Heart attack (patient information)

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What is a heart attack?

A heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.

Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.

What are the symptoms of a heart attack?

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. The most common symptom of heart attack is chest pain or discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. It can be mild or severe. Heart attack pain can sometimes feel like indigestion or heartburn.
• Shortness of breath. Shortness of breath may often occur with or before chest discomfort.
• Discomfort in the upper body. Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
• Nausea, vomiting, dizziness, lightheadedness, sweating.

Not all heart attacks begin with a sudden, crushing pain that is often shown on TV or in the movies. The warning signs and symptoms of a heart attack aren’t the same for everyone. Many heart attacks start slowly as mild pain or discomfort. Some people don’t have symptoms at all (this is called a silent heart attack).

What are the causes of a heart attack?

Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.

Who is at risk for a heart attack?

Certain risk factors make it more likely that you will develop coronary artery disease (CAD) and have a heart attack. Some risk factors for heart attack can be controlled, while others can't.

Major risk factors for heart attack that you can control include:

• Smoking
• High blood pressure
• High blood cholesterol
• Overweight and obesity
• Physical inactivity
• Diabetes (high blood sugar)

Risk factors that you can't change include:

• Age. Risk increases for men older than 45 years and for women older than 55 years (or after menopause).
• Family history of early CAD. Your risk increases if your father or a brother was diagnosed with CAD before 55 years of age, or if your mother or a sister was diagnosed with CAD before 65 years of age.

Certain CAD risk factors tend to occur together. When they do, it’s called metabolic syndrome. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

How to know you have a heart attack?

The diagnosis of heart attack is based on your symptoms, your personal and family medical history, and the results of diagnostic tests.

Diagnostic tests

EKG (Electrocardiogram)

This test detects and records the electrical activity of the heart. Certain changes in the appearance of the electrical waves on an EKG are strong evidence of a heart attack. An EKG also can show if you’re having arrhythmias (abnormal heartbeats), which a heart attack (and other conditions) can cause. Blood Tests

During a heart attack, heart muscle cells die and burst open, letting certain proteins out in the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins in the bloodstream is evidence of a heart attack.

Commonly used blood tests include troponin tests, CK or CK–MB tests, and serum myoglobin tests. Blood tests are often repeated to check for changes over time.

Coronary Angiography

Coronary angiography is a special x-ray exam of the heart and blood vessels. It's often done during a heart attack to help pinpoint blockages in the coronary arteries.

The doctor passes a catheter (a thin, flexible tube) through an artery in your arm or groin (upper thigh) and threads it to your heart. This procedure—called cardiac catheterization—is part of coronary angiography.

A dye that can be seen on x ray is injected into the bloodstream through the tip of the catheter. The dye lets the doctor study the flow of blood through the heart and blood vessels.

Where to find medical care for heart attack

Directions to Hospitals Treating Heart Attack

What to expect (Outlook/Prognosis)

Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.

Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.