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Heart Attack


​​​​​​​​​​Your heart is a muscle and it needs oxygen to survive. A heart attack occurs when the blood flow bringing oxygen to the heart muscle is severely reduced or cut off completely.

Heart attack warning signs for men and women.

This happens when coronary arteries supplying the heart muscle with blood flow slowly become thicker (narrower) and harder from a buildup of fat, cholesterol and other substances that together are called plaque.

When plaque in a heart artery ruptures, a blood clot forms around the plaque. This clot can block the blood flow to the heart muscle, starving it of oxygen and nutrients.

When arteries are narrowed and less blood and oxygen reaches the heart muscle, this is called coronary artery disease (CAD).

If damage or death to part of the heart muscle occurs, it’s called a heart attack or myocardial infarction.

Every second counts when it comes to heart attack treatment. An extensive blockage, especially in a major blood vessel, can cause a large heart attack. 

If large heart attacks are not treated early and aggressively they can lead to heart failure or even death. 

The risk of death within five years of being diagnosed with certain types of heart failure can be 50 percent or more, worse than many forms of cancer.

According to the American Heart Association, about every 34 seconds someone in the United States has a heart attack. 

However, today your chances of surviving a heart attack and living a normal life are greater than ever. 

Recognition of heart attack symptoms and seeking prompt medical attention are crucial in improving survival rates.

Symptoms of Heart Attack

Some heart attacks are sudden and intense, where there’s no doubt what's happening. But most heart attacks start slowly, with mild pain or discomfort. 

Often people affected aren't sure what's wrong and wait too long before getting help. Here are symptoms that can mean a heart attack is happening:

  • Chest discomfort – Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body -- This includes pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Breaking out in a cold sweat, nausea or lightheadedness.

More information on heart attack symptoms​

Heart Attack Symptoms in Women

As with men, a woman's most common heart attack symptom is chest pain or discomfort. 

But women are more likely than men to experience some of the other common signs and symptoms, particularly:

  • Shortness of breath
  • Nausea or vomiting
  • Indigestion
  • Sleep disturbances
  • Anxiety
  • Unusual fatigue
  • Pain in the back or jaw

More information on heart attack symptoms in women

Causes of Heart Attack

A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. 

Most heart attacks occur from coronary heart disease (CHD) in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries it’s called atherosclerosis. This buildup occurs over many years. 

Eventually an area of plaque can rupture (break open) and cause a blood clot to form on the plaque's surface. 

If the clot becomes large enough, it can partially or completely block blood flow through a coronary artery.

If the blockage isn't treated quickly, the portion of the heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. 

This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Coronary Artery Spasm

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery that cuts off blood flow through the artery. 

Spasms can occur in coronary arteries not affected by atherosclerosis. What causes a coronary artery spasm isn't always clear, but may be related to:

  • Taking certain drugs, such as cocaine
  • Emotional stress or pain
  • Exposure to extreme cold
  • Cigarette smoking

Diagnosis of Heart Attack

Most heart attacks are caused by coronary heart disease (CHD). 

Your doctor can diagnose CHD based on your medical and family histories, your risk factors, a physical exam combined with results of tests and procedures. 

​No single test can diagnose CHD, however if your doctor thinks you have CHD, he/she may recommend one or more of the following tests:

  • Electr​​ocardiogram (EKG) – a painless test that records the heart’s electrical activity
  • Stress Test​ – during this test you exercise or receive medication to make your heart work hard and beat fast. The test can detect coronary heart disease signs/symptoms like:
    • abnormal changes in your heart rate or blood pressure
    • shortness of breath or chest pain
    • abnormal changes in your heart rhythm or electrical activity
  • Echocard​​iography​ – uses sound waves to create a moving picture of the heart, providing information about the size and shape of the heart and its chambers and how the valves are working
  • Chest X-Ray – can reveal signs of heart failure as well as lung disorders related to CHD
  • Blood Tests – checks levels of certain fats, cholesterol, sugar, proteins, enzymes that are released when there has been heart muscle damage
  • Coronary Angiography – uses a dye and special x-rays to look at your coronary arteries to detect blockages

Treatment for a heart attack

The goal of treatment for a heart attack is to relieve pain, preserve the heart muscle function, and prevent death. Treatment in the emergency department may include:

  • Intravenous therapy such as nitroglycerin and morphine.
  • Continuous monitoring of the heart and vital signs.
  • Oxygen therapy improves oxygenation to the damaged heart muscle.
  • Pain medication decreases pain, and, in turn, decreases the workload of the heart, thus, the oxygen demand of the heart decreases.
  • Cardiac medication, such as beta-blockers, promote blood flow to the heart, improve the blood supply, prevent arrhythmias, and decrease heart rate and blood pressure.
  • Fibrinolytic therapy is the intravenous infusion of a medication which dissolves the blood clot, thus, restoring blood flow.
  • Antithrombin/antiplatelet therapy is used to prevent further blood clotting.
  • Antihyperlipidemics are medications used to lower lipids (fats) in the blood, particularly Low Density Lipid (LDL) cholesterol.
    Statins are a group of antihyperlipidemic medications, and include simvastatin (Zocor), atorvastatin (Lipitor), and pravastatin (Pravachol), among others.
    Bile acid sequestrants—colesevelam, cholestyramine, and colestipol—and nicotinic acid (niacin) are two other types of medications that may be used to reduce cholesterol levels.
    Once the condition has been diagnosed and the patient stabilized, additional procedures to restore coronary blood flow may be used. Those procedures include:
    • Coronary angio​plasty. With this procedure, a balloon is used to create a bigger opening in the vessel to increase blood flow.
      Although angioplasty is performed in other blood vessels elsewhere in the body, percutaneous coronary intervention (PCI) refers to angioplasty in the coronary arteries to permit more blood flow into the heart.
      PCI is also called percutaneous transluminal coronary angioplasty (PTCA). There are several types of PTCA procedures, including:
      • Balloon angioplasty. A small balloon is inflated inside the blocked artery to open the blocked area.
      • Atherectomy. The blocked area inside the artery is cut away by a tiny device on the end of a catheter.
      • Laser angioplasty. A laser is used to "vaporize" the blockage in the artery.
      • Coronary artery stent. A tiny coil is expanded inside the blocked artery to open the blocked area and is left in place to keep the artery open.
    • Coronary artery bypass​. Most commonly referred to as simply "bypass surgery", this surgery is often performed in people who have angina (chest pain) and coronary artery disease (where plaque has built up in the arteries).
      During the surgery, a bypass is created by grafting a piece of a vein above and below the blocked area of a coronary artery, enabling blood to flow around the obstruction.
      Veins are usually taken from the leg, but arteries from the chest or arm may also be used to create a bypass graft.

Frequently Asked Questions:

Do women have different heart attack symptoms then men?

Yes. Early signs of heart attacks in women include:

  • Nausea and vomiting
  • Unusual fatigue
  • Sleep disturbances
  • Indigestion
  • Anxiety
  • Pain in the back and jaw

How do I know if a heart attack has occurred?

A healthcare provider can diagnose a heart attack based on several assessments:

  • The patient's complete medical history
  • A physical examination
  • An electrocardiogram (ECG or EKG) which makes a graphical record of the heart's electrical activity to discover any abnormalities caused by damage to the heart
  • Blood testing to detect abnormal levels of certain enzymes in the bloodstream

Why didn’t I have any warning?

Arteriosclerosis is a term for thickening and hardening of arteries and it has no symptoms. 

One reason why there may not be a warning sign is because sometimes when a coronary artery becomes narrowed, other nearby vessels that also bring blood to the heart sometimes expand to help compensate. 

The network of expanded vessels is called collateral circulation and helps protect some people from heart attacks by getting needed blood to the heart. Collateral circulation often develops after a heart attack to help the heart muscle recover.

Will I recover from a heart attack?

The heart muscle begins to heal soon after a heart attack and usually takes about eight weeks to return to a normal state. 

However, scar tissue may form in the damaged area and that scar tissue does not contract or pump as well as healthy muscle tissue. The extent of damage to the heart muscle can impact how well the heart pumps blood through the body. 

The severity of function loss depends on the size and location of the scar tissue. Lifestyle changes regarding exercise and diet, smoking cessation along with medical therapy can prevent a future heart attack and dramatically improve quality of life.

Is all chest pain a heart attack?

No. One very common type of chest pain is called angina or angina pectoris. It's a recurring discomfort that usually lasts only a few minutes. 

Angina occurs when your heart muscle doesn't get the blood supply and oxygen it needs. The difference between angina and a heart attack is that angina attacks don't permanently damage the heart muscle. 

Often angina occurs during exercise or emotional stress when your heart rate and blood pressure increase and your heart muscle needs more oxygen.

Is a heart attack the same as cardiac arrest?

No. However, a heart attack can cause a cardiac arrest. Heart attacks are caused by a blockage stopping blood flow to the heart. 

Cardiac arrest is caused when the heart's electrical system malfunctions. 

In cardiac arrest – also called sudden cardiac arrest or SCA – the heart suddenly stops working properly, often due to abnormal or irregular heart rhythms (arrhythmias). 

​Cardiac arrest will result in death if not treated within minutes of the occurrence.​​