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Heart attack

This factsheet is for people who have had a heart attack, or who would like information about it.

A heart attack, also known as myocardial infarction or coronary thrombosis, happens when a coronary artery (a blood vessel that supplies the heart with blood) carrying oxygen-rich blood to the heart is blocked.

If the blood supply is completely blocked, part of the heart muscle may be starved of oxygen, can become damaged and may die

Click on the tabs below for more information about heart attack.

Published by Bupa's health information team, May 2009.

How a heart attack occurs

About

About

About heart attacks

The risk of having a heart attack increases as you get older and is more common among men than women.

You are more likely to have a heart attack if you:
  • smoke
  • have high cholesterol
  • have diabetes
  • have high blood pressure (hypertension)
  • have a family history of heart disease
  • lead an inactive lifestyle
  • are overweight or obese
  • drink alcohol excessively

Complications

Complications from a heart attack can vary widely from person to person. Some people may have few complications, whereas others may have many.

In the first few days of surviving a heart attack you may have an irregular heart beat, known as arrhythmia. You may also get angina, which is pain or discomfort in the chest after having a heart attack.

A heart attack can damage your heart muscle and cause your heart’s pumping action to be weaker, making it more difficult to pump enough blood and oxygen around the body. This is known as heart failure. The larger the area of your heart muscle damaged by a heart attack, the more likely you are to have heart failure.

It is also common for people to feel low or depressed after having a heart attack. You may be worried about having another heart attack or concerned about your recovery. If you are worried about how you are feeling, speak to a doctor for advice.

It is very rare but other complications may include blood clots in the lungs, rupture of the heart muscle, inflammation of the membrane covering the heart (pericarditis), or a bulging weakness in the heart muscle (aneurysm).

Causes of a heart attack

The main cause of a heart attack is atherosclerosis. This is when coronary arteries become narrowed over many years by fatty deposits (plaques). If one of these plaques bursts (ruptures), a blood clot forms around the plaque. The plaque and blood clot together can completely block the coronary artery, stopping blood flow to your heart and causing a heart attack.

Symptoms and diagnosis

Symptoms and diagnosis

Symptoms


If you have a heart attack, you will most likely feel pain or discomfort in the centre of your chest. This central chest pain is often described as a sensation of heaviness, tightness or squeezing, and may come on suddenly causing you to collapse. The pain may feel like bad indigestion.

Other symptoms may include:

  • pain spreading to your jaw, neck, arms, back or stomach
  • feeling sweaty or breathless
  • feeling light headed or dizzy
  • feeling sick or vomiting
The symptoms of a heart attack can vary from person to person. Sometimes you may not have any obvious symptoms, especially if you are elderly or have diabetes.
During a heart attack, life-threatening heart rhythms may develop, which is why a heart attack is a medical emergency.

If you suspect that you or someone you are with is having a heart attack, call for emergency help immediately.

Diagnosis


When you get to hospital, a doctor will ask you about your symptoms and examine you. He or she will also ask you about your medical history. You may have:

  • a physical examination – this involves measuring your blood pressure and monitoring your heart rate
  • blood tests to check for any damage to your heart muscle
  • an ECG – this checks the electrical activity of your heart and helps to diagnose any partial or complete blockages of your coronary arteries
  • a coronary angiogram – a test that uses an injection of a special dye into the blood vessels to make them clearly visible on X-ray images
  • an echocardiogram – this uses ultrasound (sound waves) to show the pumping action of your heart and valves
Please note that availability and use of specific tests may vary from country to country.

Treatment

Treatment

Emergency medical treatment is vital – getting to hospital quickly and receiving specialist care greatly improves your chance of survival. If you have some aspirin (acetylsalicylic acid), chew a single tablet, unless you know that you are allergic to it. Aspirin reduces blood clots and can help to prevent the clot that is blocking the artery from spreading.

If you are being transported to hospital in an ambulance, sit and rest in a position that is most comfortable until the paramedic (emergency medical technician) arrives. He or she may give you initial treatment and provide transport to a hospital quickly and safely for further treatment. You may also be given oxygen and medicines for pain relief.

During or after a heart attack, you may have an irregular heart beat, known as arrhythmia. The most serious form of this is called ventricular fibrillation. This is when the electrical activity of the heart becomes chaotic and the heart stops pumping, and quivers or ‘fibrillates’ instead. This is known as a cardiac arrest and the paramedic may need to use a defibrillator, which gives a large electric shock through the wall of your chest and can restore a regular heartbeat.

Hospital treatment


Your treatment will depend on how severe your heart attack was. Once you arrive at hospital, a doctor will decide on the best treatment for you.

There are two commonly used ways to restore blood flow in a blocked artery.

  • Thrombolysis. This is an injection to break down the clot in your coronary artery. Your chance of making a full recovery from your heart attack is much better if the clot is dissolved. However, thrombolytic medicines can increase your risk of bleeding and having a stroke so you may not be given these if you are at an increased risk of this, for example if you have recently had surgery.
  • A coronary angioplasty. This can be done as an emergency procedure (also known as a primary angioplasty) or as a planned procedure. A coronary angioplasty aims to widen your artery by inflating a balloon in your narrowed or blocked coronary artery. A wire mesh tube called a stent is usually inserted to hold the coronary artery open.
Sometimes a coronary angioplasty isn’t possible, for example if the blockages in your arteries are too long for a stent or they are difficult to get to, and you may be offered a coronary artery bypass graft (CABG) instead. CABG is an operation to bypass a narrowed section of your coronary artery using a blood vessel from your chest, leg or arm. This diverts the flow of blood around the narrowed or blocked coronary artery.

After treatment of a heart attack


After a heart attack, you may need to take medicines regularly for a long time. Medicines you may be prescribed include aspirin, antiplatelets (eg clopidogrel or prasugrel), statins (eg simvastatin), angiotensin-converting enzyme (ACE) inhibitors (eg ramipril), and beta-blockers (eg propranolol). A fish oil capsule may also be given.
Always ask your doctor for advice and read the patient information leaflet that comes with your medicine.
Your risk of further heart attacks can be reduced by taking these medicines. Always read the patient information leaflet that comes with your medicine.

You may be offered a cardiac rehabilitation programme to help you recover from your heart attack. These usually include an exercise regime devised by a physiotherapist (physical therapist – a health professional who specialises in maintaining and improving movement and mobility), along with advice on relaxation, lifestyle and treatment choices.

Availability and use of different treatments may vary from country to country. Ask your doctor for advice on your treatment options.

Prevention

Prevention

You can reduce your risk of having a heart attack by adopting a healthy lifestyle. This includes:

  • not smoking
  • losing excess weight
  • doing regular physical activity, for 30 minutes at least five days a week
  • eating a low-fat and high-fibre diet with five portions of fruit and vegetables a day and two portions of fish (one oily) a week
  • not exceeding recommended limits for alcohol intake. Guidelines differ from country to country
Even if you have previously had a heart attack, these measures can still reduce your chances of having another one.

Sources

Sources

  • Myocardial infarction. eMedicine. www.emedicine.medscape.com, published 24 June 2010
  • Heart attack. American Heart Association. www.heart.org, accessed 21 March 2011
  • Wyatt JP, Illingworth RN, Graham CA, et al. Oxford handbook of emergency medicine. 3rd ed. Oxford: Oxford University Press, 2006:72–79
  • Heart attack. British Heart Foundation. www.bhf.org.uk, accessed 3 March 2011
  • Cardiac arrhythmias in coronary heart disease. Scottish Intercollegiate Guidelines Network (SIGN). February 2007. www.sign.ac.uk
  • Myocardial infarction – secondary prevention. Clinical Knowledge Summaries. www.cks.nhs.uk, published December 2007
  • Acute coronary syndromes (ACS). The Merck Manuals. www.merckmanuals.com, published December 2007
  • ST-elevation myocardial infarction. BMJ Best Practice. www.bestpractice.bmj.com, accessed 21 March 2011
  • Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2010
  • Acute coronary syndromes. Scottish Intercollegiate Guidelines Network (SIGN), February 2007. www.sign.ac.uk
  • Longmore M, Wilkinson IB, Rajagopalan S. Oxford handbook of clinical medicine. 6th ed. Oxford: Oxford University Press, 2004:120–23
  • Ventricular fibrillation. American Heart Association. www.heart.org, published 4 March 2011
  • Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction. National Institute for Health and Clinical Excellence (NICE), October 2002. www.nice.org.uk
  • HIS10 Coronary angioplasty. British Heart Foundation. www.bhf.org.uk, published May 2009
  • Post myocardial infarction. Secondary prevention in primary and secondary care for patients following a myocardial infarction. National Institute for Health and Clinical Excellence (NICE), May 2007. www.nice.org.uk
  • Heart attack - heart information series number 7. British Heart Foundation. www.bhf.org.uk, published September 2006
  • Green L, Dickinson P, Nease D, et al. AAFP guideline for the detection and management of post-myocardial infarction depression. Ann Fam Med 2009; 7:71–79. doi:10.1370/afm.918 [please link to http://dx.doi.org/10.1370/afm.918]
  • Depression. Clinical Knowledge Summaries. www.cks.nhs.uk, published February 2010

This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. Photos and videos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

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