Q. What is a heart attack?
A heart attack occurs when the supply of blood and oxygen to an area of the heart muscle is blocked, usually by a blood clot in a coronary artery. If the blockage is not treated within a few hours, the heart muscle will be permanently damaged and replaced by scar tissue.
Q. What causes a heart attack?
A. Coronary artery disease, or CAD, is the most common underlying cause of a heart attack. Coronary arteries are the blood vessels that bring blood and oxygen to the heart muscle. Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. When blood cannot reach part of your heart, that area starves for oxygen. If the blockage continues long enough, cells in the affected area die.
Q. What are the symptoms of a heart attack?
A. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. It can include pain or numbness in one or both arms, the back, neck, jaw, or stomach. Heart attack pain can sometimes feel like indigestion or heartburn. Shortness of breath often happens along with, or before chest discomfort.
Other symptoms may include breaking out in a cold sweat, having nausea and vomiting, or feeling light-headed or dizzy. Symptoms vary, and some people have no symptoms. Know the symptoms of a heart attack so you can act fast to get treatment.
Q. Do I have to have all the heart attack symptoms before calling emergency services?
A. No. Most heart attack patients do not have all of the symptoms. The important thing to remember is that if you have any of the symptoms and they grow more intense, and last more than 5 minutes, you should call emergency services immediately.
Q. How common is a heart attack?
A. Very common. Each year, more than 1 million people in the U.S. have a heart attack and about half - 515,000 -of them die. About one-half of those who die do so within 1 hour of the start of symptoms and before reaching the hospital.
Q. Who is at greatest risk of a heart attack?
A. Certain factors make it more likely that you will develop coronary artery disease and have a heart attack. These risk factors include some things you cannot change. If you are a man over age 45 or a woman over age 55 you are at greater risk. Having a family history of early heart disease - heart disease in a father or brother before age 55 or in a mother or sister before age 65 is another risk factor. You are also at risk if you have a personal history of angina or previous heart attack, or if you have had a heart procedure, such as angioplasty or heart bypass. Importantly, there are many risk factors for heart attack that you can change. These include: smoking, being obese or overweight, being physically inactive or having high blood pressure, high blood cholesterol or diabetes.
Q. How can a heart attack be prevented?
A. You can help prevent a heart attack by talking with your doctor about your risk factors and taking action to lower your risks. This usually includes making healthy lifestyle choices, including quitting smoking, maintaining a healthy weight, and engaging in physical activity.
Q. What can I do if I've had a heart attack or been told I'm at high risk for one?
A. There are several things you can do to lower your risk of having a heart attack, even if you have already had one or been told that your chances of having one are high. To prevent a heart attack, you will most likely need to make some lifestyle changes. You may also need to get treatment for conditions that raise your risk.
You can lower your risk for CAD and a heart attack by making healthy lifestyle choices:
- Eat a healthy diet - such as one low in salt, saturated fat and trans fat, and calories - to prevent or reduce high blood pressure and high blood cholesterol, and maintain a healthy weight.
- If you smoke, quit.
- Exercise as directed by your doctor.
- Lose weight gradually if you are overweight or obese.
In addition to making lifestyle changes, you can help prevent heart attacks by treating conditions you already have that increase your chances of having a heart attack, such as high blood pressure, high cholesterol, and diabetes.
Q. What tests are used to diagnose a heart attack?
A. Several tests are used to diagnose a heart attack.
- An electrocardiogram, also called an EKG, measures the rate and regularity of your heartbeat.
- Blood tests identify and measure markers in the blood that can show how much damage was done to your heart. These tests are often repeated at specific time periods to check for changes.
- A nuclear heart scan uses radioactive tracers to show damage to heart chambers and major blood vessels.
- Cardiac catheterization involves passing a thin flexible tube through an artery in your groin or arm to look at your coronary arteries. It allows your doctor to examine the blood flow in your heart's chambers.
- Cardiac angiography is usually performed along with cardiac catheterization, using a dye injected through the cardiac catheter. The dye allows the doctor to see where there may be blockages in the coronary arteries.
Q. How is a heart attack treated?
A. If you are having a heart attack, doctors will work quickly to restore blood flow to the heart and continuously monitor vital signs to detect and treat complications. Restoring blood flow to the heart can prevent or limit damage to the heart muscle and help prevent another heart attack. Doctors may use clot-busting drugs called thrombolytics and procedures, such as angioplasty. Long-term treatment after a heart attack may include cardiac rehabilitation, checkups and tests, lifestyle changes, and medications.
Q. What is angina?
A. Angina is a recurring pain or discomfort in the chest that happens when some part of the heart does not receive enough blood.
Q. How is angina different from a heart attack?
A. An episode of angina is not a heart attack. However, people with angina may have a hard time telling the difference between angina and heart attack symptoms. Angina is chest pain or discomfort that occurs when your heart muscle does not get enough blood. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw, or back. It may also feel like indigestion. It is usually relieved within a few minutes by resting or by taking prescribed angina medicine.
Q. What medicines are used to treat people who have had or are having a heart attack?
A. There are many medicines that are used to treat a heart attack.
- Clot-busters or thrombolytic drugs dissolve blood clots that are blocking blood flow to the heart.
- Beta blockers decrease the workload on your heart by slowing your heart rate.
- Angiotensin-converting enzyme (ACE) inhibitors lower your blood pressure and reduce the strain on your heart.
- Nitrates, such as nitroglycerin relax blood vessels and relieve chest pain.
- Anticoagulants thin the blood and prevent clots from forming in your arteries.
- Antiplatelet medications, such as aspirin and clopidogrel, stop platelets from clumping together to form clots.
- These medications are given to people who have had a heart attack, have angina, or have had angioplasty.
Doctors may also prescribe medicines to relieve pain and anxiety, or to treat irregular heart rhythms which often occur during a heart attack.
Q. Does having a heart attack mean I can't do all the things I enjoy doing?
A. There are millions of people who have survived a heart attack. Many recover fully and are able to lead normal lives. Most people without chest pain are able to return to their normal activities within a few weeks after an uncomplicated heart attack. Most can begin walking immediately. Sexual activity can also begin within a few weeks for most patients who do not have chest pain or other complications.
Q. Should my family be especially concerned about me if I have a heart attack?
A. Having a heart attack increases your chances of having another one. Therefore, it is very important that you and your family know how and when to seek medical attention. Talk to your doctor about making an emergency action plan, and discuss it with your family.
The emergency action plan should include
- warning signs or symptoms of a heart attack
- instructions for accessing emergency medical services in your community, including calling emergency services
- steps you can take while waiting for medical help to arrive, such as taking aspirin and nitroglycerin
- important information to take along with you to the hospital, such as a list of medications that you take or that you are allergic to, and name and number of whom you should contact if you go to the hospital
Q. What about my own concern for my health?
A. After a heart attack, many people worry about having another heart attack. They often feel depressed and may have trouble adjusting to a new lifestyle. You should discuss your feelings with your doctor. Your doctor can give you medication for anxiety or depression and may recommend professional counseling. Spend time with family, friends, and even pets. Affection can make you feel better and less lonely. Most people stop feeling depressed after they have fully recovered.
Q. When I leave the hospital after a heart attack, will I need to do any follow-up?
A. After a heart attack, you will need to see your doctor regularly for checkups and tests to see how your heart is doing. Your doctor may recommend
- lifestyle changes such as quitting smoking, changing your diet, or increasing your physical activity.
- medications, such as aspirin, nitroglycerin tablets for angina, and medications to lower your cholesterol or blood pressure and help reduce your heart's workload.
- participation in a cardiac rehabilitation program.
Q. Should I be concerned if I start feeling chest pain again after a heart attack?
A. Many heart attack survivors also have chest pain or angina. The pain usually occurs after exertion or emotional stress and goes away in a few minutes when you rest or take nitroglycerin as directed. In a heart attack, the pain is usually more severe than angina, and it does not go away when you rest or take your angina medication. If you think your chest pain could be a heart attack, call emergency services immediately.