A heart attack is the death of a segment of heart muscle caused by a loss of blood supply. A heart attack occurs when the flow of blood to the heart is blocked. The blockage is most often a buildup of fat, cholesterol and other substances, which form a plaque in the arteries that feed the heart (coronary arteries).
Sometimes, a plaque can rupture and form a clot that blocks blood flow. The interrupted blood flow can damage or destroy part of the heart muscle.
A heart attack, also called a myocardial infarction, can be fatal, but treatment has improved dramatically over the years.
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There are clear symptoms of a heart attack that require immediate medical attention.
A feeling of pressure, tightness, pain, squeezing, or aching in the chest or arms that spreads to the neck, jaw, or back can be a sign that a person is having a heart attack.
The following are other possible signs and symptoms of a heart attack occurring:
. Crushing chest pain
. Shortness of breath called dyspnea
. Face seeming gray in color
. A feeling of terror that life is ending
. Feeling awful, generally
. Feeling clammy and sweaty
. Shortness of breath
Changing position does not alleviate the pain of a heart attack. The pain a person feels is normally constant, although it may sometimes come and go.
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As heart attacks can be fatal, it is vital to recognize the warning signs that an attack is occurring.
While the symptoms listed above are all linked to heart attacks, there are four warning signs listed by the American Heart Association (AHA) as being crucial signs of an attack. These include:
. Discomfort, pressure, squeezing, or fullness in the chest that lasts several minutes or resolves then returns
. Pain or discomfort in the arms, neck, back, stomach, or jaw
. Sudden shortness of breath
Other signs can include a cold sweat, a sick or nauseous feeling, or being lightheaded.
When a person has these symptoms, the emergency services should be called immediately.
Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack.
If you're in an emergency setting for symptoms of a heart attack, you'll be asked about your symptoms and have your blood pressure, pulse and temperature checked. You'll be connected to a heart monitor and have tests to see if you're having a heart attack.
Tests to diagnose a heart attack include:
. Electrocardiogram (ECG). This first test done to diagnose a heart attack records electrical signals as they travel through your heart. Sticky patches (electrodes) are attached to your chest and limbs. Signals are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
. Blood tests. Certain heart proteins slowly leak into your blood after heart damage from a heart attack. Emergency room doctors will take samples of your blood to check for these proteins, or enzymes.
If you've had or are having a heart attack, doctors will take immediate steps to treat your condition. You might also have these additional tests.
. Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for fluid in your lungs.
. Echocardiogram. Sound waves (ultrasound) create images of the moving heart. Your doctor can use this test to see how your heart's chambers and valves are pumping blood through your heart. An echocardiogram can help identify whether an area of your heart has been damaged.
. Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on X-ray, revealing areas of blockage.
. Cardiac CT or MRI. These tests create images of your heart and chest. Cardiac CT scans use X-rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. For both tests, you lie on a table that slides inside a long tubelike machine. Each can be used to diagnose heart problems, including the extent of damage from heart attacks.
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A heart attack occurs when one or more of your coronary arteries becomes blocked. Over time, a buildup of fatty deposits, including cholesterol, form substances called plaques, which can narrow the arteries (atherosclerosis). This condition, called coronary artery disease, causes most heart attacks.
During a heart attack, a plaque can rupture and spill cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture. If the clot is large, it can block blood flow through the coronary artery, starving the heart of oxygen and nutrients (ischemia).
You might have a complete or partial blockage of the coronary artery.
. A complete blockage means you've had an ST elevation myocardial infarction (STEMI).
. A partial blockage means you've had a non-ST elevation myocardial infarction (NSTEMI).
Diagnosis and treatment might be different depending on which type you've had.
Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Using tobacco and illicit drugs, such as cocaine, can cause a life-threatening spasm.
Infection with COVID-19 also may damage your heart in ways that result in a heart attack.
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Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body. You can improve or eliminate many of these risk factors to reduce your chances of having a first or another heart attack.
Heart attack risk factors include:
. Age. Men age 45 or older and women age 55 or older are more likely to have a heart attack than are younger men and women.
. Tobacco. This includes smoking and long-term exposure to secondhand smoke.
. High blood pressure. Over time, high blood pressure can damage arteries that lead to your heart. High blood pressure that occurs with other conditions, such as obesity, high cholesterol or diabetes, increases your risk even more.
. High blood cholesterol or triglyceride levels. A high level of low-density lipoprotein (LDL) cholesterol ("bad" cholesterol) is most likely to narrow arteries. A high level of triglycerides, a type of blood fat related to your diet, also increases your risk of a heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol ("good" cholesterol) may lower your risk.
. Obesity. Obesity is linked with high blood cholesterol levels, high triglyceride levels, high blood pressure and diabetes. Losing just 10% of your body weight can lower this risk.
. Diabetes. Not producing enough of a hormone secreted by your pancreas (insulin) or not responding to insulin properly causes your body's blood sugar levels to rise, increasing your risk of a heart attack.
. Metabolic syndrome. This syndrome occurs when you have obesity, high blood pressure and high blood sugar. Having metabolic syndrome makes you twice as likely to develop heart disease than if you don't have it.
. Family history of heart attacks. If your siblings, parents or grandparents have had early heart attacks (by age 55 for males and by age 65 for females), you might be at increased risk.
. Lack of physical activity. Being inactive contributes to high blood cholesterol levels and obesity. People who exercise regularly have better heart health, including lower blood pressure.
. Stress. You might respond to stress in ways that can increase your risk of a heart attack.
. Illicit drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.
. A history of preeclampsia. This condition causes high blood pressure during pregnancy and increases the lifetime risk of heart disease.
. An autoimmune condition. Having a condition such as rheumatoid arthritis or lupus can increase your risk of a heart attack.
There are two types of complications that can happen following heart attack. The first occurs pretty much straightaway and the second happens later on.
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. Arrhythmias: the heart beats irregularly, either too fast or too slowly.
. Cardiogenic shock: a person’s blood pressure drops suddenly and the heart cannot supply enough blood for the body to work adequately.
. Hypoxemia: levels of oxygen in the blood become too low.
. Pulmonary edema: fluid accumulates in and around the lungs.
. DVT or deep vein thrombosis: the deep veins of the legs and pelvis develop blood clots that either block or interrupt the flow of blood in the vein.
. Myocardial rupture: the heart attack damages the wall of the heart, meaning an increased risk of a heart wall rupture.
. Ventricular aneurysm: a heart chamber, known as a ventricle, forms a bulge.
Complications that can occur later
. Aneurysm: scar tissue builds up on the damaged heart wall, leading to blood clots, low blood pressure, and abnormal heart rhythms.
. Angina: not enough oxygen reaches the heart, causing chest pain.
. Congestive heart failure: the heart can only beat very weakly, leaving a person feeling exhausted and breathless.
. Edema: fluid accumulates in the ankles and legs, causing them to swell.
. Loss of erectile function: erectile dysfunction is generally caused by a vascular problem. However, it can also be the result of depression.
. Loss of libido: a loss of sexual drive can happen, especially in the case of men.
. Pericarditis: the lining of the heart becomes inflamed, causing serious chest pain.
It is important that a doctor monitors a person for several months after they have had a heart attack to check for any of these complications that may occur.
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The best way of preventing a heart attack is to have a healthy lifestyle. Measures for healthy living include the following:
. Not smoking
. Eating a balanced, healthful diet
. Getting plenty of exercise
. Getting plenty of good quality sleep
. Keeping diabetes under control
. Keeping alcohol intake down
. Maintaining blood cholesterol at optimum levels
. Keeping blood pressure at a safe level
. Maintaining a healthy body weight
. Avoiding stress where possible
. Learning how to manage stress
It may be helpful for people to learn more about the warning signs of a heart attack, as well.
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Heart attack treatment at a hospital
Each minute after a heart attack, more heart tissue deteriorates or dies. Restoring blood flow quickly helps prevent heart damage.
Medications to treat a heart attack might include:
. Aspirin. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery.
. Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you'll survive and have less heart damage.
. Antiplatelet agents. Emergency room doctors may give you other drugs known as platelet aggregation inhibitors to help prevent new clots and keep existing clots from getting larger.
. Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less "sticky" and less likely to form clots. Heparin is given by IV or by an injection under your skin.
. Pain relievers. You might be given a pain reliever, such as morphine.
. Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels.
. Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks.
. ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart.
. Statins. These drugs help control your blood cholesterol.
Surgical and other procedures
In addition to medications, you might have one of these procedures to treat your heart attack:
. Coronary angioplasty and stenting. In this procedure, also known as percutaneous coronary intervention (PCI), doctors guide a long, thin tube (catheter) through an artery in your groin or wrist to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to find blockages.
The catheter has a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent almost always is inserted into the artery to keep it open long term, restoring blood flow to the heart. Usually, you get a stent coated with a slow-releasing medication to help keep your artery open.
. Coronary artery bypass surgery. In some cases, doctors perform emergency bypass surgery at the time of a heart attack. If possible, however, you might have bypass surgery after your heart has had time — about three to seven days — to recover from your heart attack.
Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section.
You'll likely remain in the hospital for several days after blood flow to your heart is restored and your condition is stable.
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Recovering from a heart attack can be a gradual process. It depends on the severity of the heart attack and other factors, such as a person’s age.
A person’s recovery may involve:
. Resuming physical activity: it is vital that a recovering heart attack patient stays active. However, a specialist should design any exercise program for them.
. Returning to work: the appropriate time for someone to go back to work depends on various factors, including the severity of the heart attack and the type of job they do. It is vital not to rush back to work.
. A period of depression: many people who have had a heart attack experience depression not long afterward. Those who feel depressed or anxious should tell their doctors.
. Driving again: experts advise that a person refrains from driving for at least 4 weeks after a heart attack.
. Erectile dysfunction: approximately one-third of men have problems getting or sustaining an erection after a heart attack.
It is important that men with erectile dysfunction talk to their doctors, as medication can restore function in most cases.
Experts say that sexual activity does not raise a person’s risk of having another heart attack.
Lifestyle and home remedies
To improve your heart health, take the following steps:
. Avoid smoking. The most important thing you can do to improve your heart's health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help.
. Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored.
. Get regular medical checkups. Some of the major risk factors for a heart attack — high blood cholesterol, high blood pressure and diabetes — cause no symptoms early on. Your doctor can test for these conditions and can help you manage them, if necessary.
. Exercise. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack. Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity.
. Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes.
. Eat a heart-healthy diet. Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, and fruits and vegetables and whole grains.
. Manage diabetes. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more-desirable levels. Many people also need medication to manage their diabetes.
. Control stress. Reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life.
. Avoid or limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.
Sex after a heart attack
Some people worry about having sex after a heart attack, but most people can safely return to sexual activity after recovery. When you can resume sexual activity will depend on your physical comfort, emotional readiness and previous sexual activity. Ask your doctor when it's safe to have sex.
Some heart medications can affect sexual function. If you're having problems with sexual dysfunction, talk to your doctor.
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