better the outlook.

There are two treatments that can restore blood flow back through the blocked artery:

Emergency angioplasty An injection of a clot-busting medicine

Both the above treatments usually work well to restore blood flow and greatly improve the outlook. The most crucial factor is the speed at which one or other treatment is given after symptoms have started.

Beta-blocker medicines block the action of certain hormones such as adrenaline (epinephrine). These hormones increase the rate and force of the heartbeat. Beta-blocker medicines have some protective effect on the heart muscle and they also help to prevent abnormal heart rhythms from developing. Beta-blocker medicines will also help to prevent another heart attack.

Some people have a raised blood sugar level when they have a heart attack, even if they do not have diabetes. If this occurs then your blood sugar (glucose) levels may need to be controlled with insulin. If you have diabetes then it is also likely that you will need to be treated with insulin to control your blood glucose levels when you are in hospital.

You may be given oxygen which works to reduce the risk of damage to your heart muscle.

Normally you will be advised to take regular medication for the rest of your life. Many people recover well from a heart attack and have no complications. Before discharge from hospital, it is common for a doctor or nurse to advise you how to reduce any risk factors (see above). This advice aims to reduce your risk of a future heart attack as much as possible. Read more about medication after a heart attack (myocardial infarction) .

This often depends on the amount of heart muscle that is damaged. In many cases, only a small part of the heart muscle is damaged and then heals as a small patch of scar tissue. The heart can usually function normally with a small patch of scar tissue. A larger heart attack is more likely to be life-threatening or cause complications.

Even before treatments became available to restore blood flow, many people made a full recovery. With the help of modern treatment, particularly if you are given treatment within a few hours to restore blood flow, a higher percentage of people now make a full recovery.

Some possible complications include the following:

Heart failure Abnormal heart rhythms A further heart attack

The most crucial time is during the first day or so. If no complications arise and you are well after a couple of weeks then you have a good chance of making a full recovery. A main objective then is to get back into normal life and to minimise the risk of a further heart attack.

When recovering from a heart attack, it is natural to wonder if there are any dos and don'ts. In the past, well-meaning but bad advice to 'rest and take it easy from now on' caused some people to become over-anxious about their hearts. Some people gave up their jobs, hobbies and any activity that caused exertion, for fear of straining the heart.

However, quite the opposite is true for most people who recover from a heart attack. Regular exercise and getting back to normal work and life are usually advised. Much can be done to reduce the risk of a further heart attack. Read more about after a heart attack (myocardial infarction).

Next page:

Acute Coronary Syndrome

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Further reading and references

; NICE Clinical Guideline (July 2013)

; European Society of Cardiology (August 2015)

; 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2017 Aug 26. doi: 10.1093/eurheartj/ehx393.

; 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017 Aug 26. doi: 10.1093/eurheartj/ehx419.

; NICE Clinical Guideline (March 2010 - last updated November 2013)

; Scottish Intercollegiate Guidelines Network - SIGN (2016)

; NICE Clinical Guideline (November 2013)

; The Task Force on Myocardial Revascularization of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (Aug 2014)

; Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation. 2016 Mar 1133(9):916-47. doi: 10.1161/CIR.0000000000000351. Epub 2016 Jan 25.

; Driver and Vehicle Licensing Agency

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Review
Worldwide emergence of resistance to antifungal drugs challenges human health and food security

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18 May 2018: Vol. 360, Issue 6390, pp. 739-742 DOI: 10.1126/science.aap7999
Matthew C. Fisher
MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London W2 1PG, UK.
Nichola J. Hawkins
Department of Biointeractions and Crop Protection, Rothamsted Research, Harpenden AL5 2JQ, UK.
Dominique Sanglard
Institute of Microbiology, University of Lausanne and University Hospital, Lausanne CH-1011, Switzerland.
Sarah J. Gurr
Department of BioSciences, University of Exeter, Exeter EX4 4QD, UK. Department of BioSciences, Utrecht University, Paduallaan 8, Netherlands.

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Abstract

The recent rate of emergence of pathogenic fungi that are resistant to the limited number of commonly used antifungal agents is unprecedented. The azoles, for example, are used not only for human and animal health care and crop protection but also in antifouling coatings and timber preservation. The ubiquity and multiple uses of azoles have hastened the independent evolution of resistance in many environments. One consequence is an increasing risk in human health care from naturally occurring opportunistic fungal pathogens that have acquired resistance to this broad class of chemicals. To avoid a global collapse in our ability to control fungal infections and to avoid critical failures in medicine and food security, we must improve our stewardship of extant chemicals, promote new antifungal discovery, and leverage emerging technologies for alternative solutions.

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Science

Vol 360, Issue 639018 May 2018

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Worldwide emergence of resistance to antifungal drugs challenges human health and food security

By Matthew C. Fisher , Nichola J. Hawkins , Dominique Sanglard , Sarah J. Gurr

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