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Understanding Heart Attack

Medically Reviewed by James Beckerman, MD, FACC on June 14, 2021

 

Some people mistake a heart attack for a symptom of the flu or reflux disease, which causes heartburn.

A quarter of all heart attack victims die before reaching a hospital; others have life-threatening complications while in the hospital. Serious complications include stroke, persistent heart arrhythmias (irregular heartbeats), heart failure, formation of blood clots in the legs or heart, and aneurysm, or bulging, in a weakened heart chamber. But those who survive the initial heart attack and are free from major problems a few hours later stand a better chance of full recovery.

Recovery is always a delicate process, because any heart attack weakens the heart to some degree. But generally, you can resume a normal life. Depending on the severity of your heart attack, you may experience:

  • Heart failure, where the heart doesn't pump well enough to meet the body's needs
  • Arrhythmias or abnormal heart rhythms
  • Cardiac arrest or sudden cardiac death, where the heart stops beating
  • Cardiogenic shock, where the heart is so damaged from the heart attack that a person goes into shock, which may result in damage of other vital organs like the kidneys or liver
  • Death

Symptoms

Symptoms of a heart attack can include:

  • Chest discomfort that may last more than a few minutes or go away and come back; it may feel like squeezing, fullness, pressure, or pain.
  • Pain or discomfort in the upper body, including arm, left shoulder, back, neck, jaw, or below the breastbone
  • Difficulty breathing or shortness of breath (with or without chest pain)
  • Sweating or "cold sweat"
  • Indigestion, heartburn, nausea, or vomiting
  • Light-headedness, dizziness, or extreme weakness
  • Anxiety or rapid or irregular heartbeats

A heart attack is a medical emergency. If you think you are having a heart attack, you need immediate medical care and should call 911. If you have no history of aspirin allergy or bleeding, emergency response may ask you to chew one 325 mg aspirin slowly.

Do not try to drive to the hospital unless you have no other option. Ambulance personnel can start care as soon as they arrive.

Get medical help right away if:

  • You or someone you are with has signs of a heart attack.
  • You have chest pain (angina) that no longer responds to medication; this may indicate that a heart attack is underway.
  • Your angina attacks become more frequent, prolonged, and severe or happen at rest; as angina worsens, the risk of heart attack goes up.
  • You take aspirin to prevent heart attacks, and your stool looks black and tarry. This may mean gastrointestinal bleeding and could be a sign that aspirin has thinned your blood too much.

What Causes a Heart Attack?

Most heart attacks are the result of coronary artery disease, also known as atherosclerosis or "hardening of the arteries," a condition that clogs coronary arteries with fatty, calcified plaques over time. The typical trigger for a heart attack is often a blood clot that blocks the flow of blood through a coronary artery.

In the early 1980s, researchers confirmed that the trigger for nearly all heart attacks is not the obstructive plaque itself, but the sudden formation of a blood clot -- like a scab -- on top of plaque that cuts off blood flow in an already narrowed vessel. This is called "plaque rupture." Contrary to prior belief, doctors now recognize that the less severe plaques are the cause of most heart attacks: It's the milder blockages that rupture and then cause the blood clot to form.

Heart attacks may also be caused by coronary artery spasm, where a heart artery is temporarily constricted, although this is a fairly rare cause.

New research shows that inflammation also plays a role in the evolution of heart attacks. It appears that the coronary artery walls become inflamed over time, further increasing the buildup of fatty plaques.

Risk Factors

While the step-by-step process leading to a heart attack is not fully understood, major risk factors for coronary artery disease are well-known. You can control some of them, including high blood pressure, high cholesterol, obesity, smoking, and a sedentary lifestyle. Stress is also said to raise the risk, and exertion and excitement can act as triggers for a heart attack.

Another important risk factor is family history. A family history of heart disease can increase risk at earlier ages in both men and women.

Men older than 50 with a family history of heart disease are predisposed to heart attack. High levels of estrogen are thought to protect premenopausal women fairly well, but the risk of heart attack increases significantly after menopause.

Doctors are learning more about the risk factors specific for women, such as preeclampsia and gestational diabetes. Autoimmune diseases and inflammatory diseases, that are more prevalent in women, also increase the risk.

Diagnosis

A cardiologist, or heart specialist, relies on various tests to diagnose a heart attack. These tests can also identify sites of blockage as well as tissue damage.

Your doctor can assess for heart damage using an ECG, which also is able to monitor the heart's electrical activity. Together with blood tests an ECG provides data for an initial assessment of your condition. Your doctor can also use images of the heart and coronary arteries done with angiograms and radioisotope scans to locate specific areas of damage and blockage.

With ultrasound tests called echocardiograms, your doctor can evaluate your heart's function, see if the heart muscle has been damaged, and visualize your valve function. With such data, your doctor can decide on proper treatment and anticipate potential complications.

Treatment

If you have a heart attack, you will need emergency procedures to restore blood flow to your heart and become stabilized. Then, you will usually stay in the hospital in special coronary care units (CCU) for at least 24 to 36 hours. Standard drug therapy may include:

  • Vasodilators such as nitroglycerine to expand blood vessels
  • Beta-adrenergic blocker drugs to calm the heart
  • Aspirin to reduce clotting activity
  • Other types of blood thinners to prevent clots from forming and for breaking up those that are already there.
  • Intensive therapy with a statin medicine.
  • A painkiller such as morphine

In some cases, your doctor may also use clot-dissolving drugs like tPA or tenecteplase (TNKase). These drugs work best if given within a few hours of the beginning of a heart attack. And they are the first choice if emergency angioplasty is not available. Sometimes, your doctor may use them if there is a delay in angioplasty. Your doctor might do emergency angioplasty, and possibly surgery, to remove a clot, reopen a clogged artery, or bypass blocked arteries.

Once past the critical phase of a heart attack, you will continue to receive:

  • Beta blockers to slow the heart
  • Nitrates to increase heart blood flow
  • Blood thinners to prevent further blood clotting
  • Statins to lower the LDL cholesterol

In the hospital, electrocardiogram machines are used to monitor your heart and watch for rhythm problems. If your heart starts beating too fast or too slow, your doctor may give you medications. Some people are fitted with pacemakers. If you have a dangerous arrhythmia known as ventricular fibrillation, your doctor may use electric shock to restore the normal rhythm. People who show signs of congestive heart failure receive a variety of medications to decrease strain on the heart and encourage the heart to beat more forcefully.

Recovery

Doctors urge people recovering from a heart attack to get back on their feet as quickly as possible. Doing so reduces the chances of blood clots forming in the deep veins of your legs. These clots could travel through your circulatory system and lodge in your lungs, creating a blockage.

Doctors usually recommend gentle exercise, nothing that requires significant exertion. If you begin exercise soon after a heart attack, it can help you improve your heart function and overall well-being. You should also take part in a cardiac rehabilitation program with monitored exercise and lifestyle modification. It’s a critical piece to recovery.

Long-term recovery from heart attack requires psychological and lifestyle adjustments. Habits you need to quit include:

  • Smoking
  • Heavy drinking
  • Eating high-fat foods
  • Being inactive and sedentary

As a preventive measure, most heart attack survivors take a daily aspirin tablet to thin the blood. Your doctor may also prescribe other drugs.

Some people need invasive procedures to improve blood flow to the heart over the long term. The two most common procedures are:

  • Angioplasty, a catheter technique that widens clogged arteries by breaking up plaques. Stents are often placed to hold the artery open.
  • Coronary bypass surgery, which diverts blood flow around clogged arteries

Lifestyle After a Heart Attack

Regular aerobic exercise greatly improves your chances of preventing or recovering from a heart attack. Check with your doctor before starting any kind of exercise program. If you already have a heart condition, your doctor will probably schedule a stress test before you begin an exercise program. The test can help them decide how much exertion is safe for you.

After a heart attack, you should exercise with other people rather than alone during the first months of recovery. Many community health and recreation centers offer physician-supervised cardiac rehabilitation programs.

Mind/Body Medicine After a Heart Attack

Reducing stress may be one of the risk factors that you can control to help prevent a heart attack and aid your recovery. Many techniques promote relaxation, such as meditation, biofeedback, and yoga. Relaxation also can help relieve pain, which you may have during your recovery period.

People with a positive attitude about recovery tend to do much better. You may find that a particular mind/body technique helps you to focus on positive thoughts. You may also find, as many others have, that sharing thoughts and emotions with a support group is extremely beneficial.

Depression is also associated with heart disease. Discuss any signs of depression with your doctor. Untreated depression can interfere with your recovery.

Nutrition and Diet After a Heart Attack

The basic goals of a heart-healthy diet are to keep salt, sugar, and saturated fat to a minimum to control your cholesterol, blood pressure, and weight. You should eat magnesium-rich foods such as nuts, beans, bran, fish, and dark green vegetables. Magnesium protects the heart directly and indirectly by stabilizing heart rate, reducing coronary artery spasm, and combating such conditions as atherosclerosis and high blood pressure.

Much evidence suggests that unstable chemical compounds known as free radicals make your body more vulnerable to heart attack by striking the heart and coronary arteries and promoting atherosclerosis. You can help your body neutralize free radicals with antioxidants like vitamins A, C, and E. Fruits, vegetables, and grains supply many antioxidant vitamins. Your doctor probably won’t recommend vitamin supplements, as they have been shown not to be beneficial.  But it’s critical for you to get vitamins and nutrients from a balanced diet.

Omega-3 fatty acids have received a lot of attention for being heart healthy because they lessen inflammation in the body. You can get omega-3s from olive oil, canola oil, walnuts, and flax seed. However, omega-3 fatty acids are probably best known for being in certain types of fish like salmon, tuna, herring, and mackerel. 

Eating root vegetables such as carrots may also help prevent heart attack. These vegetables lower your cholesterol over the long term and reduce blood-clotting activity.

WebMD Medical Reference

Sources

SOURCES:

Heartcenteronline.com.

American Heart Association: "Heart Attack Symptoms and Warning Signs."

Cleveland Clinic: "Call 911 - Before It's Too Late" and "Symptoms of Coronary Artery Disease."

Merck Manual: "Acute Coronary Syndromes."

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