Count 40 seconds in your head. Someone in the United States has just had a heart attack. Now count another 40 seconds. There’s another heart attack. In total, approximately 805,000 Americans have a heart attack each year.
There are a lot of misconceptions about what having a heart attack looks and feels like. In the movies, it always involves someone clutching at their chest and falling to the floor in a dramatic and sudden way. But in reality it can be much more subtle, and symptoms may even last for days before you realize the severity.
What Is a Heart Attack?
Oxygen is what keeps our body’s tissues alive, and it’s what the heart needs in order to function properly. Oxygen is delivered to the different parts of our body via blood. When something prevents or blocks the flow of blood from bringing oxygen to the heart, the result is a heart attack, which is also called a myocardial infarction.
In simple terms, you have arteries which deliver blood all over your body, including to the heart muscle. Over time, those arteries can become clogged by a build-up of fat and cholesterol called plaque. As the artery gets clogged, the flow of blood can be impaired. One of these plaques can also rupture, causing an abrupt blockage of blood flow, and the resulting damage known as a heart attack.
There are two main types of heart attacks classified by the mechanism of damage to the heart:
- STEMI (ST-Elevation Myocardial Infarction): A heart attack caused by plaque that ruptures resulting in a blood clot. The clot fully blocks the artery and prevents oxygen from reaching the heart.
- NSTEMI (Non-ST-Elevation Myocardial Infarction): This type of heart attack is also usually caused by plaque rupture, although the resulting blood clot does not block blood flow completely.
Within the two types of heart attacks, the severity can differ based on the extent of the clot, which artery is blocked (there are three main ones in the heart and the one that is blocked determines which part of the heart is not receiving oxygen), and how quickly the heart attack is treated. You may have heard the term “widowmaker,” which refers to a heart attack in which the the artery that’s blocked (the LAD artery) is the one that supplies blood to the greatest portion of the heart muscle.
What Causes a Heart Attack?
Coronary artery disease
Most heart attacks are caused by coronary artery disease, where one of the coronary arteries that carries blood and oxygen to the heart becomes blocked due to a buildup of different substances including fat and cholesterol. This buildup can take place over many years, and eventually the plaque either blocks the flow of blood itself or it ruptures and forms a blood clot that blocks the flow. In rarer circumstances, a clot can travel from another location and block a coronary artery, having the same effect.
Coronary artery spasm
Coronary artery spasm can mimic a heart attack because it also cuts off the blood flow through an artery. These spasms can happen even if there is no buildup of plaque in the artery, and are thought to be caused by certain drugs, smoking cigarettes, stress, or exposure to extreme cold.
Heart Attack Symptoms and Early Warning Signs
With hindsight, people will often realize that they had symptoms and early warning signs of an impending heart attack days, weeks, or even months before being diagnosed with a heart attack.
The most common symptom, which can come and go over a period of time, is chest pain or pressure that comes on with physical exertion and goes away with rest. This may then be accompanied by one or more of the following symptoms:
- Tightness, pain, or squeezing in your chest or arms that possibly spreads to your neck, jaw, or back
- Nausea, upset stomach, heartburn, or abdominal pain
- Shortness of breath
- Breaking out in a cold sweat
- Lightheadedness or dizziness
It is extremely important to remember that different people experience heart attacks in wildly different ways. You may have all of the symptoms listed above or you may have just one or two. Your pain may be constant and severe or it may be mild and come and go.
When it comes to a heart attack, the quicker you get treatment, the better your prognosis, so when in doubt seek help immediately.
Heart Attack Symptoms in Women
For both men and women, chest pain is the most common symptom of a heart attack. However, women are more likely than men to also experience breathlessness, nausea, and back or jaw pain, especially in the lower left side of the jaw. While men often feel the pain of a heart attack in their left arm, women may have pain in either arm.
Women are also more likely than men to assume that what they are feeling is not anything serious. Unfortunately, doctors and other health care professionals may also underestimate symptoms of a heart attack in women. Some other warning signs of a heart attack in women are:
- Unusual extreme fatigue: Most of us are exhausted most of the time but there is a difference between the general fatigue of our day-to-day lives and the inability to function due to extreme debilitating fatigue. If you suddenly find yourself unable to complete even simple tasks like making your bed or walking up a flight of stairs without feeling extremely exhausted, you should see a doctor.
- Sweating and/or shortness of breath: Both sweating and breathlessness can be benign symptoms of menopause or just simply being out of shape. But if you have a sudden onset of these symptoms, if you sweat and can’t breathe even when you are not exerting yourself, or if the breathlessness gets worse when you lie down, it could be a sign of heart trouble.
- Neck, jaw, and/or back pain: Known as referred pain, when there is a problem in the heart, you may feel the pain in other places. If you have not strained yourself or pulled a muscle, but rather you just feel a general achiness in your neck, jaw, or back that may worsen when you exert yourself and get better when you rest, you should check in with your doctor.
How Is a Heart Attack Diagnosed?
I hope you never find yourself asking, “how do I know if I’m having a heart attack?” However, if you do suspect that you are having a heart attack, seek help immediately by calling an ambulance—the life-saving nature of immediate treatment cannot be emphasized enough.
In order to determine whether you are actually having (or had) a heart attack and what type it was, you will undergo several tests, some invasive and some non-invasive. The purpose of all of these tests is not only to confirm whether a heart attack took place, but also to assess the level of damage and to determine what the next steps should be in terms of treatment.
- Non-invasive tests: Electrocardiography to measure the heart’s electrical activity, echocardiography to view images of the heart, and blood tests to look for signs of damage to the heart.
- Invasive tests: Catheterization or angiography, which involves inserting a small catheter into the blood vessels to visualize the arteries that supply blood to the heart.
Your doctor will decide which are the necessary tests in order to best understand your specific situation.
Heart Attack Treatment Options
Once it’s clear that you are actually having or had a heart attack, the next step is determining the appropriate treatment. Treatments are likely to include medications, procedures, surgery, or a combination of these.
Medications may include:
- Aspirin: Aspirin will reduce blood-clotting and help blood flow through a partially blocked or narrow artery.
- Antiplatelets and blood thinners: These drugs may be given to help prevent new clots from forming or existing clots from growing.
- Nitroglycerin: Nitroglycerin widens the blood vessels in order to increase blood flow to the heart.
- Beta blockers: This type of drug relaxes the heart muscle and slows the heartbeat in order to make it easier for the heart to do its job particularly if it has been damaged.
Interventional or surgical procedures may include:
- Coronary angioplasty and stenting: Doctors can insert a catheter through an artery in your groin or wrist and advance it up to the heart, allowing them to identify which artery is blocked. The catheter has a special balloon attached to it that is inflated in order to open the blocked artery. Once it is open, a stent is inserted in order to keep the artery open and ensure the blood can flow.
- Coronary artery bypass surgery: The most common type of open-heart surgery in the United States, in coronary artery bypass surgery the surgeon sews arteries past the blocked artery so that blood will bypass the blockage and flow directly to the heart. Sometimes this needs to be done as emergency bypass surgery at the time of a heart attack, while at other times doctors will wait a few days before performing this surgery.
Following medical and/or surgical treatment, you are likely to need cardiac rehabilitation. Cardiac rehabilitation programs often start while you are still in the hospital and continue for a period of time once you return home. The purpose of such programs are to help you manage your medications, adjust to lifestyle changes, deal with any emotional issues, and support a gradual return to your normal activities. People who do cardiac rehabilitation are likely to live longer and are less likely to suffer another heart attack than those who do not.
There are two conditions that are related to heart attacks and can easily be confused with them, although they are different: angina and cardiac arrest.
Angina happens when the supply of oxygen to the heart is restricted. The symptoms are similar to that of a heart attack, but they typically take place while a person is exercising or otherwise exerting energy and resolved with rest. If you have these symptoms, it is important to be evaluated by a doctor to see if the pain is related to a blockage in one of the coronary arteries or another cause.
If you are diagnosed with angina, you will be given medicine that is meant to improve symptoms and may undergo one of the procedures listed above. If you develop worsening chest pain, chest pain that comes on at rest, or chest pain that does not improve with rest, this may represent a heart attack, and you should call an ambulance right away.
While a heart attack happens when an artery gets blocked and blood is not supplied to the heart, cardiac arrest takes place when the heart actually stops beating and therefore does not pump blood to the rest of your body. One of the possible complications of heart attack is cardiac arrest, although there are other possible causes of cardiac arrest as well. When a person experiences cardiac arrest, they will stop breathing and fall unconscious. In that case, you should call an ambulance immediately and start CPR.
Heart Attack Risk Factors
There are people who are more likely to suffer from a heart attack than others due to certain factors. Some of these factors are genetic and cannot be helped or changed, and others are lifestyle choices and can be modified to help reduce the risk of heart attack.
These risk factors include:
- Age: The older you get the more likely you are to have a heart attack. Most people who die of heart-related diseases are over 65.
- Gender: Males are at greater risk for heart attack than females and are also more likely to have a heart attack at a younger age.
- Family history: If your parents have heart disease, you are more likely to have it as well.
While you can’t change your age, gender, or genetic make-up, there are certain modifiable risk factors, such as:
Heart Attack Prevention
There is no foolproof way to ensure that you will never have a heart attack. All you can really do is live the best, healthiest life that you can. If you do have risk factors, you should work with your doctor to ensure that you are protecting yourself and keeping an eye on any symptoms or changes.
If you don’t have any particular risk factors, you can still:
- Avoid smoking or drinking too much alcohol
- Exercise regularly
- Eat well-balanced and nutritious meals
Complications From a Heart Attack
Even if you get treatment for a heart attack, you are still at risk of developing complications that are generally due to the damage that was done to your heart. Such complications include:
- Arrhythmias: An arrhythmia is an abnormal heart rhythm. In severe cases, arrhythmia can be fatal.
- Heart failure: If the heart attack damaged the heart tissue severely enough, the remaining muscle may not be able to pump enough blood out of the heart. Heart failure can be a temporary condition or it can be chronic if the damage was extensive.
- Cardiac arrest: Having a heart attack puts you at greater risk for going into cardiac arrest, when the heart stops because of an electrical disturbance in the heart.
When to See a Doctor
You should see a doctor immediately upon exhibiting any heart attack symptoms.
Even if you feel silly and think your symptoms are probably something minor, don’t take a chance. Remember that symptoms can be subtle and can come and go for days or weeks before turning into a major problem. Better to be sent home with a diagnosis of heartburn and a package of Tums, than find yourself in an ambulance with major damage to your heart in another couple of weeks.
What You Can Do at Home
A heart attack requires professional medical intervention as soon as possible. If you’re waiting for the ambulance or help to arrive, take aspirin to help thin your blood. This can increase the chances that your blood will be able to circulate around the blockage and get to your heart.