Heart Attack

A heart attack is also called a myocardial infarction (MI). It
happens when one or more parts of the heart muscle don’t get enough oxygen. That
occurs when blood flow to the heart muscle is blocked.

If the blood and oxygen supply is cut off, muscle cells of the
heart begin to suffer damage and start to die (infarct). Permanent) damage begins
within 30 minutes of blockage. The heart muscle may then no longer work as it
should.

A blockage in the coronary arteries that supply blood to the heart
muscle can lead to a heart attack. A blockage is caused by a buildup of plaque. This
is called atherosclerosis. Plaque is made up of deposits, cholesterol, and other
substances. When a plaque breaks (ruptures), a blood clot quickly forms. The blood
clot is the actual cause of the heart attack.

A heart attack can happen to anyone. But certain factors can raise
your risk for one. Some of these factors you can’t change. Others you may be able
to
manage through lifestyle changes and medical care.

You may be at higher risk for a heart attack if you:

  • Have high blood pressure
  • Have low levels of high-density lipoprotein (HDL)
    cholesterol, high levels of low-density lipoprotein (LDL) cholesterol, or high
    levels of triglycerides.
  • Have a family history of heart disease. This is especially
    true if the heart disease started before age 55.
  • Are older in age. Generally, men are at risk at a younger
    age than women. After menopause, women are equally at risk.
  • Have diabetes.
  • Smoke, including chewing tobacco and electronic cigarettes
    (vaping)
  • Are under a lot of stress
  • Drink too much alcohol or use illegal drugs
  • Are not active
  • Are overweight
  • Eat a diet high in saturated fat and low in fiber

Each person may have slightly different symptoms of a heart
attack. But these are the most common symptoms:

  • Severe pressure, fullness, squeezing, pain, or discomfort in
    the center of the chest that lasts for more than a few minutes
  • Pain or discomfort that spreads to the shoulders, neck,
    arms, or jaw
  • Chest pain that gets worse
  • Chest pain that doesn’t get better with rest or by taking
    nitroglycerin
  • Chest pain that happens along with any of these symptoms:
    • Sweating
    • Cool, clammy skin or paleness
    • Shortness of breath
    • Nausea or vomiting
    • Dizziness or fainting
    • Unexplained weakness or fatigue
    • Fast or irregular pulse

Chest pain is the key warning sign of a heart attack. But it may
be confused with other conditions. These include heartburn, pleurisy, and pneumonia.
Always see your healthcare provider for a diagnosis.

If you or someone you know has any of
the warning signs for a heart attack, act right away. Call 911 or your local
emergency number. Don’t drive yourself to the hospital or emergency department if
you think you are having a heart attack.

Diagnosing a heart attack often happens in an emergency
department. There, a healthcare provider will ask you about your health history and
do a physical exam. You may also need some tests, such as:

  • Electrocardiogram (ECG). This
    test checks the electrical activity of your heart. It can find signs of a heart
    attack.
  • Blood work. These tests can find
    certain proteins that the body may make during a heart attack.
  • Coronary angiography. During
    this test, a tiny plastic tube (catheter) is put into an artery in your groin or
    arm. It’s moved to the heart while monitored with fluoroscopy (video X-ray).
    X-ray dye (contrast medium) is then put into your coronary arteries. Special
    X-rays (angiograms) are then taken. They show how well blood is flowing through
    your heart and blood vessels. The test can find blockages in an artery.

The goal of treatment for a heart attack is to ease pain, restore
blood flow to the coronary artery, preserve the heart muscle function, and prevent
death. Treatment may include:

  • IV (intravenous) therapy.
    Medicines such as nitroglycerin and morphine are given through a tube into a
    vein.
  • Oxygen therapy. This treatment
    can give the damaged heart muscle more oxygen.
  • Pain medicines. These can
    decrease the workload and oxygen demand of the heart.
  • Cardiac medicine such as
    beta-blockers.
    These can help the heart muscle rest, prevent an
    irregular heartbeat and decrease heart rate and blood pressure.
  • Fibrinolytic therapy. Medicine
    is given by IV to dissolve the blood clot, restoring blood flow.
  • Antithrombin or antiplatelet therapy
    with aspirin or clopidogrel.
    This is used to prevent more blood
    clotting.
  • Medicines that lower cholesterol,
    particularly LDL cholesterol.
    These include medicines such as statins.
    Newer medicines called PCSK9-inhibitors are for people with inherited high
    cholesterol. Ask your healthcare provider if these medicines can help prevent a
    heart attack.

You may also need other procedures to restore blood flow to the
heart. These are described below.

Percutaneous coronary intervention (PCI) or coronary
angioplasty

This procedure opens up a blocked or narrowed coronary artery.
There are several ways to do so. After coronary angiography has found a
blockage, a new catheter with a small balloon at its tip may be inflated inside
the blocked artery to open the blocked area. Or the blocked area may be cut away
with a special device or vaporized with a laser. A tiny metal coil called a
stent is often expanded inside the artery. The stent remains in place to help
keep the artery open.

Coronary artery bypass graft (CABG)

This surgery is also called bypass surgery or CABG (pronounced
“cabbage”). It is often done in people who have chest pain (angina) and severe
coronary artery disease that can’t be treated with PCI. During the surgery, the
surgeon makes a bypass to let blood flow around the blockage. This is done by
grafting a piece of a vein from the aorta to the coronary artery beyond the
blocked part of the artery. The surgeon often takes veins from a leg. Arteries
from the chest or an arm may also be used to bypass blockages. These bypasses
last longer than vein grafts.

Possible complications of a heart attack include:

  • Damage to the heart or heart valves
  • Abnormal heart rhythms
  • Another heart attack
  • Heart failure because the heart doesn’t pump as well as it
    once did
  • Shock and other organ failure
  • Death

Talk with your healthcare provider about your risk for a heart
attack. You may be able to prevent a heart attack by:

  • Lowering the levels of your blood pressure, LDL cholesterol,
    and triglycerides, if needed
  • Not smoking
  • Lowering your stress levels
  • Not drinking too much alcohol
  • Being more physically active
  • Losing weight, if needed
  • Eating a healthy, low-fat diet
  • A heart attack happens when one or more areas of the heart
    muscle don’t get enough oxygen. This happens when blood flow to the heart muscle
    is blocked.
  • A blood clot is the actual cause of a heart attack. It can
    form when there is a blockage in the arteries from plaque buildup.
  • Having high blood pressure and a family history of heart
    disease can raise your risk for a heart attack.
  • Severe chest pain or discomfort is often a symptom of a
    heart attack. But you may also feel short of breath, nauseous, fatigued, or
    dizzy.
  • A coronary angiogram can find blockages in an artery.
  • Treatment includes medicines and procedures to restore blood
    flow to the heart.

Tips to help you get the most from a visit to your healthcare
provider:

  • Know the reason for your visit and what you want to
    happen.
  • Before your visit, write down questions you want
    answered.
  • Bring someone with you to help you ask questions and
    remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and
    any new medicines, treatments, or tests. Also write down any new instructions
    your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how
    it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the
    results could mean.
  • Know what to expect if you do not take the medicine or have
    the test or procedure.
  • If you have a follow-up appointment, write down the date,
    time, and purpose for that visit.
  • Know how you can contact your provider if you have
    questions.