A heart attack is a life-threatening medical emergency that requires
immediate treatment.
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.
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.
If you think you or someone else may be having a heart attack, call
9-1-1 right away. Acting
fast can save your life. The longer the heart goes without enough
oxygen, the more damage is done to the heart muscle.
Many people survive and live active, full lives after a heart attack.
Getting help and treatment quickly can limit the damage to your heart.
Symptoms
Not all heart attacks begin with the sudden and crushing chest pain that
comes when the blood flow to heart gets blocked. Heart attack symptoms
can start slowly and can be mild or more serious and sudden. Symptoms
also may come and go over several hours. The symptoms of a heart attack
can be different from person to person and different between men and
women. If you’ve already had a heart attack, your symptoms may not be
the same for another one.
Silent heart attacks
Heart attacks can happen without any symptoms or with very mild
symptoms. These are called silent heart attacks. Silent heart attacks
are more common in older adults and in people who have high blood sugar
or diabetes.
What are the symptoms of a heart attack?
If you are having a heart attack, you may experience one or
more of the symptoms below.
Chest pain, heaviness, or discomfort in the center or
left side of the chest (this is the most common
symptom)
Pain or discomfort in one or both arms, your
back, shoulders, neck, jaw, or above your belly button
Shortness of breath when resting or doing a
little bit of physical activity (this is more common in
older adults)
Sweating a lot for no reason
Feeling unusually tired for no reason, sometimes for
days (this is more common in women)
Nausea (feeling sick to the stomach) and vomiting
Light-headedness or sudden dizziness
Rapid or irregular heartbeat
It is also possible to have mild symptoms or even no
symptoms at all and still have a heart attack.
When to call 9-1-1
Any time you think you might be having a heart attack, don’t
ignore it. Call
9-1-1 for emergency medical care, even if you are
not sure that you’re having a heart attack.
Acting fast can limit damage to your heart and save your
life. The 9-1-1 operator or emergency medical services
(EMS) personnel can give you advice that can help
prevent damage to your heart.
An ambulance is the best and safest way to get to the
hospital. Do not drive to the hospital or let someone
else drive you. EMS personnel can check how you are
doing and start tests and lifesaving medicines right
away. People who arrive by ambulance often get faster
treatment at the hospital.
Every minute matters. Never
delay calling 9-1-1, taking aspirin or doing
anything else you think might help.
Knowing the difference between stable angina (chest
pain in people who have coronary artery disease) and a heart
attack is important.
The pain from angina usually happens after physical
activity and goes away in a few minutes when you rest or
take medicine to treat it.
The pain from a heart attack is more serious than the
pain from angina. Heart attack pain doesn’t go away when
you rest or take medicine.
If you don’t know whether your chest pain is angina or a
heart attack, call
9-1-1.
Diagnosis
Calling9-1-1 for
an ambulance and getting to the emergency room
quickly if you suspect a heart attack is
critical. Once at the hospital, you will likely
get tests to see whether you are having a heart
attack or whether you have already had one.
An electrocardiogram (EKG) is the most common
initial test and may be given within minutes of
your arrival at the hospital. An EKG will check
whether you may be having a heart attack.
Based on the results of the EKG, your doctor may
then order more tests, ask you about your
medical history, and do a physical exam.
Blood tests
During a heart attack, heart muscle cells die
and release proteins into your bloodstream. Blood
tests can measure the amount of these
proteins in your blood. For example, you may get
a troponin test to measure the amount of a
protein called troponin in your blood. Troponin
leaks when heart muscle cells die during a heart
attack.
Blood tests often are repeated to check for
changes over time.
Heart imaging tests
Imaging tests, such as a chest X-ray or computed
tomography (CT) help your doctor check whether
your heart is working properly. You may also
need a stress test, which can help your doctor
determine the amount of damage to your heart or
if the cause of the heart attack is coronary
artery disease.
Causes and Risk Factors
What causes a heart attack?
The most common cause of a heart attack is coronary
artery disease, which is the most common
type of heart disease. This is when your
coronary arteries cannot
carry enough oxygen-rich blood to your heart
muscle. Most of the time, coronary artery
disease happens when a waxy substance called plaque builds
up inside your arteries, causing the arteries to
narrow. The buildup of this plaque is called atherosclerosis.
This can happen over many years, and it can
block blood flow to parts of your heart muscle.
Plaques that narrow arteries slowly over time
cause angina.
Eventually, an area of plaque can break open
inside your artery. This causes a blood
clots to
form on the plaque’s surface. If the clot
becomes large enough, it can block blood flow to
your heart. If the blockage isn’t treated
quickly, a part of your heart muscle begins to
die.
Other causes of a heart attack
Not all heart attacks are caused by blockages
from atherosclerosis. When other heart and blood
vessel conditions cause a heart attack, it is
called myocardial infarction in the absence of
obstructive coronary artery disease (MINOCA).
MINOCA is more common in women, younger people,
and racial and ethnic minorities, including
Black, Hispanic/Latino, and Asian people.
Conditions that can cause MINOCA have different
effects on the heart.
Small plaques in your arteries may
not block your blood vessels, but they can
break open or their outer layer can wear
away. This can cause blood clots to form on
these plaques. The blood clots can then
block blood flow through your coronary
arteries. The formation of small plaques is
more common in women, people who smoke, and
people who have other blood vessel
conditions.
A sudden and serious spasm (tightening) of
your coronary artery can block
blood flow through your artery, even if
there isn’t a buildup of plaque. Smoking is
a risk factor for a coronary spasm. If you
smoke, you may be more likely to have a
spasm triggered by extreme cold or very
stressful situations. Drugs like cocaine may
also cause coronary spasm.
A coronary artery embolism occurs
when a blood clot travels through your
bloodstream and gets stuck in your coronary
artery. This can block blood flow through
your artery. This is more common in people
who have atrial
fibrillation or conditions that raise
the risk of blood clots, such as thrombocytopenia or
pregnancy.
Spontaneous coronary artery dissection (SCAD) occurs
when a tear forms inside your coronary
artery. A blood clot can then form at the
tear, or the torn tissue itself can block
your artery. SCAD can be caused by stress,
extreme physical activity, and pregnancy.
This condition is more common in women who
are under 50 years old or pregnant and in
people who have Marfan
syndrome.
Other conditions may cause symptoms similar to a
heart attack. Your doctor will look at all of
your test results to rule them out.
What raises the risk of a heart attack?
Certain risk factors make it more likely that
you will develop coronary artery disease and
have a heart attack.
Risk factors you can control
Lifestyle habits, such as:
An unhealthy diet, including eating too
many foods high in saturated fat or
sodium
Lack of regular physical
activity
Smoking
Other medical conditions, such as:
High blood cholesterol
High blood pressure or preeclampsia(high
blood pressure during pregnancy)
High blood sugar or diabetes
High blood triglycerides
Overweight and obesity
If you have three or more of these conditions
that raise your risk for heart disease, it is
called metabolic
syndrome. This greatly increases your risk
of a heart attack.
Risk factors you can’t control
Age: The risk of heart disease
increases for men after age 45 and for women
after age 55 (or after menopause).
Family history of early heart disease: You
have a higher risk if your father or a
brother was diagnosed with coronary artery
disease before 55 years of age or if your
mother or a sister was diagnosed with
coronary artery disease before 65 years of
age.
Infections from bacteria and
viruses
Can you prevent a heart attack?
You can lower your risk of a heart attack by
changing behaviors that can raise your risks or
treating any known coronary artery disease. Healthy
lifestyle changes, including heart-healthy
eating, staying active, quitting smoking,
managing stress, and maintaining a healthy
weight, can help prevent heart disease. Even if
you already have coronary artery disease, these
changes can lower your risk of a heart attack.
It is also important for you to get treatment
for other health conditions that raise your risk
of a heart attack. Talk to your doctor about
whether taking aspirin can help you prevent
blood clots that can lead to a heart attack.
Treatment
Your doctor or emergency medical personnel may
start treatment even before they confirm
that you are having a heart attack. Early
treatment to remove the blood clot or plaque can
prevent or limit damage to your heart, help your
heart work better, and save your life.
Emergency treatment
Medicines
Aspirin or other medicines can
prevent more blood clots from forming. In
some people, aspirin may cause bleeding in
the stomach.
Nitroglycerin, or nitrates, can
make it easier for your heart to pump blood
and to improve blood flow through your
coronary arteries. Nitroglycerin also treats
chest pain. You may also be given other
medicines for chest pain. Side effects of
this medicine include nausea, vomiting,
weakness, a slow heartbeat, and low blood
pressure.
Thrombolytic medicines, also called
clot busters, can help dissolve blood clots
that are blocking your coronary arteries.
These medicines may cause bleeding problems.
You may be given these if you were unable to
reach a hospital that can do a percutaneous
coronary intervention (see below) quickly
enough.
Oxygen therapy
Oxygen therapy is a treatment that delivers
oxygen gas for you to breathe. You can receive
oxygen therapy from tubes resting in your nose,
a face mask, or a tube placed in your trachea
(windpipe). You may need oxygen therapy if you
have a condition that causes your blood oxygen
levels to be too low.
Oxygen therapy can be given for a short or long
period of time in the hospital, another medical
setting, or at home. Oxygen poses a fire risk,
so you should never smoke or use flammable
materials when using oxygen. You may experience
side effects from this treatment, such as a dry
or bloody nose, tiredness, and morning
headaches. Oxygen therapy is generally safe.
Procedures
You may need one of the following procedures at
the hospital or later to help restore blood flow
to your heart. These procedures are often done
as soon as your healthcare team confirms that
you are having a heart attack.
Percutaneous coronary intervention
Percutaneous coronary intervention (PCI), also
called coronary angioplasty, is a nonsurgical
procedure that improves blood flow to your
heart. Doctors use PCI to open blood vessels to
the heart that are narrowed or blocked by
buildup of plaque.
PCI requires cardiac
catheterization.
A cardiologist, the doctor who specializes in
the heart, performs PCI in a hospital cardiac
catheterization laboratory. Live X-rays help
your doctor guide a catheter through your blood
vessels into your heart, where special contrast
dye is injected to highlight any blockage. To
open a blocked artery, your doctor will insert
another catheter over a guidewire and inflate a
balloon at the tip of that catheter. Your doctor
may also put a small mesh tube called a stent in
your artery to help keep the artery open.
You may develop a bruise and soreness where the
catheters were inserted. It also is common to
have discomfort or bleeding where the catheters
were inserted. You will recover in a special
unit of the hospital for a few hours or
overnight. You will get instructions on how much
activity you can do and what medicines to take.
You will need a ride home because of the
medicines and anesthesia you received. Your
doctor will check your progress during a
follow-up visit. If a stent is implanted, you
will have to take certain anticlotting medicines
exactly as prescribed, usually for at least 6 to
12 months.
Serious complications during a PCI procedure or
as you are recovering after one are rare, but
they can happen. This might include:
Bleeding
Blood vessel damage
Treatable allergic reaction to the contrast
dye
Need for emergency coronary
artery bypass grafting during the
procedure
Arrhythmias, or irregular heartbeats
Damaged arteries
Kidney damage
Heart attack
Stroke
Blood clots
Sometimes chest pain can occur during PCI
because the balloon briefly blocks blood supply
to the heart. Restenosis, when tissue regrows
where the artery was treated, may occur in the
months after PCI. This may cause the artery to
become narrow or blocked again. The risk of
complications from this procedure is higher if
you are older, have chronic kidney disease, are
experiencing heart failure at the time of the
procedure, or have extensive heart disease and
more than one blockage in your coronary
arteries.
Stenting
A stent is a small mesh tube that holds open
passages in the body, such as weak or narrow
arteries. Stenting is a minimally invasive
procedure. The most common complication after a
stenting procedure is a blockage or blood clot
in the stent. You may need to take certain
medicines, such as aspirin and other
anti-platelet medicines, for a year or longer
after receiving a stent in your artery to
prevent serious complications such as blood
clots.
Coronary artery bypass grafting (CABG)
CABG is a procedure to improve poor blood flow
to the heart. It may be needed when the arteries
supplying blood to heart tissue, called coronary
arteries, are narrowed or blocked. This surgery
may lower the risk of serious complications for
people who have a type of heart disease called
obstructive coronary artery disease. CABG may
also be used in an emergency, such as a severe
heart attack.
Recovery
Most people survive heart attacks and live
active, full lives. If you get help quickly,
your treatment can
limit damage to your heart muscle. Less heart
damage and healthy lifestyle changes improve
your chances of a better quality of life after a
heart attack.
Cardiac rehabilitation
You may need cardiac rehabilitation to help you
recover from a heart attack and to help prevent
another heart attack.
Cardiac rehabilitation is a medically supervised
program for people recovering from heart
problems. Cardiac rehabilitation involves
adopting heart-healthy lifestyle changes to
lower your risk for more heart and blood vessel
diseases. To help you adopt lifestyle changes,
these programs include exercise training,
education about heart-healthy living, and
counseling to reduce stress and help you return
to an active life.
Cardiac rehabilitation is provided in an
outpatient clinic or in a hospital rehab center.
Your team will design a program to meet your
needs. During cardiac rehabilitation, you will
learn to exercise safely and increase your
physical activity. The length of time that you
spend in cardiac rehabilitation depends on your
condition. Medicare and most insurance plans
cover a standard cardiac rehabilitation program
that includes 36 supervised sessions over 12
weeks.
Cardiac rehabilitation can benefit you by:
Improving your health and quality of life
Reducing the need for medicines to treat
heart or chest pain
Decreasing the chance you will need to go
back to a hospital or emergency room for a
heart problem
Preventing future heart problems
The heart-healthy lifestyle changes in cardiac
rehabilitation have few risks. In very rare
cases,, physical activity during the
rehabilitation program can cause serious
problems, such as injuries to your muscles and
bones, or possible life-threatening heart rhythm
problems.
Returning to normal activities
You may be able to return to your normal
activities within a few weeks if you don’t have
chest pain, discomfort, or other problems. Many
people can start walking right away. Talk with
your doctor about a safe schedule for returning
to your normal routine, including sexual
activity.
Depending on your state laws, you may be able to
start driving within a week. You shouldn’t start
driving if you still have symptoms
of a heart attack.
Take steps to prevent another heart attack
Once you’ve had a heart attack, you have a
higher risk of another one. Your doctor may
prescribe medicines or talk to you about steps
you can take, including heart-healthy lifestyle
changes.
Medicines
ACE inhibitors lower your blood
pressure and make it easier for your heart
to pump blood. Side effects may include pain
in your stomach area and swelling in your
face and neck.
Anticlotting medicines, such as
aspirin and clopidogrel, stop platelet from
clumping together to form blood clots.
Anticoagulants, or blood thinners,
help prevent blood clots from forming in
your blood vessels. These medicines also
keep existing clots from getting larger.
Both anticlotting medicines and
anticoagulants can cause bleeding problems.
Beta blockers make it easier for
your heart to pump blood. These medicines
are also used to treat irregular heartbeats
and chest pain and discomfort. Side effects
include an irregular heartbeat and
worsening heart
failure.
Statins control or lower your blood
cholesterol. Serious side effects include
muscle pain and muscle damage.
Take all your medicines as instructed by your
doctor. Don’t change the amount of your medicine
or skip a dose unless your doctor tells you to.
If you find it hard to get your medicines or
complete your cardiac rehabilitation program,
talk to your doctor.
Make heart-healthy lifestyle changes
Learn more about heart-healthy living:
Heart-healthy eating
Aiming for a healthy weight
Managing stress
Physical activity
Quitting smoking
The symptoms of a second heart attack may not be
the same as those of your first heart attack.
Don’t take a chance if you’re not sure. Always call
9-1-1 right away if you or someone else
has heart attack symptoms.
What kind of health problems can a heart attack
cause?
A heart attack can cause serious heart problems,
including the ones listed below.
Cardiac
arrest
Cardiogenic shock
Heart failure
Heart inflammation
Irregular heartbeat
Sticking to your treatment plan can help prevent
other problems.
Take care of your mental health
After a heart attack, you may worry about having
another heart attack. You may also feel
depressed and have trouble adjusting to your new
lifestyle changes.
Talk about how you feel with your healthcare
team. They may recommend talking to
a professional counselor or joining a
patient support group.
Let your loved ones know how you feel and
what they can do to help you. Support from
family and friends can help lower your
stress and anxiety.
If you’re depressed, you may need medicines or
other treatments that can improve your quality
of life.
Heart Attacks in Women
The causes, risk factors, and symptoms of a
heart attack can be different in women compared
with men.
Causes and risk factors
Risk factors such as age, lifestyle habits, and
other health conditions affect men and women
differently.
Women may get heart attacks at older ages
than men do.
Smoking, high blood pressure, high blood
cholesterol, high blood sugar, obesity, and
stress raise the risk of a heart attack more
in women than in men.
Women are more likely than men to have heart
attacks that are not caused
by coronary artery disease. This can
make it more difficult for healthcare
providers to diagnose heart attacks in
women.
Women have more health problems after having
a heart attack than men do.
Symptoms of a heart attack in women
Both women and men who have a heart attack often
have chest pain. However, in addition to chest
pain, women are more likely to have these
symptoms:
Pain in the shoulder, back, or arm
Shortness of breath
Unusual tiredness and weakness
Upset stomach
Anxiety
These symptoms can happen together with chest
pain or without any chest pain.
Many women may not recognize that these are
symptoms of a heart attack. Women may not get
emergency treatment right away if they downplay
their symptoms and delay going to the hospital,
or if the usual initial screening tests
performed at the hospital may not detect an
early or atypical heart attack. Because of this,
women have a higher risk of serious health
problems after a heart attack.
It is important to call
9-1-1 if you have these symptoms. Early
treatment can limit damage to your heart and can
save your life.
Pregnancy and heart attacks
Heart attacks are not common among pregnant
women, but they are possible both during and
soon after delivery. Normal changes to your body
during pregnancy can raise your risk of a heart
attack. Your age, lifestyle habits, and other
health conditions, such as bleeding disorders,
obesity, preeclampsia(high
blood pressure during pregnancy), and diabetes,
can also raise your risk.
If you already have coronary artery disease,
being pregnant can raise your risk of a heart
attack. Coronary artery disease is a major cause
of heart attacks during pregnancy. Ask your
doctor whether it is safe for you to get
pregnant and what steps you need to take to keep
your heart healthy during your pregnancy.
Heart attacks caused
by spontaneous coronary artery dissection (SCAD),
a coronary artery embolus, or a coronary artery
spasm are more common in pregnant women than in
people who are not pregnant.
If you have symptoms of a heart attack during
your pregnancy, or at any time, call
9-1-1 right away. Your healthcare team
will take steps to protect your baby during
these tests. Your healthcare team will also make
sure that any treatment
you take for a heart attack is safe to use
during pregnancy.
