Heart Attack

A heart attack is when the blood supply that normally brings oxygen to the heart is cut off and the heart muscle begins to die. Heart attacks (myocardial infarctions) are very common in the United States. It is estimated that one heart attack happens every 40 seconds. 

Heart attacks most often occur as a result of coronary heart disease (CHD), also called coronary artery disease. CHD is a condition where plaques (a waxy substance) builds up inside the coronary arteries. Eventually, an area of plaque can rupture (break open) inside of an artery. This causes a blood clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through the coronary artery. If the blockage isn’t treated quickly, the portion of the heart muscle fed by the artery begins to die. 

  • Warning Signs & Symptoms
  • Risk Factors
  • Diagnosis
  • Treatments
  • Screening & Prevention

Some people have warning signs before they have a heart attack, while others won’t have any signs. Don’t wait to experience any of these warnings. Some heart attacks are sudden and intense. But most start slowly, with mild pain or discomfort. 

Some signs people reported: 

  • Chest pain – Most heart attacks involve mild to severe pain or discomfort in the center or left-center of your chest. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Upper body discomfort – You may feel pain in your arms, jaw, neck, back, shoulders, or upper part of your stomach. It may start in your chest and spread to other areas. 
  • Trouble breathing, shortness of breath – You may experience trouble breathing or the sensation of being winded when you’re at rest. This may be the only symptom you experience.

Other Common signs

  • Light-headedness or sudden dizziness
  • Cold sweat or clammy skin
  • Nausea and vomiting
  • Heart flutter or palpitations (especially in women)
  • Heartburn (especially in women)
  • Cough (especially in women)
  • Sleep disturbances (especially in women)
  • Anxiety (especially in women)
  • Extreme fatigue or exhaustion (especially in women, may occur for days or even weeks leading up to a heart attack)
Symptoms can vary between men and women. The most common symptom between both men and women is chest pain and discomfort. However, women are more likely to experience other symptoms, especially shortness of breath, nausea/vomiting, and back or jaw pain.

Certain risk factors make it more likely that you’ll develop coronary heart disease and have a heart attack. Many of these factors are controllable. 

Risk Factors You Can Control
  • Smoking
  • High blood pressure
  • High cholesterol
  • Overweight and obesity
  • An unhealthy diet (diets high in saturated fat, trans fats, cholesterol, and sodium)
  • Lack of routine physical activity
  • High blood sugar due to insulin resistance or diabetes
Risk Factors You Cannot Control
  • Age – The risk of heart disease increases for men after age 45 and for women after 55 (or after menopause).
  • Family history of early heart disease. Your risk increases if your father/brother was diagnosed with heart disease before 55 years of age or if your mother/sister was diagnosed with heart disease before 65 years of age. 
  • Preeclampsia – This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease. 

Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results.

Types of Tests

  • EKG (Electrocardiogram) – An EKG is a simple, painless test that detects and records the heart’s electronic activity. An EKG can show signs of heart damage, irregular heartbeat, and signs of previous or current heart attack. 
  • Blood test – During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood test can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack. 
  • Coronary Angiography  – This test uses dye and special x-rays to show the insides of your coronary arteries. It is often done during a heart attack to help find blockages in the coronary arteries. 

Early treatment for a heart attack can prevent or limit damage to the heart muscle. Calling 9-1-1 at the first signs of symptoms can save your life. Medical personnel can begin diagnosis and treatment before you even get to the hospital.

Immediate Treatment
Certain treatment start right away. If a heart attack is suspected, even before the diagnosis is confirmed. These include:
  • Aspirin to prevent further clotting
  • Nitroglycerin to reduce your heart’s workload and improve blood flow
  • Oxygen therapy
  • Treatment for chest pain

Once a heart attack is confirmed or strongly suggested, doctors start treatments to try to restore blood flow through the blood vessels.

Medication treatments may include aspirin, drugs to break up clots, antiplatelet and anticoagulants (blood thinners), painkillers, nitroglycerin, and blood pressure medications.

Cardiac Catheterization – This is a probe that is inserted into your blood vessels through a soft, flexible tube (catheter). This will allow your doctor to see areas where plaque may have built up. Your doctor may also inject dye into your arteries through the catheter. By doing this, your doctor will be able to see how the blood flows and any blockages with an x-ray.

If you’ve had a heart attack, your doctor may recommend a procedure (surgical or nonsurgical). These may relieve pain and help prevent another attack from happening.

Common Procedures:

  • Angioplasty – This opens the blocked artery using a balloon or by removing the plaque buildup.
  • Stent – A wire mesh tube that’s inserted into the artery to keep it open after angioplasty.
  • Heart bypass surgery – The blood is rerouted around the blockage.
  • Heart valve surgery – The leaky valves are replaced to help the heart pump.
  • Pacemaker – A device implanted beneath the skin. It’s designed to help your heart maintain a normal rhythm.

Lowering your risk for coronary heart disease can help you prevent a heart attack. Even if you already have coronary heart disease, you still can take steps to lower your chances of having a heart attack. These steps involve making heart-healthy lifestyle changes and getting ongoing medical care for related conditions that make heart attack more likely. Talk to your doctor about whether you may benefit from an aspirin regiment or using aspirin to help prevent your first heart attack.

A heart-healthy lifestyle involves heart-healthy eating, being physically active, quitting tobacco use, and managing your weight. Treating ongoing conditions that make a heart attack more likely can help lower your chances as well. These conditions include:

  •  diabetes
  • high blood cholesterol
  • high blood pressure
  • chronic kidney disease
  • peripheral artery disease

Have an action plan:

Make sure your family has an emergency plan in place, in case you or a family member has a heart attack. This is especially important if you are at high risk or have already had a heart attack. Write down a list of medications you are taking, medicines you are allergic to, your health care provider information, and contact information for a friend or relative. Keep the list handy.

What to do when you are having a heart attack

A heart attack is a medical emergency. The faster you get to a hospital, the better your chances of surviving  and minimizing damage to your heart muscle. Even if you are not experiencing symptoms, you should seek emergency medical care.
 

Follow these steps if you or someone around you is having heart attack symptoms:

Call 911 immediately – don’t wait more than 5 minutes before calling for help. 

  • If you take nitroglycerin for chest pain that comes with exertion and goes away with rest – take it immediately. If your chest pain doesn’t go away within 5 minutes, call 9-1-1.
  • An ambulance is the best way to get to the hospital, since they can monitor your condition and start treatment if needed. 
  • If you cannot call 911, have someone drive you to the hospital. Never drive yourself unless there is absolutely no other choice. 

Chew one aspirin, if recommended.

After you call 9-1-1, the operator may tell you to take an aspirin. This may help to slow or reduce clotting and blockage around the site of a ruptured plaque deposit in your artery. This can limit damage to your heart and help same your life. But aspirin won’t cure a heart attack or make your symptoms go away, never delay calling 911 to take aspirin. You might be told NOT to take aspirin, if you take a medication that can interact with it. 

Sit down and stay calm

Try to relax and remain clam while you wait for help to arrive. If you’re at home alone, open the front door and sit on the floor near the entrance. This will help the paramedics easily find you in case you lose consciousness before they arrive, and give them a flat surface to do CPR if they need to. 

If you are able to do so, record the time your heart attack symptoms began and what you were doing when they started. This information may help doctors treat you when you reach the hospital. 

If you are at risk of a heart attack, talk to your doctor about the signs and symptoms, what steps you should take if you have a heart attack, when you should call 911, and what you should do while waiting for help to arrive.

Resources

Links to various resources on the topics discuss on this page.