Understanding Heart Attack
When you think of a heart attack, you may have an image in your mind of someone—typically a man—suddenly folded over and clutching their chest. After all, this is how it’s often portrayed in many movies and TV shows. But while this can be the case, the signs of a heart attack may be much more subtle.
Heart attack, also called myocardial infarction, is a leading killer of men and women in the United States. Fortunately, there are treatments that can save lives and help people live an active life. But this hinges on getting timely care.
About heart attack
More than 730,000 Americans suffer a heart attack each year, according to the Centers for Disease Control and Prevention.
A heart attack happens when the heart’s blood supply is suddenly cut off. When this happens, the heart muscle is starved of oxygen-rich blood. In just a short period of time, part of the heart can be damaged or die and scar tissue forms. That’s why immediate care is critical—it can spare your heart and save your life. If your heart has a lot of damage, it can be very weak.
Most often, heart attacks result from a build up of plaque inside the coronary artery (atherosclerosis). When the plaque breaks away inside of the artery, a blood clot can form, blocking blood flow through a coronary artery. Two less common causes of heart attacks are an intense, prolonged spasm of the coronary artery or a tear in the artery wall (called spontaneous coronary artery dissection), both of which can reduce blood flow to the heart muscle.
Having a heart attack can be scary, and it’s often life-changing. For some people, it’s the scare they need to live a heart healthier life—making a conscious decision to eat better, exercise, manage other risk factors such as high cholesterol or blood pressure and not smoke. For others, they may have lived for years unaware they were even at risk.
Heart attacks are linked to heart failure and possibly life-threatening problems with how the heart beats (arrhythmias).
Who is at risk?
Most heart attacks are due to coronary artery disease. Risk factors for coronary heart disease and heart attack include:
- Having high blood pressure
- Having high cholesterol
- Carrying extra weight
- Eating a diet that is high in fat and sodium
- Not exercising regularly
- High blood sugar due to insulin resistance or diabetes
Many of the above risk factors occur together, which can make a heart attack even more likely. Other factors that have been linked to heart attack, but are less in your control include:
- Age—generally after 45 for men and 55 for women
- Family history of early heart disease
Still, there may not be clear reasons why heart attacks occur when they do. There is some evidence that lack of sleep and intense emotional stress, fear, anger or the “fight or flight” response and the accompanying surges of adrenaline can trigger a heart attack in certain people.
The best thing you can do to prevent a heart attack is to lead a healthy lifestyle.
What it feels like
The most common symptom for both men and women is chest pain or discomfort; however, women are more likely than men to have other symptoms.
Signs and symptoms may include:
- Chest pain or pressure or discomfort
- Discomfort or tingling in one or both arms, back, shoulder, neck or jaw
- Shortness of breath
- Cold sweat
- Unusual tiredness
- Heartburn-like feeling
- Nausea or vomiting
- Sudden dizziness
Remember, sudden, crushing chest pain or pressure or tightness aren’t the only signs of a heart attack. In one study, one in three people who had a heart attack had no chest pain; they were more likely to be older, a female or diabetic.
Think you’re having one?
If you think you might be having a heart attack, don’t delay. Call 9-1-1 right away. Delaying treatment can lead to permanent heart damage—even death. An ambulance is the best, safest way to get to the hospital.
Women are more likely to delay seeking help for a variety of reasons, including not wanting to bother others and being unsure about whether they are having a heart attack. It is always better to play it safe and call 9-1-1 right away and let the medical experts determine if you are having a heart attack.
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How is it diagnosed?
Doctors can usually diagnose a heart attack based on a combination of:
- Your signs and symptoms
- Your medical history
- Electrocardiogram (EKG) that can detect and record the heart's electrical activity and show signs of heart damage
- Blood tests that check the levels of certain proteins released into the bloodstream as heart muscle cells die; troponin tests, CK or CK–MB tests are commonly used and may be repeated over a period of time.
What are common treatments?
There are a number of treatment options. Treatments work best when they are given right after symptoms occur—within the first 1-2 hours. Early treatment to open up the blockage can help prevent or limit damage to the heart muscle.
In the acute scenario, when medical personnel think a heart attack is likely, you may be started on:
- Oxygen therapy
- Aspirin and other antiplatelet agents to thin your blood and prevent further clotting
- Nitroglycerin to help improve blood flow through the heart’s arteries
- Pain relief medications like morphine to address any chest pain
- Anticoagulants to prevent further clotting
- Beta-blockers to reduce workload on heart by decreasing the heart rate and blood pressure
Once doctors can confirm you are having an acute heart attack, treatments might include:
- Coronary angioplasty or percutaneous coronary intervention to open blocked arteries. In this procedure, a thin, flexible tube is threaded through a blood vessel, usually in the upper thigh, to the blocked artery. A stent is placed to open up the artery and restore blood flow. This is the best treatment of heart attacks and has the best outcomes when done within two hours.
- Clot-busting medications are usually given within hours of a heart attack to dissolve any blood clots blocking the artery. This is usually given in situations when angioplasty is unable to be performed because there are delays getting the patient to a facility with a catheterization lab.
- Medications including beta blockers, ACE inhibitors, statins, aspirin and other antiplatelet agents may be prescribed. Always take your medications as directed and discuss with your doctor any issues you may have with the medications.
- Procedures including heart bypass or an implantable device to even out your heart’s rhythm
- Cardiac rehabilitation, a medically supervised program to help people recover from heart attack and live a heart healthier life
- Lifestyle changes, for example following a better diet, getting routine exercise, quitting smoking and keeping up with medical appointments and advice are very important steps you can take to improve your health.
Life After a Heart Attack
If you’ve already had a heart attack, there are some things you need keep in mind.
- You are at greater risk of having another one. Talk with your doctor about what to look for—keep in mind a repeat heart attack may not feel the same as your first. Also, some people have chest pain (angina) that is usually brought on by physical activity. Ask your doctor how you can tell the difference between this and pain that might be related to a heart attack.
Call 9-1-1 if you think you are having a heart attack.
- Follow your care plan. It’s really important to keep up with your treatments—lifestyle changes and medications. There may also be things you should avoid—for example, certain medications, alcohol or foods. Also, know what your ideal weight is, as well as your blood pressure and cholesterol levels.
- Say ‘yes’ to cardiac rehabilitation. Cardiac rehab programs, which include health education and supervised exercise, can help you gain strength during your recovery. It’s also been shown to lower the risk of dying or going back to the hospital.
- Ask for support. Ask trusted friends and family to help you live a healthier life, come to appointments with you and be there as a source of comfort.
- Have an emergency plan in place. Keep a current list of your medications (names, prescriber, dosage and how often you take each), health care providers with contact information, basic medical history and contact info of a close friend or relative. If you suspect you are having a heart attack, aside from dialing 9-1-1, find out from your doctor if there is anything you can take while you wait for emergency services to arrive (e.g., chewing an aspirin, nitroglycerin pill or other medication).
Preventing a heart attack -- or another one
There are steps you can take to prevent a heart attack or help strengthen your heart after having one.
Talk to your care team
Your care team knows what’s best in terms of supporting your heart health.
Learn about your condition, and share any concerns or questions with your doctor.
Here are some questions you might want to ask:
- What caused my heart attack?
- When can I return to normal activities? What do I need to limit?
- How likely is it that I will have another heart attack?
- Should I be taking a daily aspirin? What other medications should I take?
- In the event of a heart attack, what can I do to increase the chances that I stay alive?
- Is there a cardiac rehab program I qualify for?
- How often should I be seeing my doctor? What types of tests might be needed?
- Should I be seeking psychosocial support? Are you aware of any local support groups?
- When can I drive or be sexually active again?
- What warning signs should I be watchful for?
To learn more about heart attack, click here. In addition to resources on CardioSmart.org, you can find out more about heart attacks at:
American Heart Association
National Heart, Lung and Blood Institute
Published: Aug. 2015
Medical Reviewer: Laxmi S. Mehta, MD, FACC, FAHA, The Ohio State University Medical Center