Heart Attack

Each year over a million people in the U.S. have a heart attack. About half of them die. Many people have permanent heart damage or die because they don’t get help immediately. It’s important to know the symptoms of a heart attack and call 9-1-1 if someone is having them. Those symptoms include

• Chest discomfort – pressure, squeezing, or pain
• Shortness of breath
• Discomfort in the upper body – arms, shoulder, neck, back
• Nausea, vomiting, dizziness, lightheadedness, sweating

These symptoms can sometimes be different in women.

Prevention

Lowering your risk factors for coronary heart disease can help you prevent a heart attack. Even if you already have coronary heart disease, you still can take steps to lower your risk for a heart attack. These steps involve following a heart-healthy lifestyle and getting ongoing medical care.

HEART-HEALTHY LIFESTYLE

A heart-healthy lifestyle can help prevent a heart attack and includes heart-healthy eating, being physically active, quitting smoking, managing stress, and managing your weight.

ONGOING CARE

Treating conditions that make a heart attack more likely also can help lower your risk for a heart attack. These conditions may include:

• Diabetes. If you have diabetes, try to control your blood sugar level through diet and physical activity (as your doctor recommends). If needed, take medicine as prescribed.
• High blood cholesterol. Your doctor may prescribe a statin medicine to lower your cholesterol if diet and exercise aren’t enough.
• High blood pressure. Your doctor may prescribe medicine to keep your blood pressure under control.

HAVE AN EMERGENCY ACTION PLAN

Make sure that you have an emergency action plan in case you or someone in your family has a heart attack. This is very important if you’re at high risk for, or have already had, a heart attack.

Talk with your doctor about the signs and symptoms of a heart attack, when you should call 9–1–1, and steps you can take while waiting for medical help to arrive.

Risk Factors

Certain risk factors make it more likely that you’ll develop coronary heart disease and have a heart attack. You can control many of these risk factors.

THE MAJOR RISK FACTORS FOR A HEART ATTACK THAT YOU CAN CONTROL INCLUDE:

• Smoking
• High blood pressure
• High blood cholesterol
• Overweight and obesity
• An unhealthy diet (for example, a diet high in saturated fat, trans fat, cholesterol, and sodium)
• Lack of routine physical activity
• High blood sugar due to insulin resistance or diabetes

Some of these risk factors—such as obesity, high blood pressure, and high blood sugar—tend to occur together. When they do, it’s called metabolic syndrome. In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn’t have metabolic syndrome.

RISK FACTORS THAT YOU CAN’T CONTROL INCLUDE:

• 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. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
• Preeclampsia. This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine. Preeclampsia is linked to an increased lifetime risk of heart disease, including CHD, heart attack, heart failure, and high blood pressure.

Causes

CORONARY HEART DISEASE

A heart attack happens if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can’t get oxygen. Most heart attacks occur as a result of coronary heart disease.

CHD is a condition in which a waxy substance called plaque builds up inside of the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Eventually, an area of plaque can rupture inside of an artery. This causes a blood clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

CORONARY ARTERY SPASM

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren’t affected by atherosclerosis.

What causes a coronary artery to spasm isn’t always clear.

A SPASM MAY BE RELATED TO:

• Taking certain drugs, such as cocaine
• Emotional stress or pain
• Exposure to extreme cold
• Cigarette smoking

Symptoms

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies.

The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they’ve had a heart attack. If you’ve already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts:

• Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours.
• People who have high blood sugar may have no symptoms or very mild ones.
• The most common symptom, in both men and women, is chest pain or discomfort.
• Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw.

Some people don’t have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks.

MOST COMMON SYMPTOMS

The most common warning symptoms of a heart attack for both men and women are:

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe.
• Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach.
• Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they’re active. Angina pain usually lasts for only a few minutes and goes away with rest.

Chest pain or discomfort that doesn’t go away or changes from its usual pattern can be a sign of a heart attack. All chest pain should be checked by a doctor.

PAY ATTENTION TO THESE OTHER POSSIBLE SYMPTOMS OF A HEART ATTACK:

• Breaking out in a cold sweat
• Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
• Nausea (feeling sick to the stomach) and vomiting
• Light-headedness or sudden dizziness
• Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)

Not everyone having a heart attack has typical symptoms. If you’ve already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur.

The more signs and symptoms you have, the more likely it is that you’re having a heart attack.

Diagnosis

Your doctor will diagnose a heart attack based on your signs and symptoms, your medical and family histories, and test results.

EKG (ELECTROCARDIOGRAM)

An EKG is a simple, painless test that detects and records the heart’s electrical activity.It can show signs of heart damage due to coronary heart disease (CHD) and signs of a previous or current heart attack.

BLOOD TESTS

During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack.

CORONARY ANGIOGRAPHY

Coronary angiography is a test that uses dye and special x rays to show the insides of your coronary arteries. This test often is done during a heart attack to help find blockages in the coronary arteries.

Treatment

Early treatment for a heart attack can prevent or limit damage to the heart muscle. Acting fast, by calling 9–1–1 at the first symptoms of a heart attack, can save your life. Medical personnel can begin diagnosis and treatment even before you get to the hospital.

Certain treatments usually are started right away if a heart attack is suspected, even before the diagnosis is confirmed.

THESE INCLUDE:

• Aspirin to prevent further blood clotting
• Nitroglycerin to reduce your heart’s workload and improve blood flow through the coronary arteries
• Oxygen therapy
• Treatment for chest pain

Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments promptly to try to restore blood flow through the blood vessels supplying the heart. The two main treatments are clot-busting medicines and percutaneous coronary intervention, also known as coronary angioplasty, a procedure used to open blocked coronary arteries.

CLOT-BUSTING MEDICINES

Thrombolytic medicines, also called clot busters, are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible.

OTHER TREATMENTS FOR HEART ATTACK INCLUDE:

• Medicines
• Medical procedures
• Heart-healthy lifestyle changes
• Cardiac rehabilitation

HEART-HEALTHY LIFESTYLE CHANGES

Treatment for a heart attack usually includes making heart-healthy lifestyle changes. Your doctor also may recommend:

• Heart-healthy eating
• Maintaining a healthy weight
• Managing stress
• Physical activity
• Quitting smoking

Taking these steps can lower your chances of having another heart attack.

Recovery

Many people survive heart attacks and live active, full lives. If you get help quickly, treatment can limit damage to your heart muscle. Less heart damage improves your chances for a better quality of life after a heart attack.

MEDICAL FOLLOWUP

After a heart attack, you’ll need treatment for coronary heart disease (CHD). This will help prevent another heart attack. Your doctor may recommend:

• Lifestyle changes, such as following a healthy diet, being physically active, maintaining a healthy weight, and quitting smoking
• Medicines to control chest pain or discomfort, high blood cholesterol, high blood pressure, and your heart’s workload
• A cardiac rehabilitation program

RETURNING TO NORMAL ACTIVITIES

After a heart attack, most people who don’t have chest pain or discomfort or other problems can safely return to most of their normal activities within a few weeks. Most can begin walking right away.

Talk with your doctor about a safe schedule for returning to your normal routine.

RISK OF A REPEAT HEART ATTACK

Once you’ve had a heart attack, you’re at higher risk for another one. Knowing the difference between angina and a heart attack is important. Angina is chest pain that occurs in people who have CHD. The pain from angina usually occurs after physical exertion and goes away in a few minutes when you rest or take medicine as directed.

The pain from a heart attack usually is more severe 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.

The symptoms of a second heart attack may not be the same as those of a first heart attack. Don’t take a chance if you’re in doubt. Always call 9–1–1 right away if you or someone else has heart attack symptoms.