Heart Attack
A heart attack (medically known as a myocardial infarction) is a deadly medical emergency where your heart muscle begins to die because it isn’t getting enough blood flow. A blockage in the arteries that supply blood to your heart usually causes this. If a healthcare provider doesn’t restore blood flow quickly, a heart attack can cause permanent heart damage and death.
A myocardial infarction (commonly called a heart attack) is an extremely dangerous condition that happens because of a lack of blood flow to your heart muscle. The lack of blood flow can occur because of many different factors but is usually related to a blockage in one or more of your heart’s arteries. Without blood flow, the affected heart muscle will begin to die. If blood flow isn’t restored quickly, a heart attack can cause permanent heart damage and death.
A heart attack is a life-threatening emergency. If you suspect you or someone you’re with is having a heart attack, call or your local emergency services phone number. Time is critical in treating a heart attack, and a delay of even a few minutes can result in permanent heart damage or death.
When a heart attack happens, blood flow to a part of your heart stops or is far below normal, which causes injury or death to that part of your heart muscle. When a part of your heart can’t pump because it’s dying from lack of blood flow, it can disrupt the pumping sequence for your entire heart. That reduces or even stops blood flow to the rest of your body, which can be deadly if it isn’t corrected quickly.
Symptoms of a heart attack
Heart attacks can have a number of symptoms, some of which are more common than others. Men and people assigned male at birth (AMAB) are likely to have different heart attack symptoms than women and people assigned female at birth (AFAB).
Symptoms of a heart attack that people describe most often include:
- Chest pain (angina). This can be mild and feel like discomfort or heaviness, or it can be severe and feel like crushing pain. It may start in your chest and spread (or radiate) to other areas like your left arm (or both arms), shoulder, neck, jaw, back or down toward your waist.
- Shortness of breath or trouble breathing.
- Fatigue.
- Trouble sleeping (insomnia).
- Nausea or stomach discomfort. Heart attacks can often be mistaken for indigestion or heartburn.
- Heart palpitations.
- Anxiety or a feeling of “impending doom.”
- Sweating.
- Feeling lightheaded, dizzy or passing out.
Heart attack symptoms in women and people AFAB
Medical research in recent years has shown that women and people AFAB are less likely to have chest pain or discomfort that feels like indigestion. They’re more likely to have shortness of breath, fatigue and insomnia that started before the heart attack. They also have nausea and vomiting or pain in the back, shoulders, neck, arms or abdomen.
The vast majority of heart attacks occur because of a blockage in one of the blood vessels that supplies your heart. This most often happens because of plaque, a sticky substance that can build up on the insides of your arteries (similar to how pouring grease down your kitchen sink can clog your home plumbing). That buildup is called atherosclerosis.
Sometimes, plaque deposits inside the coronary (heart) arteries can break open or rupture, and a blood clot can get stuck where the rupture happened. If the clot blocks the artery, this can deprive the heart muscle of blood and cause a heart attack.
Heart attacks are possible without a blockage, but this is rare and only accounts for about 5% of all heart attacks. This kind of heart attack can occur for the following reasons:
- Coronary artery spasm.
- Rare medical conditions: An example of this would be any disease that causes unusual narrowing of blood vessels.
- Trauma: This includes tears or ruptures in the coronary arteries.
- Obstruction that came from somewhere else in your body: A blood clot or air bubble (embolism) that gets trapped in a coronary artery.
- Electrolyte imbalance.
- Eating disorders: Over time, these can damage your heart and ultimately result in a heart attack.
- Takotsubo or stress cardiomyopathy.
- Anomalous coronary arteries (a congenital heart defect you’re born with where the coronary arteries are in different positions than normal in your body. Compression of these causes a heart attack).
How are heart attacks diagnosed
Healthcare providers usually diagnose heart attacks in an emergency room setting. Anyone with heart attack symptoms should undergo a physical examination, including checking pulse, blood oxygen levels and blood pressure and listening to heart and lung sounds.
A healthcare provider will diagnose a heart attack using the following:
- History and symptoms: The provider will ask you about the symptoms you experienced. They might also ask someone who was with you to describe what happened.
- Blood tests: During a heart attack, the damage to heart muscle cells almost always causes a chemical marker, a cardiac troponin, to appear in your bloodstream. Blood tests that look for that marker are among the most reliable methods to diagnose a heart attack.
- Electrocardiogram (EKG or ECG): This is one of the first tests you get when you come to an ER with heart attack symptoms.
- Echocardiogram: Using ultrasound (high-frequency sound waves), an echocardiogram generates a picture of the inside and outside of your heart.
- Angiogram: This test shows areas with little or no blood flow.
- Heart computed tomography (CT) scan: This creates a highly detailed scan of your heart.
- Heart MRI: This test uses a powerful magnetic field and computer processing to create an image of your heart.
- Nuclear heart scans: Similar to angiography, these scans use a radioactive dye injected into your blood. What sets them apart from an angiogram is that they use computer-enhanced methods like computed tomography (CT) or positron emission tomography (PET) scans.
How are heart attacks treated?
Treating a heart attack means restoring blood flow to the affected heart muscle as soon as possible. This can happen in a variety of ways, ranging from medication to surgery. It’s extremely likely that treatment will use several of the following methods.
Supplementary oxygen
People having trouble breathing or with low blood oxygen levels often receive supplementary oxygen along with other heart attack treatments. You can breathe the oxygen either through a tube that sits just below your nose or a mask that fits over your nose and mouth. This increases the amount of oxygen circulating in the blood and reduces the strain on your heart.
Medications
- Anti-clotting medications: This includes aspirin and other blood-thinning medicines.
- Nitroglycerin: This medicine relieves chest pain and causes blood vessels to widen so blood can pass through more easily.
- Thrombolytic (clot-busting) medications: Providers use these only within the first 12 hours after a heart attack.
- Anti-arrhythmia medications: Heart attacks can often cause malfunctions in your heart’s normal beating rhythm called arrhythmias, which can be life-threatening. Anti-arrhythmia medications can stop or prevent these malfunctions.
- Pain medications: The most common pain medication given during heart attack care is morphine. This can help alleviate chest pain.
Percutaneous coronary intervention
Providers restore circulation to your affected heart muscle with a procedure called percutaneous coronary intervention (PCI). This uses a catheter-based device inserted into a major blood vessel (usually one near your upper thigh or your wrist).
PCI is a critical tool in restoring blood flow, and the sooner that happens, the better the chance of a good outcome. Hospitals use a metric called “door-to-balloon time” to measure their ability to treat a heart attack. This is the average time it takes for people to undergo PCI after they first come into the Emergency Room. PCI often includes the placement of a stent at the site of the blockage to help hold the artery open so another blockage doesn’t happen in the same spot.
Coronary artery bypass grafting
People who have severe blockages of their coronary arteries may undergo coronary artery bypass grafting. This surgery is often called open-heart surgery, bypass surgery or CABG (the acronym is pronounced the same as “cabbage”).
CABG involves using a blood vessel from elsewhere in your body (usually your chest, arm or leg) to construct a detour for blood. This reroutes blood around one or more blocked artery sections and brings blood to your heart muscle.
PREVENTION
Although there are several risk factors that you can’t control, there are many ways you can help yourself and reduce your risk of a heart attack. These include:
- Schedule a checkup: Find a primary care provider and see them at least once a year for a checkup or wellness visit. An annual checkup can catch many of the early warning signs of heart disease, including signs that you can’t feel. These include your blood pressure, blood sugar levels, cholesterol levels and more.
- Quit tobacco products: This includes smokeless tobacco and all vaping products.
- Exercise regularly: Aim for 30 minutes of moderately intense physical activity five days a week.
- Eat a healthy diet: Examples include the Mediterranean or Dash diets. A plant-based diet approach is an excellent alternative.
- Maintain a weight that’s healthy for you: Your primary care provider can advise you on a healthy goal weight and provide you resources and guidance to help you reach that goal.
- Manage your existing health conditions: This includes high cholesterol levels, high blood pressure and diabetes.
- Reduce your stress: Consider techniques such as yoga, deep breathing and meditation.
- Take your medications as prescribed: Don’t just take medications when you remember to or when you have a doctor’s appointment coming up.
- Keep all your medical appointments: Seeing your healthcare providers regularly can help uncover heart-related issues or other medical problems you didn’t know you had. This can also help treat problems sooner rather than later.
Being an active contributor to your health doesn’t mean you have to make lifestyle changes all on your own. Ask your primary care provider and other providers on your healthcare team for help. They can provide the information and resources you need.
If you’ve already had a heart attack, your healthcare provider will recommend a cardiac rehabilitation program. This program’s goals are to reduce your chance of a second heart attack. These medically supervised programs provide counseling and focus on the same healthy living goals listed above.
After you’ve had a heart attack, you’re at a higher risk of a similar occurrence. Your healthcare provider will likely recommend follow-up monitoring, testing and care to avoid future heart attacks. Some of these include:
- Heart scans: Similar to the methods used to diagnose a heart attack, these can assess the effects of your heart attack and determine if you have permanent heart damage. They can also look for signs of heart and circulatory problems that increase the chance of future heart attacks.
- Stress test: These heart tests and scans that take place while you’re exercising can show potential problems that stand out only when your heart is working harder.
- Cardiac rehabilitation: These programs help you improve your overall health and lifestyle, which can prevent another heart attack.
Additionally, you’ll continue to take medicines — some of the ones you received for immediate treatment of your heart attack — long-term. These include:
- Beta-blockers.
- ACE inhibitors.
- Aspirin and other blood-thinning agents.
Complications associated with heart attacks include:
- Arrhythmias (abnormal heart rhythms).
- Heart failure.
- Heart valve problems.
- Sudden cardiac arrest.
- Depression and anxiety.
- Mechanical complications of a heart attack, such as a ventricular septal defect or free wall rupture. These are more likely to happen with delayed treatment of a heart attack.
Who fares better after a heart attack?
Younger women (pre-menopause) and people AFAB under age 45 have a better outcome than men and people AMAB of a similar age. Scientists believe this is because of estrogen’s heart-protective effects. However, after menopause ends the protective benefits of estrogen, women fare worse than men. More specifically:
- Women between the ages of 45 and 65 who’ve had a heart attack are more likely to die within a year of the event compared with men of this same age.
- Women over age 65 are more likely to die within weeks of their heart attack than men over age 65.
How common are heart attacks?
New heart attacks happen to about 635,000 people in the U.S. each year. About 300,000 people a year have a second heart attack. About 1 in 7 deaths in the U.S. is due to coronary heart disease, which includes heart attacks.
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