A heart attack is the blockage of blood flow to an area of the heart. The heart tissue becomes damaged or dies within a short time after blood flow is stopped. If a large or vital area is affected the damage may stop the heart from working.
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The coronary arteries deliver oxygen-rich blood to the heart muscle. A heart attacks occurs when blood flow is interrupted in these arteries because of one or more of the following: Narrowing of the coronary arteries due to: Thickening of the artery walls (common aging process) Build up of fatty plaques inside the arteriesSpasm of the coronary arteriesDevelopment of a blood clot in the arteriesEmbolism, blood clot, that travels to the heart and blocks off smaller coronary arteries
The severity of the heart attack will depend on how much of the heart tissue was affected and how long the blockage lasted. The amount of heart tissue that is affected will depend on which artery is blocked. There are two main coronary arteries that gradually split down into smaller branches of arteries. If the blockage occurs in the larger arteries it will affect a larger area of the heart. If the blockage occurs further down in the smaller vessels it affects a smaller area of the heart.
The risk of heart attack is greater in males and older adults.
Factors that affect the health of your blood vessels and increase your chance of developing a heart attack include: ObesitySmokingHigh blood pressureSedentary lifestyleHigh blood cholesterol
—specifically, high LDL cholesterol, and low HDL cholesterol
High blood triglycerides
DiabetesStressFamily members with heart diseaseUsing testosterone therapy medication
Symptoms can vary but common symptoms include:
Squeezing, heavy chest pain behind breastbone, that usually comes on quickly especially with:
Exercise or exertionEmotional stressCold weatherA large mealPain in the left shoulder, left arm, or jawShortness of breathSweating, clammy skinNauseaWeaknessLoss of consciousnessAnxiety
, especially feeling a sense of doom or panic without apparent reason
Unusual symptoms of heart attack—may occur more frequently in women: Stomach painBack and shoulder painConfusionFainting
If you think you may be having a heart attack, call for emergency medical services right away.
If the doctor suspects a heart attack it may be confirmed with: EKG—records the electrical activity of the heart and can show if a heart attack has happened or may be happening. It can also help determine if the heart attack is: STEMI—suggests total blockage of artery and more serious type of heart attack. NSTEMI—suggests partial blockage of artery Blood tests—certain markers in the blood will appear or increase if a heart attack has occurred. These markers can also indicate how much damage was done to the heart muscle.Echocardiogram—an imaging test to examine the size, shape, function, and motion of the heartCoronary angiography—a wire is passed through blood vessels to look for any blockages or damage to the coronary arteries.
Further testing may be done to look for any damage or changes to the heart. Test will be based on your specific needs but may include: Stress test
—Records the heart's electrical activity under increased physical stress, usually done days or weeks after the heart attack.Electron-beam computed tomography
(EBCT)—to make detailed pictures of the heart, coronary arteries, and surrounding structures.
The first goal of treatment is to improve blood flow and get oxygen to your heart as quick as possible. Treatment includes:
Aspirin and other antiplatelet agents—will decrease clotting in the blood to help it flow smoother. Oxygen—inhaling more oxygen will increase the amount of oxygen in the blood for the heartNitrate medications—these medications can help the blood vessels open up and allow better blood flow.Pain-relieving medicationBeta-blockers
and/or angiotensin-converting enzyme
(ACE) inhibitor medications—to decrease the workload on the heart
Anti-anxiety medicationCholesterol-lowering medications
such as statin drugs—may play an important role in decreasing chance of another heart attack or stroke.
If a blood clot is present, medications may be given to try to break up the clot. The sooner these medications are delivered the better the outcome will be. Ideally, the medications are delivered within the first 6 hours after symptoms appear.
Other blockages, blood clots that don't respond to medication or plaque build up, may need to be surgically managed. The procedure may need to be done immediately for severe blockages or delayed for a few days if there is adequate blood flow. Surgical options include: Balloon angioplasty—a wire is passed through blood vessels and a device is used to open up the blocked artery. A stent may also be placed in the blood vessel to help keep it open.Coronary artery bypass grafting (CABG)—an open surgery that uses a section of blood vessel from another part of the body to create a path around the blocked area.
Cardiac rehabilitation can help during recovery after a heart attack. It may include monitoring during physical activity in the first few weeks of recovery and education on healthful nutrition and lifestyle changes.
A heart attack can be a major life event. It is common for people to experience depression
after having a heart attack.
can help manage these challenges.
Many lifestyle habits influence the health of the blood vessels and heart. Healthy heart habits include:
Begin a safe
. Follow your doctor's advice.
Don't smoke, or quit smoking if you already started.
healthy diet. Aim for a diet that is low in saturated fat and rich in
fruits, and vegetables.
long-term conditions, like
high blood pressure
high cholesterol which can affect heart health.
Develop relaxation techniques to help manage stress.
Small daily doses of aspirin may help some people decrease their risk of aspirin. Aspirin for heart protection should only be done with a doctor's supervision since aspirin can cause complications like bleeding in the stomach or intestines. Aspirin may also interact with other medications like pain medications.
About heart attacks. American Heart Association website. Available at:
http://www.heart.org/HEARTORG/Conditions/HeartAttack/AboutHeartAttacks/About-Heart-Attacks_UCM_002038_Article.jsp. Updated September 2, 2014. Accessed September 29, 2014.
What is a heart attack? National Heart Lung and Blood Institute website. Available at:
http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/. Updated December 13, 2013. Accessed September 29, 2014.
Last reviewed September 2016 by Michael J. Fucci, DO, FACC
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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