A heart attack (also called myocardial infarction and acute coronary syndrome) is when part of the heart muscle is damaged or dies because it isn't receiving enough oxygen. Normally, the blood in your coronary arteries carries oxygen to the heart muscle. Most heart attacks occur when a blockage slows down or stops the flow of blood through these arteries.
Heart attacks are usually treatable when diagnosed quickly. However, without treatment, heart attacks can be fatal.
Women are less likely to survive heart attacks than men. No one knows why. It may be that women don't seek or receive treatment as soon as men, or that they don’t recognize the symptoms of a heart attack, which can be different from the symptoms that men experience. It may be because women's smaller hearts and blood vessels are more easily damaged. Doctors are working on finding answers to these questions. Clearly, it makes sense to prevent heart problems before they start.
Portions of this article were supported by an educational grant from Daiichi Sankyo, lnc. and Lilly USA, LLC
Assessment and Treatment of Depression Following Myocardial Infarction by TP Guck, PH.D., MG Kavan, PH.D., GN Elsasser, PHARM.D., and EJ Barone, M.D. (American Family Physician August 15, 2001, http://www.aafp.org/afp/20010815/641.html)
Symptoms of heart attack may include:
Like men, the most common heart attack symptom for women is pain or discomfort in the chest. However, women may also have a heart attack without having any chest pain. Women should be especially aware of the other possible symptoms of heart attack, including shortness of breath, sweating, fatigue and dizziness.
If you think you may be having a heart attack, it’s important to seek treatment right away. Follow these steps:
A heart attack occurs when part of the heart muscle is damaged or dies because it isn't receiving enough oxygen. The arteries that carry blood and oxygen to the heart are called coronary arteries. Blockages in one or more of the coronary arteries can reduce the flow of blood and oxygen to the heart.
Usually, a blockage starts with atherosclerosis. Atherosclerosis is the buildup of fatty deposits (called plaque) inside your arteries and the hardening of your artery walls. The buildup is like the gunk that builds up in a drainpipe and slows the flow of water. When plaques become cracked or damaged, blood clots can form. If a clot forms in one or more of the coronary arteries, the clots can slow down or stop blood flow to the heart.
You may need several tests to determine the cause of your symptoms.
Other tests your doctor may want you to have include:
Your treatment will depend on what is causing your symptoms. If you have an acute case of angina (chest pain), your doctor will probably give you nitroglycerin. Nitroglycerin can temporarily relieve your symptoms and improve blood flow to your heart. It does that by widening the arteries that carry blood to the heart.
If you are having a heart attack, your doctor may give you a medicine called a thrombolytic, or may choose to do an angiography and possibly an angioplasty or stent. A thrombolytic drug can help dissolve the blood clot that is blocking the coronary artery. An angioplasty is a procedure in which a tiny balloon is inserted through an artery in the arm or leg up to the heart. The balloon pushes open blocked coronary arteries. A small metal rod called a stent might be put into the artery where the blockage was to hold the artery open.
If an angioplasty and/or stenting are not appropriate, you may need coronary artery bypass surgery. This is a major surgery, in which the doctor takes either veins from your legs and/or an artery from your upper body to bypass the blockages in your coronary arteries. Coronary bypass surgery allows blood to flow to the area of the heart past the blockage.
Regardless of the treatment your doctor selects for you, the sooner you get medical help, the greater your chances of surviving a heart attack. Do not delay getting immediate medical attention if you are experiencing symptoms of heart attack.
Treatment of heart attack also includes medicines that you will need to take even after you leave the hospital. These medicines help improve blood flow to your heart, prevent clotting, and reduce the risks of having another heart attack. These medicines include: aspirin, beta blockers, statins, ACE inhibitors and fish oil. Your doctor will prescribe the medicines that are right for you.
If you have had a heart attack, your doctor will also talk to you about lifestyle changes you can make to prevent more heart problems.
Before you leave the hospital, your doctor will probably talk to you about enrolling in a cardiac rehabilitation program. A cardiac rehabilitation program provides information that will help you understand your risk factors. The program will also guide you to begin a heart-healthy lifestyle that can prevent future heart problems. You will learn about exercise and diet, and how to reach and maintain a healthy weight. You will also learn ways to control your stress level, your blood pressure and your cholesterol levels.
Your cardiac rehabilitation program will probably start while you are still in the hospital. After you leave the hospital, your rehabilitation will continue in a rehab center. The rehab center may be at the hospital or in another location.
Most cardiac rehabilitation programs last 3 to 6 months. Your doctor will talk to you about how often you need to attend the program. Once you enroll in a cardiac rehabilitation program, regular attendance is very important. The more you learn and make changes in your lifestyle to live a heart-healthy life, the better your chances of preventing more heart problems in the future.
Depression is common after a heart attack. As many as 1 out of every 3 people who have a heart attack report feelings of depression. Women, people who have had depression before, and people who feel alone and without social or emotional support are at a higher risk of depression after a heart attack.
Many people who have depression don’t recognize it, seek help or get treatment. Being depressed can make it harder for you to recover physically. However, depression can be treated.
Depression is a medical illness, just like diabetes or high blood pressure. The emotional and physical symptoms of depression include some or many of the following:
People who are depressed have symptoms from the list above nearly every day, all day, for 2 or more weeks. Depressed mood and loss of interest in daily activities are two of the most common symptoms.
If you have some or all of the symptoms of depression, see your family doctor. Your doctor will ask you questions about your symptoms, your health and your family's history of health problems.
A healthy lifestyle can help prevent ACS. This includes:
Probably. If you have had a heart attack, your doctor will probably want you to take certain medicines for a long time to reduce your risk of more heart problems. Your doctor can answer any questions you have about these medicines, such as the benefits and risks of taking them.
Aspirin can reduce the risk of a heart attack. Your doctor may want you take a low dose of aspirin each day to keep your blood from forming clots that can eventually block the arteries. Talk to your doctor about the risks and benefits of aspirin therapy.
Antiplatelet drugs can also help stop blood clots from forming. Blood clots can block the arteries that carry blood and oxygen to the heart (called the coronary arteries) and cause a heart attack or a stroke. These drugs are especially important to take for at least a year if you have had a stent placed in your heart.
Beta blockers are a group of drugs that lower the heart rate and blood pressure. They help improve blood flow to the heart.
ACE inhibitors are a group of drugs that can help if your heart is not pumping blood well. This medicine helps open (dilate) your arteries and lower your blood pressure. This improves blood flow.
Statins are a group of drugs that are used to lower “bad” cholesterol (also called LDL, or low-density lipoprotein) levels and may help increase “good” cholesterol (also called HDL, or high-density lipoprotein). If you have had a heart attack, your doctor may prescribe a statin.
No. Estrogen replacement therapy, also called hormone replacement therapy (HRT), was prescribed by doctors because they hoped it could help guard against certain diseases as well as treat the symptoms of menopause. It was once thought that HRT could help protect against heart disease. New studies have shown that when it comes to heart health, HRT actually does more harm than good. If you’re taking HRT to help prevent heart disease, talk to your doctor about whether you should stop.
Written by familydoctor.org editorial staff. Portions of this article were written by Susan D. Housholder, RN, MSN, ANP-BC, FAHA.