Let's Talk About Heart Attack
We've got all the doctor-approved details on how to prevent, recognize, and treat a heart attack.by Matt McMillen Health Writer
You’ve watched a heart attack happen in films and on TV enough times to know how they’re scary—but Hollywood’s “reel” life does not always reflect real life. It’s not just a man clutching at his chest in agony before collapsing to the ground. In fact, one in five heart attacks occur without ANY symptoms at all, meaning you could be having a heart attack and not even know it. Fortunately, treatment for heart attack has improved greatly, and your odds of not only surviving but thriving after having one have also increased. Even better? There is a great deal you can do to prevent having one in the first place. We’ve got all the info you need.
Our Pro Panel
We went to some of the nation’s top experts in heart attack to bring you the most up-to-date information possible.
Michael Goyfman M.D., MPH
Director of Clinical Cardiology
Long Island Jewish Forest Hills
Guy Mintz, M.D.
Director of Cardiovascular Health & Lipidology
Sandra Atlas Bass Heart Hospital
David Friedman, M.D.
Director of Heart Failure Services
Northwell Health’s LIJ Valley Stream
Long Island, NY
Heart muscle can undergo what is known as "positive remodeling," and the heart can often resume normal function—but *only *if blood flow is quickly restored and the right medications are taken as prescribed.
You will have to redefine what normal means to you. Caring for your heart often means making significant lifestyle changes, which will likely include a more nutritious diet and regular exercise. It may not be the life you’ve been accustomed to—but’s it’s life! You’re still here. And that’s what counts.
As many as one in three heart attack survivors develop depression. Anxiety is also common. Both can make recovery more difficult, so be sure to discuss your feelings with your doctor. Treatment for psychological issues can help improve how well you manage your heart health treatment plan.
First, know your risk factors, such as high blood pressure and high cholesterol levels. Then, evaluate your lifestyle. Do you get plenty of exercise and eat well? That’s good! Do you smoke? Not so good. Your heart health depends on the choices you make throughout your life, so begin taking care of your ticker as early as possible, while knowing your heart will benefit no matter when you start.
What Is a Heart Attack, Anyway?
Heart attacks are quite common. They occur when arteries that lead to and from the heart become blocked. They can no longer deliver sufficient blood, starving the heart of oxygen. Heart attacks can be fatal if not treated quickly, as the lack of oxygen kills heart tissue. (Don't stress yet, there's a lot doctors can do to make sure that doesn't happen.)
The CDC estimates that a heart attack occurs approximately every 40 seconds in the U.S. All told, that’s about 805,000 heart attacks a year. Formally known as myocardial infarction, heart attack is a form of heart disease, and though they can be fatal, most are not. These days, nine out ten people who have a heart attack survive. But what’s happening in the body during one? It comes down to blood flow in and out of your heart:
Your heart pumps blood to every cell in your body via a system of veins, arteries, and capillaries, collectively known as your blood vessels.
This blood provides oxygen and other essential nutrients, without which your body could not function.
Your heart also needs its own steady supply of oxygen-rich blood, and it has its own network of coronary arteries to provide it.
Types of Heart Attacks
Technically, a heart attack is a single type of event—one that damages the heart muscle—but there are three different ways to cause that damage. The two most common have to do with blockages that lead to the heart, and the third interferes with blood flow in a different way. They are:
STEMI, or ST-elevation myocardial infarction: This is a heart attack caused by a critical, if not always complete, obstruction, usually in a single coronary artery known as the "culprit vessel."
NSTEMI, or non-ST-elevation myocardial infarction: This is a heart attack caused by a critical obstruction in one or more coronary vessels. In this kind of heart attack, more vessels are likely to be involved but less heart muscle may be at risk (compared to a STEMI), because people with NSTEMI often have had time to develop what is known as "collateral circulation" that goes around blockages to supply the heart muscle in spite of obstructions in the main coronary vessels.
Coronary artery spasms: This is when your arteries spasm and dangerously narrow, causing a partial or complete blockage of the heart’s blood supply, which leads to heart attack. It’s not common, but it does sometimes happen.
What Causes a Heart Attack?
Most heart attacks occur as a result of coronary artery disease (CAD). When you have CAD, one or more of your heart’s arteries hardens and narrows as a dangerous, but slowly moving, buildup of fatty deposits called plaque accumulates on the artery walls.
Over time, this process, known as atherosclerosis, progressively restricts the flow of blood to the heart. Initially, this causes angina—the fancy word for chest pain—as the heart’s supply of oxygen gradually diminishes.
Plaque buildup is mainly comprised of cholesterol, calcium, and fat, and other substances collect around it. If plaque buildup grows to the point that the supply of oxygen is blocked and no longer meets the heart’s demand, a heart attack may occur.
More commonly, though, heart attacks happen when one of the plaque buildups suddenly ruptures, or breaks apart. Your body’s emergency response system kicks in and forms a protective blood clot around the damaged spot. Unfortunately, this clot may result in an even bigger roadblock in your arteries, significantly or sometimes completely shutting down the flow of blood to your heart. The result? You guessed it: a heart attack.
Less commonly, the coronary artery spasms. When this occurs, an artery narrows to a dangerous degree. That partially or completely cuts off your heart’s blood supply, causing chest pain. Spasms are often short-lived, lasting less than 15 minutes, and are not usually life-threatening. However, a severe, prolonged spasm can cause a heart attack if the artery remains narrowed long enough to damage the heart. Or, in some cases, a spasm may rupture a plaque buildup, which in turn triggers a heart attack.
What Are the Risk Factors for a Heart Attack?
But what produces the plaque buildup in the first place? According to the American Heart Association, damage to the inner lining of your arteries may be the trigger. The likely causes of that damage include some familiar suspects, such as:
Smoking: It boosts blood pressure, contributes to plaque buildup, and increases your risk of blood clots.
High blood pressure (HBP): It stresses your arteries’ delicate tissue, which leads to damage and contributes to the start of plaque buildup.
High cholesterol: This, too, contributes to plaque buildups. You have two types of cholesterol. The first, called low-density lipoprotein cholesterol (LDL), or "bad" cholesterol, is responsible for those buildups. The second, called high-density lipoprotein (HDL), or "good" cholesterol, helps rid your body of LDL. When you have high cholesterol, you have too much LDL and too little HDL.
High triglycerides: These are a type of fat found in your bloodstream, and are linked to heart attack risk because they may help harden and stiffen your arteries.
Obesity, particularly belly fat: Obesity raises blood pressure and inflammation, both potential triggers of plaque buildup, while an oversized waist indicates excessive visceral fat, which has been linked to high cholesterol.
High blood sugar: This damages your blood vessels as well as the nerves that control your heart and blood vessels.
While these risk factors can be tied to lifestyle choices that you can modify, some heart attack risks can’t be altered. They include:
Age: As you get older, your arteries begin to stiffen. That, in turn, increases your risk of HBP, and it puts adults 65 and over at much higher risk of heart attack than younger people.
Genetics and family history: If one or both of your parents had a heart attack at an early age (dad before 55, mom before 65), that bumps up your risk. According to Harvard Medical School, your risk of heart attack triples if both parents had one at age 50 or older, and it's seven times higher if their heart attacks occurred before age 50. Also, households often share the same habits and environments, which can include poor diet, lack of exercise, and smoking. Even if you didn’t smoke yourself, growing up around smokers exposes you to secondhand smoke.
Some chronic diseases also up your odds of having a heart attack, including:
Type 2 diabetes: Elevated blood sugar levels will damage your arteries over time. People with this condition often have other heart attack risk factors such as high blood pressure and obesity.
Inflammatory diseases: These include chronic conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, and lupus, because inflammation common to all these diseases contributes to plaque buildups in your arteries.
Sleep apnea: This disorder, where your breathing repeatedly stops and starts throughout the night while you are sleeping, raises your blood pressure and puts strain on your heart.
What Are the Symptoms of a Heart Attack?
Heart attacks can have a wide variety of symptoms—and sometimes they have none at all. They can come on suddenly, or they can develop over a period of hours, days, or even weeks. And some symptoms may not seem like they’d be related to heart attack, which makes it all the more important to understand your risk factors and the symptoms to be on the alert for. Still, if you think you might be experiencing any of the symptoms listed below, don’t hesitate—call 911. It just might save your life.
Let’s take a look at some of the ways your body may tell you there’s a problem:
Chest pain, pressure, squeezing (also referred to as angina): It may feel like an elephant is sitting down on your chest, but it can also be much milder and resemble symptoms of heartburn. It can also come and go. Women are less likely than men to have chest pain, but it’s still the most common symptom for both. Do not ignore it. But remember: You can have a heart attack without chest pain. This occurs in close to half of all people.
Shortness of breath: This can occur whether or not you have chest pain. It may come on suddenly, even though you haven’t exerted yourself, and worsen over time.
Pain or discomfort in your upper body: The pain you experience may have originated in your heart, but your nerve pathways leading from your heart may cause you to feel that pain (which is not sharp but rather gives off a sensation of heaviness or numbness) in other parts of your body, including your arms, back, neck, jaw, and stomach. Back and jaw pain occur more often in women, according to the American Heart Association.
Nausea and vomiting: When a heart attack happens, you might feel queasy. The feeling can be constant or come and go, and while its causes are not fully understood, it’s thought to be triggered by the stimulation of your vagus nerve and/or other nearby nerves which can upset your stomach.
Fatigue: This is not your typical ‘I’m worn out from a long day’ fatigue. This is feeling excessively tired or run down after your normal routine. It can come on suddenly. But not always. About two out of three people will experience fatigue for days or even weeks prior to having a heart attack.
Lightheadedness or dizziness: Feeling whoozy, like you might faint, is likely the result of a drop in blood pressure from heart damage, which causes the heart to pump less efficiently. Decreased blood flow also affects the brain.
Cold sweats: The sudden, drenching sweats that can accompany a heart attack may be part of your nervous system’s response to your chest pain, or to a sudden spike in blood pressure.
Heart Attacks Can Also Be Silent
A silent heart attack can mean one of two things:
Your heart attack had no symptoms.
Or, the symptoms were so mild or non-specific that they were easy to write off as a strained chest muscle, the flu, or a case of indigestion. Often, they are not diagnosed until you visit your doctor for a routine checkup, or if you see your doctor because of symptoms you likely didn’t realize were heart-related, such as fatigue, heartburn, and shortness of breath.
But make no mistake: Silent heart attacks are just as dangerous as any other type, potentially causing permanent damage. They comprise up to 45% of all heart attacks, according to estimates from the The American Heart Association (AHA), which also reports that women may be more likely than men to have a silent heart attack, which may explain why their symptoms can be misunderstood and often misdiagnosed, even by trained emergency room staff. Patients with diabetes are also more likely to have a silent heart attack.
There are no hard and fast rules that cover what symptoms you will experience. That makes it extra important to discuss any risk factors you may have with your doctor. Know the warning signs—and take even vague symptoms seriously. Remember, don’t waste time trying to diagnose yourself. If you’re not sure what’s causing your symptoms, play it safe. Call 911.
How Do Doctors Diagnose a Heart Attack?
Diagnosing a heart attack may require several tests. Some of them do not require invasive procedures, while others do. But first, the basics. Your doctor will review your symptoms, check your blood pressure, pulse, and temperature, as well as learn your health history and identify any heart disease risk factors you may have, including smoking, diabetes, poor diet, lack of exercise, and stress.
Typical tests include:
Electrocardiogram (ECG or EKG): The first test you’ll receive, an ECG, measures your heart’s electrical activity and displays it in the form of wave-like patterns either on a computer monitor or on a paper printout. If you’ve had a heart attack—or are still having one—the waves will show that your heart no longer conducts electricity normally, a sign of injury.
Blood tests: Your doctor will draw blood to help diagnose what’s happening. The test most likely to be used first detects the presence of a protein call troponin. Your heart releases this into your bloodstream only when it has been damaged, and its presence will help confirm that you’ve had a heart attack. The more troponin there is, the larger your heart attack. If your doctor strongly suspects a heart attack, you’ll likely be moved to treatment before the blood test results return.
Coronary angiography: During this invasive test, done while you are awake, your doctor will perform a cardiac catheterization, threading a very thin and flexible tube called a catheter through one of the blood vessels in your groin until it reaches the blockage in your artery. Once in place, dyes and X-rays allow your doctor to see the blockage and observe blood flow.
What Are the Treatments for a Heart Attack?
Your doctor’s first goal when you have a heart attack: improve the flow of oxygen-rich blood to your heart. The sooner treatment begins, the less damage to your heart and the greater the likelihood you’ll survive.
Treatment will depend in part on the type of heart attack. If you don’t have a total blockage of your artery, meaning that some blood can still flow to your heart, medications may be all that you require. Total blockages, on the other hand, will require more drastic, invasive interventions to get blood flowing to your ticker once again.
Heart Attack Medications
The following types of drugs will be in your doctor’s arsenal:
Anti-platelet drugs: This type of medication, which includes aspirin, helps prevent more blood clots from forming.
Anti-coagulants: Often called blood thinners, these medications are used to slow the development of clots, but they increase the risk of bleeding.
Nitroglycerin: This medication helps ease your heart’s workload by increasing blood flow and reducing chest pain.
Beta blockers: These slow your heart rate, reducing your heart’s need for oxygen while easing the pressure in your arteries.
Clot busters (thrombolytics): These drugs target the clot that’s blocking blood flow and causing your heart attack. Treatment with these intravenous drugs typically lasts about an hour during a heart attack.
Pain relievers: Your doctor may give you a drug like morphine to ease your chest pain (angina).
ACE inhibitors: This type of drug brings down your blood pressure to ease the stress on your heart.
Statins and non-statins: Statins are used to control cholesterol. But statins don’t work well enough for everyone, or they can cause side effects you might not be able to tolerate, such as muscle pain, mental fogginess, and digestive disturbances. If that happens, your doctor likely will prescribe another type of cholesterol-lowering drug, such as a bile acid-binding resin.
You may also receive:
Oxygen therapy: If your blood oxygen levels have dipped below 90% due to your heart attack, you will likely receive supplemental oxygen via a mask placed over your face. Normal oxygen levels range from 95% to 100%.
Surgeries for a Heart Attack
If you have a severe or critical blockage in your artery, you may require a stent or surgery to restore blood flow. These procedures include:
Coronary angioplasty and stenting: This procedure is frequently performed immediately following a cardiac catheterization. Once the catheter reaches the location of the blockage, the cardiologist inflates a tiny balloon at its end to open the blood vessel and restore blood flow. At the same time, a metal mesh tube called a stent is implanted at this point. It is used to keep your artery open.
Coronary artery bypass surgery: During this surgery, the surgeon takes part of a healthy blood vessel from another part of your body, such as your lower leg. The surgeon then attaches that blood vessel to points on the blocked artery before and beyond the blockage, allowing the flow of blood to bypass the obstruction. This is usually a planned procedure, but it is sometimes performed during a heart attack or shortly after. It will depend on where your artery blockages occur, and how many blockages there are.
What’s Life Like After a Heart Attack?
Your number-one priority is to improve your heart health and prevent another heart attack from happening. That means making some important lifestyle changes to reduce your risk from having another one. Follow your cardiologist’s recommendation and enroll in a cardiac rehabilitation program—many hospitals offer them.
Cardiac rehab programs involve health professionals from many different specialties, including cardiologists, nutritionists, and exercise physiologists. Over 12 weeks, you’ll learn how to live a healthier life through:
Better adherence to your prescription drug plan
Help with quitting smoking, if necessary
No doubt about it: Having a heart attack is extremely scary. Your world will change after you experience one. It has to! You’ll need to recover, yes, but you’ll also likely have to make some big changes to how you live your life. That can feel overwhelming and even increase your risk of depression. That’s why doctors strongly recommend patients begin their new post-HA lives by entering a cardiac rehab program.
Cardiac rehab works. According to the American Heart Association, people who complete such programs are nearly 50% more likely to live longer than those who don’t because they learn the skills and information needed to get—and stay—healthy while managing heart disease. And that means healthy in mind as well as body. Addressing the stress, anxiety, and depression that often follow a heart attack and make recovery more difficult will be a key part of your treatment plan.
Talk to your doctor about the symptoms to watch out for. Do you no longer stick to your regular routine? Have you become more withdrawn than is normal for you? Both may be signs of depression. Talk to your doctor, who can recommend the best cardiac rehab program that is closest to you.
Heart Attack (1.): CDC. (2019). “Heart Attack Facts.” cdc.gov/heartdisease/facts.htm
Heart Attack (2.): Mayo Clinic. (2018). “Heart attack.” mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106
Heart Attack (3.): American Heart Association. (2016). “About Heart Attack.” heart.org/en/health-topics/heart-attack/about-heart-attacks
Heart Attack Causes (1.): Mount Sinai Health System. (n.d.). “Heart attack and acute coronary syndrome.” mountsinai.org/health-library/report/heart-attack-and-acute-coronary-syndrome
Heart Attack Causes (2.): American Heart Association. (2016). “Understand Your Risks to Prevent a Heart Attack.”
Heart Attack Causes (3.): American Heart Association. (2017). “Atherosclerosis.” heart.org/en/health-topics/cholesterol/about-cholesterol/atherosclerosis
Heart Attack Types (1.): Seconds Count. (n.d.). “Types of Heart Attacks.” secondscount.org/heart-condition-centers/info-detail-2/types-of-heart-attacks#.XnJXB6ipGUk
Heart Attack Types (2.): StatPearls. (2019). “Non ST Segment Elevation (NSTEMI) Myocardial Infarction.” ncbi.nlm.nih.gov/books/NBK513228/
Heart Attack Types (3.): StatPearls. (2019). “Acute Myocardial Infarction ST Elevation (STEMI).” ncbi.nlm.nih.gov/books/NBK532281
Heart Attack Prevention: Mayo Clinic. (2019.) “Strategies to prevent heart disease.” mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease-prevention/art-20046502
Heart Attacks in Women (1.): American Heart Association. (2015.) “Heart Attack Symptoms in Women.” heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women
Heart Attacks in Women (2.): American Heart Association. (n.d.). “What is a Silent Heart Attack?” goredforwomen.org/en/about-heart-disease-in-women/facts/silent-heart-attack-symptoms-risks
Heart Attack Treatment: American Heart Association. “Treatment of a Heart Attack.” heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack