Heart attack

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Overview

A heart attack, also known as a myocardial infarction, happens when the flow of blood that brings oxygen to a part of your heart muscle suddenly becomes blocked. Your heart can’t get enough oxygen. If blood flow is not restored quickly, the heart muscle will begin to die.

A heart attack occurs when an artery that sends blood and oxygen to the heart is blocked. Fatty, cholesterol-containing deposits build up over time, forming plaques in the heart's arteries. If a plaque ruptures, a blood clot can form. The clot can block arteries, causing a heart attack.

Heart attacks are very common. According to the Centers for Disease Control and Prevention, more than 800,000 people in the United States have a heart attack each year.


A heart attack is not the same as cardiac arrest, which happens when your heart suddenly and unexpectedly stops beating. A heart attack can cause sudden cardiac arrest.


Most heart attacks are caused by coronary artery disease. Your age, lifestyle habits, and other medical conditions can raise your risk of a heart attack. Symptoms of a heart attack include chest and upper body pain, shortness of breath, dizziness, sweatiness, and nausea. Women often experience different symptoms of a heart attack.


Symptoms

Discomfort, pressure, heaviness, tightness, squeezing, or pain in your chest or arm or below your breastbone

Discomfort that goes into your back, jaw, throat, or arm

Fullness, indigestion, or a choking feeling (it may feel like heartburn)

Sweating, upset stomach, vomiting, or dizziness

Severe weakness, anxiety, fatigue, or shortness of breath

Fast or uneven heartbeat

Symptoms can be different from person to person or from one heart attack to another.  Women are more likely to have these heart attack symptoms:

Unusual fatigue

Shortness of breath

Nausea or vomiting

Dizziness or lightheadedness

Discomfort in your gut. It may feel like indigestion.

Discomfort in the neck, shoulder, or upper back

With some heart attacks, you won’t notice any symptoms (a "silent" myocardial infarction). This is more common in people who have diabetes.

Angina

Angina isn’t a condition or disease. It’s a symptom, and sometimes it can signal a heart attack. The sensations may occur with normal activities or exertion but then go away with rest or when you take nitroglycerin.

You may feel:

Pressure, pain, squeezing, or a sense of fullness in the center of the chest

Pain or discomfort in the shoulder, arm, back, neck, or jaw

Call 911 if it gets worse, lasts more than 5 minutes, or doesn't improve after you've taken nitroglycerin. Doctors call that “unstable” angina,” and it’s an emergency that could be related to a heart attack that is about to happen.


Causes

Your heart muscle needs a constant supply of oxygen-rich blood. Your coronary arteries give your heart this critical blood supply. If you have coronary artery disease, those arteries become narrow, and blood can’t flow as well as it should. When your blood supply is blocked, you have a heart attack.


Fat, calcium, proteins, and inflammatory cells build up in your arteries to form plaques. These plaque deposits are hard on the outside and soft and mushy on the inside.


When the plaque is hard, the outer shell cracks. This is called a rupture. Platelets (disc-shaped things in your blood that help it clot) come to the area, and blood clots form around the plaque. If a blood clot blocks your artery, your heart muscle becomes starved for oxygen. The muscle cells soon die, causing permanent damage.


Rarely, a spasm in your coronary artery can also cause a heart attack. During this coronary spasm, your arteries restrict or spasm on and off, cutting off the blood supply to your heart muscle (ischemia). It can happen while you’re at rest and even if you don’t have serious coronary artery disease.



Each coronary artery sends blood to a different part of your heart muscle. How much the muscle is damaged depends on the size of the area that the blocked artery supplies and the amount of time between the attack and treatment.


Your heart muscle starts to heal soon after a heart attack. This takes about 8 weeks. Just like a skin wound, a scar forms in the damaged area. But the new scar tissue doesn’t move the way it should. So your heart can’t pump as much after a heart attack. How much that ability to pump is affected depends on the size and location of the scar.


Risk factors

Age. Men age 45 and older and women age 55 and older are more likely to have a heart attack than are younger men and women.

Tobacco use. ...

High blood pressure. ...

High cholesterol or triglycerides. ...

Obesity. ...

Diabetes. ...

Metabolic syndrome. ...

Family history of heart attacks.

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Complications

Irregular or atypical heart rhythms (arrhythmias). ...

Cardiogenic shock. ...

Heart failure. ...

Inflammation of the saclike tissue surrounding the heart (pericarditis). ...

Cardiac arrest.

Prevention

The goal after your heart attack is to keep your heart healthy and lower your risk of having another heart attack. Take your medications as directed, make healthy lifestyle changes, see your doctor for regular heart checkups, and consider a cardiac rehabilitation program.

:Prevent blood clots

Help your heart work better

Prevent plaques by lowering cholesterol

You might take medications that treat an uneven heartbeat, lower your blood pressure, control chest pain, and treat heart failure.

Know the names of your medications, what they’re used for, and when you need to take them. Go over your medications with your doctor or nurse. Keep a list of all your medications, and take it to each of your doctor visits. If you have questions about them, ask your doctor or pharmacist.

SUGGESTED

It sounds like a no-brainer, but don't skip your medications. Many people don't take their medications the way their doctor told them to. Figure out what keeps you from taking your medicine -- it could be side effects, cost, or forgetfulness -- and ask your doctor for help.

What lifestyle changes are needed after a heart attack?

To keep heart disease from getting worse and to head off another heart attack, follow your doctor's advice. You might need to change your lifestyle. Here are some changes you can make that can cut your risk and put you on the path to a healthier life:

Stop smoking:Smoking dramatically raises your risk of both heart attacks and strokes. Talk to your doctor about how to quit. You'll also be doing your friends and family a favor, since secondhand smoke can also lead to heart disease. You also can call the hotline 800-QUIT-NOW and visit the smokefree.gov website.

Keep a healthy body weight: If you're overweight or obese, you don't have to get thin to reduce your risk for a heart attack or stroke. If you lose 5% to 10% of your weight, you'll improve your cholesterol numbers and lower your blood pressure and blood sugar levels.

Follow an exercise plan: Moderate physical activity lowers your chances of a heart attack. It also can reduce your blood pressure and LDL or "bad" cholesterol, raise your HDL or "good" cholesterol, and help you stay at a healthy weight.

Aim for 30 minutes of exercise that gets your heart pumping at least 5 days a week. Brisk walking or swimming are some good choices. On the other 2 days, do strength training, like lifting weights. If you've got a tight schedule, break your exercise routine into small chunks.

Eat a heart-healthy diet: Fill your plate with different kinds of fruits, veggies, beans, and lean meats, such as poultry without the skin. Also up your intake of whole grains like oatmeal, quinoa, and brown rice and of f ish, especially those with omega-3 fatty acids, such as salmon, trout, and herring.

SUGGESTED

Avocados, olive oil, and flaxseeds also have omega-3s, as do some nuts and seeds. Fat-free or low-fat dairy products such as milk, yogurt, and cheese also are better choices for your heart health than higher-fat versions. 

Cut back on unhealthy foods: Stay away from processed or prepared foods that often are high in salt and added sugar. They're also filled with preservatives. Avoid fatty beef, butter, fried foods, and palm oil. All are high in saturated fats.

Skip sugary drinks like sodas and fruit punch, which can lead to weight gain. So can packaged baked goods such as cookies, cakes, and pies. They are high in trans fats and can raise your cholesterol levels.

Limit alcohol: If you don't drink already, don't start. If you do drink, limit how much you drink. The recommendation is no more than one drink a day if you are a woman and no more than two a day if you are a man. Drinking raises your heart rate and blood pressure. It also increases the level of fat in your blood and can cause weight gain.

Get regular checks of your cholesterol, blood pressure, and blood sugar (glucose) levels: If you have diabetes, make sure it’s controlled. Keeping a check on these numbers can help you be more aware of the changes you need to make to keep these levels within normal limits.

Control stress: You may feel anxious or frustrated at times. Make sure you open up to your family and friends about what’s going on. Support groups can help you learn how others adjusted to life after a heart attack or stroke.

You may want to talk to a mental health professional or ask your doctor about a stress management program. You can also reduce stress with plenty of physical activity and mind-body practices like meditation.