Heart Attack

What is a heart attack?

A heart attack happens when part of the heart muscle is damaged or dies because it isn’t receiving enough oxygen. 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 attack is sometimes called myocardial infarction or acute coronary syndrome. Heart attacks are often treatable when diagnosed quickly. However, they 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. Their symptoms can be different from what men experience. Sometimes they may not recognize the symptoms of a heart attack. Or 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.

Symptoms of heart attack

The most common symptoms of heart attack in both men and women include:

  • chest discomfort (also called angina), which may feel like pain, pressure, tightness, heaviness, or burning like heartburn.
  • pain or discomfort in the neck, shoulders, lower jaw, arms, upper back, or abdomen.
  • shortness of breath that lasts more than a few seconds.

Other symptoms you could have include:

  • feeling lightheaded, dizzy, or faint
  • nausea and/or vomiting
  • unusual sweating
  • overwhelming fatigue
  • feeling anxious
  • heart palpitations (feeling like your heart is beating really fast, or out of rhythm)
  • feeling unusually tired for no reason (sometimes for several days).

Are the symptoms of heart attack different for women?

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 pay close attention to other symptoms of heart attack. These include shortness of breath, sweating, fatigue, and dizziness.

What should I do if I have symptoms of heart attack?

If you think you may be having a heart attack, it’s important to get treatment right away. Follow these steps:

  • Dial 911 right away. Do not have someone else drive you or try to drive yourself to the hospital. Medical personnel can give you life-saving treatment in the ambulance on the way to the hospital.
  • After calling for help, take 1 uncoated adult aspirin (325 mg) or 4 uncoated baby aspirins (81 mg each). Don’t take this if you’re allergic to aspirin.
  • If you are alone and are able, unlock your door to let emergency help enter your home.
  • Sit in a comfortable chair and wait for help.
  • Keep a phone near you.

What causes a heart attack?

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. Blockage in a coronary artery can reduce the flow of blood and oxygen to the heart.

Most heart attacks are a result of coronary heart or artery disease. In this disease, a waxy substance called plaque builds up in the arteries. This is called atherosclerosis. It takes years for the plaque to build up. If the plaque become cracked or damaged, blood clots can form. The clots can slow down or stop blood flow to the heart. Then the heart won’t get enough oxygen. The tissue not receiving the oxygen will begin to die.

Risk factors for a heart attack include:

  • smoking
  • diabetes
  • age – Risk increases for men older than 45 and for women older than 55 (or after menopause). About 83% of people who die from heart disease are 65 or older.
  • high cholesterol
  • high blood pressure
  • high blood sugar
  • family history of heart attack
  • race – African Americans, Mexican Americans, Native Americans, and native Hawaiians are at greater risk.
  • lack of exercise
  • stress
  • obesity
  • gender – More men have heart attacks. But heart disease is the leading cause of death for American women.

A less common cause of heart attack is a severe spasm, or tightening, of a coronary artery. This can happen in an artery that doesn’t have plaque built up in it. Instead, the tightening cuts off the blood flow. Spasms aren’t as well understood as a cause for heart attack. They seem to be related to:

  • taking specific drugs, such as cocaine
  • cigarette smoking
  • exposure to extreme cold
  • severe emotional pain or stress.

How is heart attack diagnosed?

You may need several tests to determine the cause of your symptoms.

  • Electrocardiogram (ECG or EKG). This test records the electrical activity of your heart. It can help diagnose heart rhythm problems. It can also find damage that the decrease in blood flow may have caused to your heart.
  • Blood tests. When not enough blood flows to the heart, special proteins leak into the blood system. A simple blood test can detect these proteins. Your doctor will probably want to test your blood several times during the first 24 to 48 hours after yours symptoms start.

Other tests your doctor may want you to have include:

  • Echocardiogram. This test sends out sound waves that create pictures of your heart. The pictures show your doctor how well your heart is pumping. It can show if there are problems with your heart valves.
  • Chest X-ray. This allows your doctor to evaluate the size and shape of your heart. It can show if there is any fluid in your lungs.
  • Nuclear imaging. A very small amount of a radioactive substance is injected into your blood. This substance travels to your heart. A special camera uses the substance to produce pictures. These show how well your heart is pumping. The radioactive substance is safe and leaves your body completely after the test is finished.
  • Coronary angiography. This test is sometimes called cardiac catheterization. In this test, a long tube is inserted into a blood vessel. The tube is guided to the heart or arteries that carry blood to the heart. Then, a substance is injected into the tube. This substance is visible by X-ray. It allows your doctor to see where the blockage that caused the decrease in blood flow to your heart is located.

Can heart attacks be prevented or avoided?

A healthy lifestyle can help prevent heart attack. This includes:

  • Quitting smoking if you smoke, and avoiding secondhand smoke.
  • Keeping a healthy diet that is low in fat and low in cholesterol.
  • Exercising regularly.
  • Managing your stress.
  • Controlling your blood pressure.
  • Managing your blood sugar level (if you have diabetes).
  • Seeing your doctor regularly for check-ups.

I’m a woman. Can estrogen replacement therapy reduce my risk for heart disease?

Hormone replacement therapy (HRT), also known as estrogen replacement therapy, is used to treat the symptoms of menopause. It was hoped that it could also help guard against certain diseases, including heart disease. New studies have shown that HRT actually does more harm to your heart than good. If you’re taking HRT to help prevent heart disease, talk to your doctor about whether you should stop.

Heart attack treatment

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 and aspirin. Nitroglycerin improves blood flow to your heart. It can temporarily relieve your symptoms by widening the arteries that carry blood to the heart.

If you are having a heart attack, your doctor can:

  • Give you medicine. The medicine is called a thrombolytic. It can help dissolve the blood clot that is blocking the coronary artery.
  • Do a coronary angiography (X-ray of the blood vessels).
  • Do an angioplasty or stent. Angioplasty involves inserting a tiny balloon into an artery in your arm or leg. The balloon is threaded up the artery 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.
  • Do coronary artery bypass surgery. If an angioplasty and/or stenting are not appropriate, you may need this major surgery. Your doctor removes a healthy vein from your leg or an artery from your upper body. He or she makes a bypass around the blockage in your coronary artery. This allows blood to flow around the blockage.

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
  • 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 these changes to prevent more heart problems.

What is a cardiac rehabilitation program?

Before you leave the hospital, your doctor will may talk to you about a cardiac rehabilitation program. These programs provide information that will help you understand your risk factors. It will guide you to begin a 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 lifestyle changes you make, the better your chances of preventing more heart problems in the future.

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.

Living with a heart attack

After you’ve had a heart attack, you are at higher risk of having another one. Your doctor will likely recommend heart-healthy lifestyle changes to help reduce your risk. They include:

  • heart-healthy diet
  • work toward a healthy weight
  • manage stress
  • be physically active
  • quit smoking.

Symptoms during a second heart attack may be different than the first one. If you have any new symptoms of heart attack or are in any doubt, call 911. Early treatment is the key to surviving a heart attack.

Will I have to take medicine for the rest of my life?

If you have had a heart attack, your doctor will probably want you to take certain medicines for a long time. This can help reduce your risk of more heart problems. Your doctor can answer your questions about these medicines. He or she can tell you the benefits and risks of taking them.

  • Aspirin can reduce the risk of a heart attack. A low dose of aspirin each day can 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 medicines also help stop blood clots from forming. 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 your arteries and lower your blood pressure. This improves blood flow.
  • Statins are a group of drugs that are used to control cholesterol. They lower “bad” cholesterol (LDL) levels and may help increase “good” cholesterol (HDL).

What does depression have to do with a heart attack?

Depression is common after a heart attack. As many as 1 out of every 3 people who have had a heart attack report feelings of depression. People with a higher risk of depression after a heart attack include:

  • women
  • people who have had depression before
  • people who feel alone and without social or emotional support .

Many people who have depression don’t recognize it. They don’t seek help or get treatment. Being depressed can make it harder for you to recover physically. However, depression can be treated.

Questions to ask your doctor

  • Is there a test I can take to see if my arteries or blocked so I know if I’m at risk of a having a heart attack?
  • What is the likely cause of my heart attack?
  • How serious was my heart attack?
  • What course of treatment do you recommend? Do I need medicine? Surgery?
  • Do I need to participate in a cardiac rehabilitation program?
  • When can I return to normal physical and sexual activity?
  • What is my risk of having another heart attack?
  • Are my family members at an increased risk of heart attack?
  • Do I need to take medicine(s) to prevent another heart attack?
  • Will the medicine(s) interact with any of the medicine(s) I already take?
  • What lifestyle changes should I make at home to prevent another heart attack?