Heart Attack

Overview

What is a heart attack?

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.

What do women need to know about heart attacks?

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

Source 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

What are the symptoms of heart attack?

Symptoms of heart attack may include:

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

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 be especially aware of the other possible symptoms of heart attack, including 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 seek treatment right away. Follow these steps:

  • Dial 911 or call an ambulance right away. Do not drive yourself to the hospital.
  • After calling for emergency medical help, chew and swallow 1 uncoated adult aspirin (325 mg) or 4 uncoated baby aspirins (81 mg each). Don’t take the aspirin if you’re allergic to aspirin.
  • If you are alone, unlock your door to let emergency help enter your home.
  • Sit in a comfortable chair and wait for help.
  • Keep a phone near you.

Causes & Risk Factors

What causes 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. 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.

Risk factors for a heart attack

  • Smoking
  • Diabetes
  • Age–Risk increases for men older than 45 years of age and for women older than 55 years of age (or after menopause). About 83% of people who die from heart disease are 65 years of age or older.
  • High cholesterol level
  • High blood pressure
  • Family history of heart attack
  • Race–African Americans, Mexican Americans, Native Americans and native Hawaiians are at greater risk.
  • Atherosclerosis (hardening of the arteries)
  • Lack of exercise
  • Stress
  • Obesity
  • Sex (Gender)–More men have heart attacks, although heart disease is the leading cause of death for American women.

Diagnosis & Tests

How is heart attack diagnosed?

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

Other tests your doctor may want you to have include:

  • Electrocardiogram (ECG, or sometimes called “EKG”): Your doctor will want you to have an ECG. This test records the electrical activity of your heart. It can help diagnose heart rhythm problems or any damage that the decrease in blood flow may have caused to your heart.
  • Blood tests: Your doctor will probably order blood tests to help diagnose your symptoms. 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 hours to 48 hours after yours symptoms start.
  • Echocardiogram: This test sends out sound waves that allow your doctor to get pictures of your heart. The pictures show your doctor how well your heart is pumping. It can also show if there are problems with your heart valves.
  • Chest X-ray: This test allows your doctor to evaluate the size and shape of your heart. It also shows if there is any congestion (fluid) in your lungs.
  • Nuclear imaging: This test involves injecting a very small amount of a radioactive substance into your blood. This substance travels to your heart. Then, a special camera or scanner uses the radioactive substance to produce pictures that 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.

Treatment

How is heart attack treated?

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.

What is a cardiac rehabilitation program?

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.

Medicines to Treat Heart Attack

If you have had a heart attack, your doctor has probably prescribed medicines that you will need to take for a long time. These medicines help improve blood flow to your heart, prevent blood clotting, and reduce your risk of having more heart problems in the future.

Below you will find an overview of medicines usually prescribed to treat heart attack and information about their benefits, risks and side effects. If you have questions or concerns about the medicines you are taking, be sure to ask your doctor for more information.

ACE Inhibitors

ACE inhibitors are a group of drugs that can help if your heart is not pumping blood well. This type of medicine improves blood flow by helping to open (dilate) your arteries and lower your blood pressure.

If you have ACS, your doctor may want you to take an ACE inhibitor alone or in combination with other medicines, such as a diuretic or a beta blocker.

Side effects. ACE inhibitors don’t usually cause troublesome side effects. The most common side effect is a dry cough. More rare side effects include dizziness, reduced appetite, fatigue (feeling out of energy), problems with the kidneys and an increase in the level of potassium in the blood.

Risks. Because ACE inhibitors can cause birth defects, pregnant women should not take this type of medicine.

In rare cases, ACE inhibitors can lead to a serious allergic reaction (called an anaphylactic reaction) that causes swelling in certain areas of the body. This reaction is more common in black people and people who smoke. It can be life-threatening. You should get immediate medical attention if you experience swelling after taking an ACE inhibitor.

Aspirin

Your doctor may want you to take a low dose of aspirin each day. Aspirin helps keep your blood from forming clots. Blood clots can clog the arteries that carry blood and oxygen to the heart (called the coronary arteries). Blockages in the coronary arteries increase your risk of having a heart attack or stroke.

Side effects. Common side effects of aspirin include nausea and upset stomach. Some people feel nervous or have difficulty falling asleep when taking aspirin. Call your doctor if your symptoms are severe.

Risks. Aspirin can increase your risk of stomach ulcers and gastrointestinal bleeding (bleeding in your stomach and intestines). Doctors usually prescribe a low dose of aspirin (between 81 mg per day and 162 mg per day) for people who have ACS. The low dose provides the same benefits as a higher dose, with less risk of internal bleeding.

Talk to your doctor about the risks and benefits of aspirin therapy. He or she will prescribe the aspirin dose that is right for you and tell you exactly how to take it.

Beta Blockers

Beta blockers are a group of drugs that lower the heart rate and blood pressure. They also help improve blood flow to the heart, reduce chest pain and prevent more damage to the heart.

If you have had a heart attack, your doctor may prescribe a beta blocker. He or she may want you to take a beta blocker alone or in combination with other medicines, such as a diuretic or an ACE inhibitor.

Side effects. The side effects of beta blockers tend to be mild. Common side effects include cold hands, fatigue, dizziness and weakness. Less common side effects include shortness of breath, difficulty sleeping, depression and decreased sex drive.

Risks. Beta blockers are not recommended for people who have asthma. This type of medicine can trigger severe asthma attacks.

Beta blockers may make it difficult to recognize signs of low blood sugar (such as rapid heartbeat) in people who have diabetes. If you have diabetes, your doctor will probably tell you to check your blood sugar often.

Stopping beta blockers abruptly increases the risk of heart problems. If you need to stop taking a beta blocker, it’s important to stop gradually, according to your doctor’s instructions.

Antiplatelet Drugs

Antiplatelet drugs are sometimes prescribed along with aspirin therapy. This type of medicine helps prevent blood clots by not allowing certain cells in the blood (called platelets) to clump together. This reduces the risk of blockages in the coronary arteries that can lead to heart attack and stroke.

Side effects. Some common side effects of antiplatelet drugs include nausea, upset stomach, stomach pain, diarrhea, itching and a rash. Talk to your doctor if you experience side effects while taking this medicine.

Risks. Because antiplatelet drugs prevent blood clotting, they can increase the risk of serious bleeding in some people.

Diuretics

Diuretics (also called water pills) help the body get rid of extra sodium (salt) and fluid. This type of medicine lowers your blood pressure by reducing the amount of fluid flowing through your blood vessels.

Diuretics are very commonly prescribed to treat high blood pressure. They are sometimes used in combination with beta blockers and ACE inhibitors.

Side effects. Common side effects of diuretics include increased urination, increased thirst, fatigue, muscle cramps and low blood pressure. Less common side effects include increased blood sugar, increased cholesterol, irregular menstrual periods in women and impotence in men.

Risks. People who take diuretics can have too much or too little potassium in their blood, depending on the type of diuretic they take.

Statins

If you have had a heart attack, your doctor may prescribe a statin. Statins are a group of drugs used to lower “bad” cholesterol (also called LDL, or low-density lipoprotein) levels. Statins may also help increase “good” cholesterol (also called HDL, or high-density lipoprotein) levels.

Most people who take statins will take this type of medicine for the rest of their lives.

Side effects. Muscle pain is the most common side effect of statins. The pain can be mild or severe. Less common side effects include nausea, diarrhea, gas and constipation. People who take statins may also get a rash. This side effect is more common when a statin is taken in combination with another drug used to lower cholesterol levels (called niacin).

You are at higher risk of having side effects from statins if you:

Some people may feel discouraged by the side effects caused by statins. However, the side effects are not usually life-threatening. Your doctor can help you find ways to manage them. If you are worried about side effects, talk to your doctor about the risks and benefits of taking statins.

Risks. In some people, statins can cause liver damage. Your doctor will probably want to have your liver function tested on a regular basis.

  • Are a woman.
  • Are age 65 or older.
  • Have liver or kidney disease.
  • Have type 1 or type 2 diabetes.
  • Take several types of medicine.

Complications

What does depression have to do with my heart attack?

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.

What is depression?

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:

  • Feeling sad or crying often (depressed mood)
  • Losing interest in daily activities that used to be fun
  • Changes in appetite and weight
  • Sleeping too much or having trouble sleeping
  • Feeling agitated, cranky or sluggish
  • Loss of energy
  • Feeling very guilty or worthless
  • Problems concentrating or making decisions
  • Thoughts of death or suicide

How will I know if I am depressed?

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.

Learn more about depression.

Prevention

What can I do to help prevent heart attack?

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.

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

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.

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

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.

Questions to Ask Your Doctor

  • 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?