A heart attack, also known as myocardial infarction, or coronary thrombosis, is when part of the heart muscle dies because it has been starved of oxygen. A heart attack usually occurs when a blood clot forms in one of the coronary arteries (the blood vessels that lead to the heart muscle), blocking the blood supply to the heart. A blockage can also sometimes be caused by a spasm (sudden narrowing) of a coronary artery.
A heart attack often causes severe and crushing pain in the middle of the chest. This pain may then travel from the chest to the neck, jaw, ears, arms and wrists. The person may also be cold and clammy, and their skin may appear pale and grey in colour.
Heart attack symptoms
The common symptoms of a heart attack are:
- crushing central chest pain, or mild chest discomfort,
- shortness of breath,
- clammy, sweaty, and grey complexion,
- nausea and vomiting,
- a general feeling of being unwell, and
- a frightening sense that one is about to die.
The pain that you experience when having a heart attack often starts in your chest and then travels to your neck, jaw, ears, arms and wrists. Sometimes, it travels between the shoulder blades, back, or to the abdomen. The pain can last from five minutes to several hours. Moving around, changing your position, or resting, will not stop, or ease, the pain. The pain may be constant, or it may come and go, and feel like pressure, squeezing, or fullness.
Some people do not feel any pain during a heart attack. This is known as a ‘silent’ heart attack and tends to affect people with diabetes, or those who are over 75 years of age. Some evidence suggests that up to 20% of mild heart attacks go undiagnosed. This means that some people, because of previous undiagnosed attacks, may be suffering progressive damage to the heart muscle.
Heart attack symptoms in women
Heart attack symptoms in women can be similar to those in men, but they can also be different. Some common heart attack symptoms in women include:
- Chest pain or discomfort: This can feel like pressure, fullness, or a squeezing sensation in the center or left side of the chest.
- Shortness of breath: This can occur with or without chest pain.
- Nausea or vomiting: Some women may experience these symptoms instead of or in addition to chest pain.
- Pain or discomfort in other areas of the upper body: This can include the arms, neck, jaw, back, or stomach.
- Sweating: Some women may break out in a cold sweat during a heart attack.
- Fatigue: Feeling overly tired for no reason can be a symptom of a heart attack, especially in women.
- Lightheadedness or dizziness: Some women may feel faint or unsteady during a heart attack.
It’s important to note that not all women will experience these symptoms during a heart attack, and some women may experience very mild symptoms or none at all. If you suspect that you or someone you know is having a heart attack, seek medical attention immediately. The faster treatment is received, the better the outcome is likely to be.
Heart attack causes
The factors that increase the risk of a heart attack include:
- increasing age (men over 45 years of age, and women who are over 55 years of age),
- being overweight, or obese,
- high blood pressure,
- high blood cholesterol level,
- a diet high in saturated fats (animal fats),
- a family history of heart disease, and
- lack of regular exercise.
The risk of a heart attack is also increased if you have:
- angina (chest pain, or discomfort, caused by a lack of oxygen to your heart),
- had a previous heart attack, or
- had heart surgery.
Sometimes, angina can be mistaken for a heart attack because the signs are similar. However, unlike a heart attack, angina will usually disappear within 15-20 minutes of resting, and/or taking medication.
Diagnosing a heart attack
A heart attack is typically diagnosed based on a combination of clinical signs and symptoms, as well as the results of certain medical tests. Some of the common diagnostic tests for a heart attack include:
- Blood tests: Blood tests can measure the levels of certain biomarkers, such as troponin and creatine kinase, which are released into the bloodstream when heart muscle cells are damaged.
- Electrocardiogram (ECG): An ECG is a test that measures the electrical activity of the heart and can detect changes in the heart rhythm or evidence of a heart attack.
- Chest pain: Chest pain or discomfort is a common symptom of a heart attack and may be described as a pressure, fullness, or squeezing sensation.
- Echocardiogram: An echocardiogram is an ultrasound test that creates a moving picture of the heart and can show if the heart is pumping normally and if there is any damage to the heart muscle.
- Coronary angiogram: A coronary angiogram is a special X-ray test that uses dye and special cameras to show the blood flow in the coronary arteries and determine if any of them are blocked or narrowed.
It’s important to seek medical attention immediately if you suspect you may be having a heart attack. The faster you get treatment, the better your chances of recovering and minimizing damage to your heart muscle.
Treating a heart attack
Most heart attacks can be successfully treated if immediate medical help is provided. The sooner the treatment, the more effective it will be, and the greater the chance of survival.
Treatment during a heart attack
Cardio-pulmonary resuscitation (CPR)
If someone is not breathing, coughing, moving, or responding to stimulation (being touched or spoken to), immediate lifesaving treatment with cardio-pulmonary resuscitation (CPR) should be started. CPR consists of giving 30 chest compressions to massage the heart for every two mouth-to-mouth resuscitation breaths.
If your heart has stopped (cardiac arrest), the medical team at the scene, or in hospital, will try to restart it using a device called a defibrillator. This sends an electric shock across your chest to kick-start your heart. The heart rhythm may become temporarily irregular as it recovers, so this treatment is best given when the heart is being continuously monitored on an electrocardiograph (ECG) in an ambulance, or in hospital.
If you are having a heart attack, you will normally be given a one-off 300mg dose of aspirin. This helps to prevent the blood clot in your coronary artery from getting bigger. Ideally, it should be chewed, or taken dissolved in water, to ensure that it gets into your bloodstream as quickly as possible.
Also known as ‘clot-busters’, thrombolytics dissolve the clot in your coronary artery, allowing blood to flow back to the damaged heart muscle. Commonly prescribed thrombolytics include alteplase and streptokinase.
During a heart attack, thrombolytics are given by injection as soon as possible, ideally within one hour of symptoms starting. The part of the heart muscle starved of blood does not die immediately. If blood flow is restored within a few hours, much of the heart muscle that would have been damaged will survive.
Morphine is a strong type of painkilling medication. A dose of this medicine may be injected into your bloodstream to help ease pain and discomfort, and to reduce anxiety.
Treatment following a heart attack
Following a heart attack, you may need to take a number of different medicines. They will help to reduce the risk of a further heart attack occurring. You may need to take them indefinitely.
Anti-platelets help to reduce the ‘stickiness’ of platelets (tiny particles in blood that help it to clot). When a large number of platelets stick to an atheroma or plaque (fatty deposit) inside an artery, they can form a thrombosis (clot). If this happens in a coronary artery, it causes a heart attack.
Low dose aspirin is the preferred anti-platelet following a heart attack. You will normally be prescribed a 75mg dose to take once a day.
If you have a stomach ulcer, or asthma, you may not be able to take aspirin. Options if you have a stomach ulcer include taking an additional medicine to ‘protect the stomach’. And, options if you have asthma include taking a different anti-platelet medicine such as clopidogrel.
Beta-blockers (such as metoprolol, propranolol, timolol, and atenolol) help to protect the heart after a heart attack. They make the heart beat slower and with less force in order to lessen the work it has to do. Beta-blockers also stabilise the heart’s electrical activity.
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin-converting-enzyme inhibitors (ACE) inhibitors open up your blood vessels and lower blood pressure, which help to ease the burden on your heart. They also help to protect your heart from further damage. ACE inhibitors such as lisinopril, perindopril and ramipril are started at a low dose, which is slowly increased over a period of two to four weeks. Before you start taking an ACE inhibitor, you will normally have a blood test to check your kidneys are functioning normally. Seven to ten days after your first dose, your kidneys will be tested again. This is because ACE inhibitors can affect the kidneys of a small number of people who take them.
Statins help to lower your blood cholesterol level by preventing cholesterol from being made in your liver. Generally, the higher your blood cholesterol level, the greater your risk of developing plaques (fatty deposits) in your arteries. The aim is to reduce your total blood cholesterol level to less than 4mmol/l, or by 25% of the original blood level, whichever gives the greatest reduction. Commonly prescribed statins include atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin.
After having a heart attack, if your heart has been seriously damaged, you may require surgery to treat it. Two of the most common surgical procedures are outlined below.
Angioplasty is a type of surgery which opens up a coronary artery. It is usually carried out after you recover from your attack. However, in some specialist units, an angioplasty may be performed as an emergency treatment for people having a very serious heart attack.
A tiny wire with a sausage-shaped balloon at the end is put into a large artery in your groin, or arm. It is then passed through your blood vessels up to your heart and into the narrowed section of a coronary artery using X-ray guidance. The balloon is then inflated inside the narrowed part of the artery to widen it. A stent (a flexible metal mesh) is usually inserted into the artery to help keep it open.
Coronary artery bypass graft (CABG)
A coronary artery bypass graft (CABG) is a form of surgery which allows a blocked blood vessel to be bypassed with healthy blood vessel segments (grafts) taken from other parts of the body. Segments of vein from your legs, or chest, are used to create a new channel through which the blood can be directed past the blocked part of your artery. More blood can then get past into your heart muscle. However, not everyone with angina is suitable for this surgery as it depends on where the narrowed arteries are.
Recovering from a heart attack
Recovering from a heart attack requires time, patience, and a commitment to making lifestyle changes and following your healthcare provider’s recommendations. Here are some steps you can take to help ensure a successful recovery:
- Follow your medication regimen: Take all medications as prescribed and don’t stop taking them without first discussing it with your healthcare provider.
- Attend follow-up appointments: Regular check-ups with your healthcare provider are important to monitor your progress and make any necessary adjustments to your treatment plan.
- Make lifestyle changes: Quit smoking, eat a healthy diet, get regular physical activity, manage stress, and maintain a healthy weight to reduce the risk of future heart attacks and improve heart health.
- Take care of your mental health: Recovering from a heart attack can be emotionally challenging. It’s important to seek support from friends, family, and a mental health professional if needed.
- Participate in a cardiac rehabilitation program: Cardiac rehabilitation programs can help you regain strength, improve your overall fitness, and reduce the risk of future heart problems.
- Monitor for signs of recurrent heart attack: Pay attention to any chest pain or discomfort, shortness of breath, or other symptoms that may indicate another heart attack is occurring and seek medical attention immediately.
It’s important to be patient and realistic about the recovery process. The amount of time it takes to recover from a heart attack can vary, and some people may experience lingering symptoms even after treatment. However, with proper care and lifestyle changes, many people are able to fully recover and live a healthy, active life after a heart attack.
Complications of a heart attack
Immediate complications of a heart attack can include those outlined below.
- Arrhythmias – these are irregular, uneven heart rhythms (either very fast or slow). If necessary, these can be corrected by passing an electric current through the heart (cardioversion). However, in most cases, your heart rate will return to normal, either naturally or with the help of medication.
- Cardiogenic shock – is when you experience a sudden and dangerous drop in your blood pressure. Your heart is unable to supply enough blood for your body to function properly.
- Hypoxaemia – is low levels of oxygen in your blood.
- Pulmonary oedema – is when fluid builds up in and around your lungs.
- Deep vein thrombosis (DVT) – this occurs when a blood clots forms in the deep veins of your legs, or pelvis. It either blocks, or interrupts, the flow of blood in your vein.
- Myocardial rupture – occurs when your heart wall is damaged by a heart attack. It can sometimes cause the heart wall to rupture.
- Ventricular aneurysm – this is when you develop a bulge in one of the heart ventricles (chambers).
Later complications of a heart attack can include those outlined below.
- Aneurysm (blow out) – caused by build up of scar tissue on the damaged heart wall. An aneurysm can result in abnormal heart rhythms, blood clots, and low blood pressure.
- Pericarditis – this condition causes inflammation of the lining of your heart. This can happen days or months after the heart attack, and can cause significant chest pain.
- Angina – this condition can cause similar symptoms to a heart attack. The most notable symptom is chest pain. However, unlike a heart attack, the chest pain from angina should disappear naturally, usually after about ten minutes. It is caused by a shortage of oxygen to the heart.
- Congestive heart failure – is when your heart is only able to beat very weakly which often leaves you with a feeling of breathlessness.
- Oedema – is when fluid builds up in your ankles and legs.
- Depression and loss of confidence.
- Loss of sex drive and erectile dysfunction – although having sex after a heart attack will not increase your risk of having another attack, many men find it difficult to think about having sex again. If you have erectile dysfunction, it means that you have difficulty in getting, or maintaining, an erection.
- Increased risk of heart attack in the future.
When you have a heart attack, your health will be closely monitored for several months afterwards. This is so that your doctor or healthcare provider can minimise the risk of you developing any of the complications which are described above. If you attend your regular check-ups, and follow your rehabilitation programme, your risk of experiencing complications will be greatly reduced. Early diagnosis and treatment of a complication will also help minimise the risk of permanent damage to your body.
Preventing a heart attack
Preventing a heart attack is an important goal, as heart disease is a leading cause of death worldwide. Here are some steps you can take to reduce your risk of having a heart attack:
- Quit smoking: Smoking is a major risk factor for heart disease, and quitting can significantly reduce your risk.
- Eat a healthy diet: A diet rich in fruits, vegetables, whole grains, and lean protein can help lower your risk of heart disease.
- Get regular physical activity: Aim to get at least 30 minutes of moderate-intensity physical activity most days of the week.
- Manage stress: Chronic stress can increase the risk of heart disease, so finding healthy ways to manage stress is important.
- Maintain a healthy weight: Excess weight, especially around the waist, increases the risk of heart disease.
- Limit alcohol intake: Heavy alcohol use can increase the risk of heart disease.
- Control other risk factors: High blood pressure, high cholesterol, and diabetes are all risk factors for heart disease that can be managed with medication and lifestyle changes.
- Get regular check-ups: Regular check-ups with your healthcare provider can help identify and manage any risk factors for heart disease.
It’s never too early or too late to start making changes to reduce your risk of heart disease. By making healthy lifestyle choices and working with your doctor or healthcare provider, you can take control of your heart health and reduce your risk of having a heart attack.
What does a heart attack feel like?
A heart attack can feel differently from person to person, and not all heart attacks have the same symptoms. The following are common signs and symptoms of a heart attack:
- Chest pain or discomfort: This can feel like pressure, fullness, or a squeezing sensation in the center or left side of the chest. The pain may last for a few minutes or come and go.
- Pain or discomfort in other areas of the body: This can include the arms, back, neck, jaw, or stomach.
- Shortness of breath: This can occur with or without chest pain.
- Breaking out in a cold sweat: Some people may sweat profusely during a heart attack.
- Nausea or vomiting: Some people may experience these symptoms instead of or in addition to chest pain.
- Lightheadedness or dizziness: Some people may feel faint or unsteady during a heart attack.
- Unusual fatigue: Feeling overly tired for no reason can be a symptom of a heart attack.
It’s important to note that not all heart attacks have the same symptoms, and some people may experience very mild symptoms or none at all. If you suspect that you or someone you know is having a heart attack, seek medical attention immediately.