Heart Attack

What is a heart attack?

A heart attack happens when blood flow to a part of the heart is suddenly blocked. It is the most visible sign of heart disease.

The medical term for heart attack is myocardial infarction.

What is the cause?

A heart attack may happen at any time and often happens without warning. Most often it happens when plaque in a blood vessel ruptures and the soft fatty core gets out. This can lead to a clot, and the clot can block the flow of blood to the heart.

Also, as people grow older, the coronary arteries may become narrowed by the buildup of cholesterol plaque. When the arteries narrow, less blood can go through them, and less oxygen gets to the heart muscle. The process of narrowing is called atherosclerosis. The narrower the artery becomes, the more likely it is that a blood clot may form and block the artery completely, causing a heart attack. However, sudden blockages can happen even in places where the artery was not narrow before.

A heart attack may happen when the heart muscle needs more oxygen than the blood vessels can provide. This might happen, for example, during hard exercise such as shoveling snow, or with a sudden increase in blood pressure.

Sometimes a heart attack is caused by coronary spasm. Coronary spasm is a sudden and temporary narrowing of a small part of an artery that supplies blood to the heart. It may be caused by smoking or drugs such as cocaine.

Risk factors for heart disease include:

• cigarette smoking
• a family history of heart attack
• diabetes
• overweight
• high blood pressure
• high blood cholesterol
• low HDL cholesterol (that is, too little "good" cholesterol)
• stress
• a lifestyle that does not include much physical activity

Lack of blood and oxygen during a heart attack damages the heart muscle. Part of the heart muscle usually dies. However, if only a small amount of heart muscle dies, the odds of surviving and living normally after the heart attack are good. Early treatment of a heart attack is the best way to improve the chance of surviving the heart attack.

Heart attacks can cause death in several ways:

• If too much muscle dies, the heart is not able to pump enough blood to the rest of the body.
• Damage to the heart cells that control the heartbeat may cause fatal heart rhythm problems.
• Sometimes, the heart muscle weakens and can tear as a result of the damage. This causes internal bleeding.

You are more likely to have a heart attack as you get older. Heart attacks are more likely to happen at a younger age in men than in women. Female hormones seem to help protect women until menopause, when the body makes less of these hormones. Heart disease is more likely to be correctly diagnosed in men and less likely to be suspected in women.

What are the symptoms?

Not everyone has the same symptoms. Signs of a heart attack may be one or more of the following:

• Chest discomfort that lasts for more than 5 minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or burning.
• Chest pain that goes beyond your chest to one or both arms, neck, jaw, shoulder, or stomach.
• Significant trouble breathing, which you may have before you feel chest discomfort.
• Other signs with the chest discomfort, such as sweating or feeling faint or sick to your stomach.

In severe cases, sudden death may occur.

Sometimes people who are having a heart attack delay getting care because they have different symptoms, like abdominal pain or unexplained tiredness. Because they may not have chest pain, someone who is having these symptoms may not think that they are having a heart attack. They may think they have indigestion and not get medical help as soon as they should.

If you think you or someone else may be having a heart attack, call 911 and get emergency care right away.

How is it diagnosed?

Your healthcare provider examines you and asks about your symptoms and your medical history. You may have the following tests:

• A heart monitor can show abnormal heart rates or rhythms.
• An ECG (electrocardiogram) measures and records the electrical activity of the heart. It gives early information about areas of heart muscle that are damaged.
• Your blood oxygen level can be monitored by a sensor that is attached to your finger or ear.
• Blood tests may be done to find out whether the heart muscle has been damaged.
• A chest X-ray can show abnormal heart size and signs of heart failure (poor pumping by the heart).
• Doppler ultrasound (echocardiogram) is a type of scan used to examine your heart valves, muscles, and blood flow, and to look at how efficiently your heart is pumping.
• A coronary angiogram (cardiac catheterization) is a special X-ray procedure in which dye is used to find out which blood vessel is blocked and how severely.

These tests may be done in the hospital or after you leave the hospital.

How is it treated?

Heart attacks require immediate hospital treatment. Medicines that dissolve the coronary artery blood clot are quickly given through a vein and by mouth. Another way to break up the blood clot is to have an immediate balloon angioplasty procedure. Your heart rhythm is monitored and rhythms that might be dangerous are treated promptly. Some people need a temporary heart pacemaker.

You may stay in the hospital 2 to 6 days. For part of that time, you will probably be in a special intensive care unit for heart patients.

Your healthcare provider may use medicine to:

• reduce your pain
• stabilize your heart rhythm
• make it easier for you to breathe
• lower your blood pressure
• prevent further damage to your heart
• dissolve blood clots

The exact treatment you receive depends on how you feel, how much heart muscle is damaged, and how much the arteries in your heart are blocked or narrowed. You will be started on beta-blocker drugs, aspirin, and possibly other medicines to lessen the risk of another heart attack. In some cases, your healthcare provider may recommend balloon angioplasty or a stent to improve blood flow to the heart. This may mean a longer stay in the hospital.

You may have a low-level treadmill stress test before you leave the hospital. The results of this test will help your provider decide what treatments are best for you or may be needed in the future.

After a heart attack, it is important to begin a rehab program. This involves a closely watched and gradually increasing exercise program, as well as education about diet and other ways to improve your health and prevent more heart attacks in the future.

How can I take care of myself and help prevent a heart attack?

Follow the treatment plan your healthcare provider prescribes. In addition:

• Eat healthy foods that are low in fat and sodium.
• Lose weight if you need to and keep the lower weight.
• Exercise regularly, according to your provider's instructions.
• If you smoke, quit.
• Keep your cholesterol at a normal level.
• Keep your blood pressure under control.
• Follow your provider's instructions for medicine and follow-up appointments.
• Talk with your provider about any questions or fears you may have.
• Carry your medicine with you and know how to take it properly. A list of the names and doses and instructions for taking each medicine can be helpful to have.

You need to call 911 for emergency help right away if:

• You have chest discomfort that lasts for more than 5 minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or burning.
• You have chest discomfort and are feeling faint.
• You have chest pain that goes beyond your chest to one or both arms, neck, jaw, shoulder, or stomach.
• You have significant trouble breathing, with or without chest pain.
• You have chest discomfort along with sweating, indigestion, vomiting, or feeling sick to your stomach.
• You still have pain after taking your nitroglycerin tablets as directed by your healthcare provider.

If you are having these symptoms, do not drive yourself to the hospital. You could pass out if the chest pain is severe.

Immediate emergency care improves your chances of survival and may help avoid damage to your heart.