Heart Attack occurs when blood flow to part of the heart is blocked, often by a blood clot, causing damage to the affected muscle. The clot, often caused by rupturing or tearing of plaque in an artery, is sometimes called a coronary thrombosis or a coronary occlusion.
The heart beats on average 70 times a minute to push blood around the body. Like any busy muscle, the heart tissues need a good supply of blood from their blood vessels, which are called the coronary arteries. When this process is interrupted or doesn’t work properly, serious illness and even death can result.
If blood supply is cut off for a long time, the muscle cells are irreversibly damaged and die, leading to disability or death depending on the extent of the damage.
Diseases that narrow the coronary arteries can reduce the supply of blood and cause a shortage of oxygen and essential nutrients in the heart muscle.
This triggers chest pain known as angina, especially when the heart is made to work extra hard, for example during exercise. If someone has angina, the more severe the narrowing of the arteries, the less they can do before they experience pain.
A heart attack can occur if the shortage of oxygen to an area of the heart muscle is severe and prolonged. Heart attacks (also known as a myocardial infarction or MI) can also occur when a coronary artery temporarily contracts or goes into spasm, decreasing or cutting the flow of blood to the heart.
Most of the deaths from a heart attack are sudden, occurring within one hour of onset of symptoms and before reaching the hospital, and are often due to dangerous heart rhythms. Most people who survive the first month will still be alive five years later, but many are left with long-term heart problems.
Heart Attack Causes
A heart attack occurs when one or more of your coronary arteries become blocked. Over time, a coronary artery can narrow from the buildup of various substances, including cholesterol (atherosclerosis). This condition, known as coronary artery disease, causes most heart attacks.
When a heart attack occurs, one of these plaques can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If large enough, the clot can block the flow of blood through the coronary artery, starving the heart muscle of oxygen and nutrients (ischemia).
One might have a complete blockage or partial. A complete blockage means you’ve had an ST-elevation myocardial infarction (STEMI). A partial blockage means you’ve had a non-ST elevation myocardial infarction (NSTEMI). Diagnostic steps and treatment might be different depending on which you’ve had.
There are other common causes. These causes include:
- Atherosclerosis, where fatty plaques build up on the inner lining of the coronary arteries (often compared to the furring up you see inside a kettle)
- High cholesterol
- High blood pressure
- Age: Heart attacks are more likely when a man is over 45, and when a woman is over 55.
- Angina: This causes chest pain due to a lack of oxygen or blood supply to the heart.
- Diet: For example, consuming large quantities of saturated fats can increase the likelihood of a heart attack.
- Genetics: A person can inherit a higher risk of a heart attack.
- Heart surgery: This can lead to a heart attack later on.
- Obesity: Being significantly overweight can put pressure on the heart.
- Previous heart attack.
- HIV: People who are HIV-positive have a 50 percent higher risk.
- Work stress: Those who are shift workers or have stressful jobs can face a higher heart attack risk.
Heart Attack Symptoms
Heart attack symptoms vary. Unfortunately, for many people, the first indication that something’s wrong is a heart attack. Not all people who have heart attacks have the same symptoms or have the same severity of symptoms. Some people have mild pain; others have more severe pain.
Some people have no symptoms; for others, the first sign may be sudden cardiac arrest. However, the more signs and symptoms you have, the greater the likelihood you’re having a heart attack.
Some heart attacks strike suddenly, but many people have warning signs and symptoms hours, days or weeks in advance. The earliest warning might be recurrent chest pain or pressure (angina) that’s triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart.
The common signs of a heart attack are:
- Chest pain, usually a central crushing pain that may travel into the left arm or up into the neck or jaw, and persists for more than a few minutes. Unlike angina, the pain doesn’t subside when you rest. Sometimes it can be mild and be mistaken for indigestion. Some people have a heart attack without experiencing pain
- Stomach or abdominal pain
- Shortness of breath or difficulty breathing
- Nausea or vomiting
- Unexplained anxiety
- Weakness or fatigue
- Cold sweat or paleness
- Feeling light-headed or dizzy
- Palpitations or an abnormal heart rate.
Heart Attack Symptoms in Women
- Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath with or without chest discomfort.
- Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
- As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.
Heart Attack Symptoms in Men
This condition is the most common symptom of a heart attack in both men and women.
Chest Discomfort or Pressure
The pain can be severe, but it doesn’t have to be. It can be a feeling of “fullness,” squeezing, or pressure. It can even be mistaken for heartburn. The discomfort often happens in the left or center of your chest. The feeling may last for more than several minutes, or it may come and go.
Pain in Other Parts of Your Body
Pain or discomfort sometimes shows up in other areas because they’re not getting enough blood. Usually, it’s an area of the body that’s above the waist, including the upper part of your stomach, your shoulders, one arm (probably the left) or both, your back, neck or jaw, even your teeth.
Heart Attack Signs
A heart attack is fatal, it is vital to recognize the warning signs that an attack is occurring. While the symptoms listed above are all linked to heart attacks, there are four warning signs listed as being crucial signs of an attack. These signs include:
- Discomfort, pressure, squeezing, or fullness in the chest that lasts several minutes or resolves then returns
- Pain or discomfort in the arms, neck, back, stomach, or jaw
- Sudden shortness of breath
- Other signs can include a cold sweat, a sick or nauseous feeling, or being lightheaded.
When to See A doctor
When does one need to see a doctor?
- Act immediately. Some people wait too long because they don’t recognize the important signs and symptoms. Take these steps:
- Call for emergency medical help. If you suspect you’re having a heart attack, don’t hesitate. Immediately for your local emergency number. If you don’t have access to emergency medical services, have someone drive you to the nearest hospital.
- Drive yourself only if there are no other options. Because your condition can worsen, driving yourself puts you and others at risk.
- Take nitroglycerin, if prescribed to you by a doctor. Take it as instructed while awaiting emergency help.
- Take aspirin, if recommended. Taking aspirin during a heart attack could reduce heart damage by helping to keep your blood from clotting. Aspirin can interact with other medications, however, so don’t take an aspirin unless your doctor or emergency medical personnel recommend it. Don’t delay calling 911 to take an aspirin. Call for emergency help first.
Heart Attack First Aid
What to do if you or someone else may be having a heart attack. The following are some of the things you can do to help solve this kind of condition:
Call your local emergency number. Don’t ignore or attempt to tough out the symptoms of a heart attack. If you don’t have access to emergency medical services, have a neighbor or a friend drive you to the nearest hospital.
Drive yourself only as a last resort, and realize that it places you and others at risk when you drive under these circumstances.
Chew and swallow an aspirin, unless you are allergic to aspirin or have been told by your doctor never to take aspirin.
Take nitroglycerin, if prescribed. If you think you’re having a heart attack and your doctor has previously prescribed nitroglycerin for you, take it as directed. Don’t take anyone else’s nitroglycerin, because that could put you in more danger.
Begin CPR if the person is unconscious. If you’re with a person who is unconscious, tell the 911 dispatcher or another emergency medical specialist. You may be advised to begin cardiopulmonary resuscitation (CPR). If you haven’t received CPR training, doctors recommend performing only chest compressions (about 100 to 120 compressions a minute). The dispatcher can instruct you in the proper procedures until help arrives.
If an automated external defibrillator (AED) is immediately available and the person is unconscious, follow the device instructions for using it.
Heart Attack Diagnosis
Ideally, a doctor should screen you during regular physical exams for risk factors that can lead to a heart attack. If you’re in an emergency setting for symptoms of a heart attack, you’ll be asked about your symptoms and have your blood pressure, pulse and temperature checked. You’ll be hooked up to a heart monitor and have tests to see if you’re having a heart attack.
Electrocardiogram (ECG). This first test done to diagnose a heart attack records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn’t conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
Certain heart proteins slowly leak into your blood after heart damage from a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes.
Additional tests Are:
If you’ve had or are having a heart attack, doctors will take immediate steps to treat your condition. You might also have these additional tests.
An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs.
Sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn’t pumping normally.
Coronary catheterization (angiogram).
A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that’s fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage.
Exercise stress test.
In the days or weeks after your heart attack, you might also have a stress test to measure how your heart and blood vessels respond to exertion. You might walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you might receive a drug intravenously that stimulates your heart similar to the way exercise does.
Another possibility is a nuclear stress test, which is similar to an exercise stress test but uses an injected dye and special imaging techniques to produce detailed images of your heart while you’re exercising.
Cardiac CT or MRI.
These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.
In a cardiac MRI, you lie on a table inside a long tubelike machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.
Heart Attack Treatment
Treatment at The Hospital
Each minute after a heart attack, more heart tissue deteriorates or dies. Restoring blood flow quickly helps prevent heart damage.
Medications given to treat a heart attack might include:
The 911 operator might tell you to take aspirin, or emergency medical personnel might give you aspirin immediately. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery.
These drugs also called clot busters, help dissolve a blood clot that’s blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you’ll survive and have less heart damage.
Emergency room doctors may give you other drugs known as platelet aggregation inhibitors to help prevent new clots and keep existing clots from getting larger.
Other blood-thinning medications.
You’ll likely be given other medications, such as heparin, to make your blood less “sticky” and less likely to form clots. Heparin is given intravenously or by an injection under your skin.
Pain relievers. You might be given a pain reliever, such as morphine.
This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels.
These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart’s job easier. Beta-blockers can limit the amount of heart muscle damage and prevent future heart attacks.
ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart.
Statins. These drugs help control your blood cholesterol.
Surgical and other procedures
In addition to medications, you might have one of these procedures to treat your heart attack:
Coronary angioplasty and stenting.
In this procedure, also known as percutaneous coronary intervention (PCI), doctors insert a long, thin tube (catheter) that’s passed through an artery in your groin or wrist to a blocked artery in your heart. If you’ve had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to find blockages.
This catheter has a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent might then be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, you might get a stent coated with a slow-releasing medication to help keep your artery open.
Coronary artery bypass surgery.
In some cases, doctors perform emergency bypass surgery at the time of a heart attack. If possible, however, you might have bypass surgery after your heart has had time — about three to seven days — to recover from your heart attack.
Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section.
Once blood flow to your heart is restored and your condition is stable, you’re likely to remain in the hospital for several days.
Most hospitals offer programs that might start while you’re in the hospital and continue for weeks to a couple of months after you return home.
Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities.
It’s extremely important to participate in this program. People who attend cardiac rehab after a heart attack generally live longer and are less likely to have another heart attack or complications from the heart attack. If cardiac rehab is not recommended during your hospitalization, ask your doctor about it.
Heart Attack Lifestyle and Home Remedies
For an improvement in your heart health, you are advised to take the following measures:
Avoid smoke. The most important thing you can do to improve your heart’s health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help.
Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored.
Get regular medical checkups. Some of the major risk factors for heart attack — high blood cholesterol, high blood pressure, and diabetes — cause no symptoms early on. Your doctor can test for these conditions and can help you manage them, if necessary.
Exercise. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack. Walking 30 minutes a day, five days a week can improve your health.
Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure, and diabetes.
Eat a heart-healthy diet. Saturated fat, trans fats, and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, and fruits and vegetables and whole grains.
Manage diabetes. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes.
Control stress. Reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life.
If you drink alcohol, do so in moderation. That means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.
Having a heart attack is scary, and you might wonder how it will affect your life and whether you’ll have another one.
Fear, anger, guilt, and depression are all common after a heart attack. Discussing them with your doctor, a family member or a friend might help. Or consider talking to a mental health provider or joining a support group.
It’s important to mention signs or symptoms of depression to your doctor. Cardiac rehabilitation programs can be effective in preventing or treating depression after a heart attack.
Sex After A heart attack
Some people worry about having sex after a heart attack, but most people can safely return to sexual activity after recovery.
When you can resume sexual activity will depend on your physical comfort, psychological readiness, and previous sexual activity. Ask your doctor when it’s safe to have sex.
Some heart medications can affect sexual function. If you’re having problems with sexual dysfunction, talk to your doctor.
What can be done in the Meantime
It’s never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against having a heart attack.
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