Heart attack, also called myocardial infarction, is a leading killer of men and women in the United States. The good news is that treatments can save lives and help people live an active life after a heart attack. But getting care quickly is the key.

What Causes a Heart Attack?

During a heart attack, the heart’s blood supply is suddenly cut off. When this happens, the heart muscle doesn’t get enough oxygen-rich blood. In a short period of time, part of the heart can be damaged or die. That’s why immediate care is so important – it can spare your heart and save your life. If your heart has a lot of damage, it can be very weak.

Most often, heart attacks result from a buildup of plaque inside the coronary artery (atherosclerosis). When the plaque breaks away inside of the artery, a blood clot can form, blocking blood flow through a coronary artery. Less common causes of heart attacks include an intense spasm of the coronary artery that lasts a long time or a tear in the artery wall (called spontaneous coronary artery dissection). Both of these can reduce blood flow to the heart muscle.

Having a heart attack can be scary, and it’s often life-changing. For some people, it’s the scare they need to live a heart healthier life – making a conscious decision to eat better, exercise, manage other risk factors such as high cholesterol or blood pressure, and not smoke. For others, they may have lived for years unaware they were even at risk.

Heart attacks are linked to heart failure and possibly life-threatening problems with how the heart beats (arrhythmias).

Signs and symptoms may include:

• Chest pain or pressure or discomfort
• Discomfort or tingling in one or both arms, back, shoulder, neck or jaw
• Shortness of breath
• Cold sweat
• Unusual tiredness
• Heartburn-like feeling
• Nausea or vomiting
• Sudden dizziness
• Fainting

Remember, sudden, crushing chest pain or pressure or tightness aren’t the only signs of a heart attack. In one study, 1 in 3 three people who had a heart attack had no chest pain; they were more likely to be older, a female or diabetic.

When to Call 999

If you think you might be having a heart attack, don’t delay. Call 999 right away. Delaying treatment can lead to permanent heart damage – even death. An ambulance is the safest way to get to the hospital.

Women are more likely to delay seeking help for a number of reasons, including not wanting to bother others and being unsure about whether they are having a heart attack. It is always better to play it safe and call 911 right away and let the medical experts find out if you are having a heart attack.

Doctors can usually diagnose a heart attack based on a combination of:

• Your signs and symptoms
• Your medical history
• Electrocardiogram (ECG) that can detect and record the heart’s electrical activity and show signs of heart damage
• Blood tests that check the levels of certain proteins released into the bloodstream as heart muscle cells die; troponin tests tests are commonly used and may be repeated over a period of time.

In an emergency, when your health care team thinks a heart attack is likely, you may be started on:

• Oxygen therapy
• Aspirin and other antiplatelet agents to thin your blood and prevent further clotting
• Nitroglycerin to help improve blood flow through the heart’s arteries
• Pain relief medications like morphine to address any chest pain
• Anticoagulants to prevent further clotting
• Beta blockers to reduce workload on the heart by decreasing the heart rate and blood pressure

If your care team confirms you are having a heart attack, treatments usually include procedures, surgery, or medications, and lifestyle changes.

Procedures/Surgery

• Coronary angioplasty, also called a percutaneous coronary intervention, to open blocked arteries. In this procedure, a thin, flexible tube is threaded through a blood vessel, usually in the wrist or upper thigh, to the blocked artery. A stent is placed to open up the artery and restore blood flow. This is the best treatment of heart attacks and has the best outcomes when done within two hours.
• Heart bypass surgery to insert segments of arteries or veins around the obstruction and bypass the blockage and restore blood flow to the heart.
• Implantable device to protect against abnormal heart rhythms that could kill you or to make sure your heart rhythm is normal and stable. This therapy, if needed, is usually offered about one month after a heart attack.

Medications

• Clot-busting medications are usually given within hours of a heart attack to dissolve any blood clots blocking the artery. This is usually given in situations when angioplasty cannot be performed because there are delays getting the patient to a facility with a catheterization lab.
• Beta blockers can slow a rapid heart rate and lower your blood pressure.
• ACE inhibitors relax your blood vessels and reduce strain on your heart. They also lower blood pressure.
• Statins help reduce levels of low density lipoprotein (LDL), also called the “bad” cholesterol, in your blood. Lowering your LDL helps lower your risk of a heart attack.
• Aspirin and other antiplatelet agents may be prescribed.

Cardiac Rehabilitation

Cardiac rehabilitation is a medically supervised program to help people recover from a heart attack and live a heart healthier life.

Lifestyle Changes

Following a better diet, getting routine exercise, quitting smoking, and keeping up with health visits and advice are very important steps you can take to improve your health.

• Eat a heart-healthy, plant-rich diet
• Lose weight if you need to
• Be physically active – talk with your health care team about the best program for you
• Don’t smoke
• Limit alcohol
• Ask about cardiac rehabilitation
• Keep in check other conditions that make a heart attack more likely (high cholesterol, high blood pressure, poorly controlled diabetes)
• Reduce stress levels
• Keep up with health visits and pay attention to your body and how you feel. Talk to your care team about any issues or concerns with your medications.

1. You are at greater risk of having another one.

Talk with your health care team about what to look for – keep in mind a repeat heart attack may or may not feel the same as your first.

Also, some people have chest pain (angina) that is usually brought on by physical activity. Ask your care team how you can tell the difference between this and pain that might be related to a heart attack.

Call 999 if you think you are having a heart attack.

2. Follow your care plan.

It’s really important to keep up with your treatments – lifestyle changes and medications. There may also be things you should avoid – for example, certain medications, alcohol or foods. Also, know what your ideal weight is, as well as your blood pressure and cholesterol levels.

3. Say ‘yes’ to cardiac rehabilitation.

Cardiac rehab programs, which include health education and supervised exercise, can help you gain strength during your recovery. It’s also been shown to lower the risk of dying or going back to the hospital.

4. Ask for support.

Ask trusted friends and family to help you live a healthier life, come to health visits with you and be there as a source of comfort.

5. Have an emergency plan in place.

Keep a current list of your medications (names, prescriber, dosage and how often you take each), health care professionals with contact information, basic medical history and contact info of a close friend or relative.

If you suspect you are having a heart attack, aside from dialing 999, find out from your care team if there is anything you can take while you wait for emergency services to arrive (for example, chewing an aspirin, nitroglycerin pill or other medication).

If you’ve had a heart attack, there are several key questions that you should ask your health care team during your next visit. Below is a list of these questions to consider asking.

Print them out or write them down and bring them with you to your next health visit.

Tip: You might want to pick the top three or four questions that concern you the most so that you are sure to have enough time to discuss them.

• What caused my heart attack?
• Should I go to cardiac rehab?
• What activities can I do and what do I need to avoid? What about sexual activity? Driving? Travel?
• What can I do to lessen my risk of a heart attack?
• When and how should I use nitroglycerin?
• What medications do I need to take? What medications or prescription medications should I avoid?
• How long will I need to take medicine?
• If I need to take a common over-the-counter medicine from the drugstore to treat a cold or lessen pain, which ones are safest for me?
• What diet do I need to follow?
• What is my self-care plan?
• What should I do if I have chest pain, shortness of breath or feel like I’m going to pass out?