Everything You Need to Know About a Heart Attack

A heart attack—also known as a myocardial infarction (MI)—is when the heart muscle does not receive enough blood flow and the heart cells begin to die. This can result from a severely decreased blood flow to the coronary arteries or because there is a complete blockage in the arteries. When the heart muscle begins to die, the person has a heart attack.

Symptoms may or may not precede a heart attack. If the heart arteries narrow by more than 70%, some symptoms may occur.

This article discusses heart attack symptoms, causes, diagnosis, treatment, and recovery.

Heart Attack Symptoms: What Does a Heart Attack Feel Like?

Heart attack symptoms vary from person to person. They can include classic symptoms like severe chest pain, or more subtle symptoms, or no symptoms at all. Heart attack symptoms can come on suddenly or develop slowly and come and go over many hours.

The symptoms of a heart attack include:

• Chest pain or chest pressure
• Neck or jaw pain
• Arm pain
• Nausea
• Vomiting
• Lightheadedness or dizziness
• Shortness of breath
• Sweating
• Fast or irregular heart rate

Heart Attack Symptoms in Women

Heart disease is the No.1 cause of death in women in the U.S. A woman's heart attack symptoms can include classic symptoms like chest pain. A study from the Journal of American Heart Association in 2019 found that chest pain was the presenting heart attack symptom in 92% of women.

However, women can also have other symptoms that aren't seen as often in men.

The other symptoms that women may have during a heart attack include:

• Middle or upper back pain
• Neck or jaw pain
• Shortness of breath
• Nausea
• Vomiting
• Cough
• Indigestion
• Weakness or tiredness
• Decreased appetite
• Dizziness
  

Heart Attack Symptoms in Men

Just like women, heart disease is the No.1 cause of death in men. Heart attack symptoms in men typically present with chest pain, also known as angina. A 2019 study showed that 91% of men had chest pain on presentation in the emergency department. Other heart attack symptoms in men include:

• Chest pain: Felt in the center or left side of the chest that lasts a few minutes. The pain can resolve and come back
• Lightheaded: Can feel weak, tired, or dizzy
• Sweat: Some people break out into a cold sweat
• Shortness of breath: This can happen before or after the chest pain starts
• Jaw or neck pain
• Arm pain: In one or both arms

Does the Body Show Signs Before a Heart Attack?

When someone has a heart attack the signs and symptoms can slowly progress as the coronary arteries narrow with atherosclerosis. This is the buildup of plaque in the artery. When a coronary artery narrows by 70% or more, cramps and muscle pain may ensue.

As the coronary arteries narrow, the body can compensate by making connections around the narrowed arteries. These are called collaterals. Collateral circulation is the body's way of protecting itself from a heart attack. A heart attack will occur when the new collaterals or coronary arteries do not provide enough circulation to the heart muscle. This process can happen abruptly or gradually. When it is gradual, early warning signs may occur.

The early warning signs of a heart attack can include:

• Radiating chest pain
• Heart palpitations
• Cold sweat
• Shortness of breath
• Tiredness
• Sense of doom or unease

What to Do if You Think You’re Having a Heart Attack

If you or someone you are with thinks they are having a heart attack, the first step is to call 911. Do not delay. A heart attack is a medical emergency. Do not try and drive yourself or someone else to the hospital. An ambulance is designed to transport people who may be having a heart attack and can get them prepared for the hospital while they are en route.

Take any medication you have been prescribed for chest pain. If the chest pain does not go away after you take the medicine, call 911.

What Causes a Heart Attack?

Heart attacks most commonly result from coronary artery disease (CAD). This is a condition in which plaque develops along the insides of coronary arteries. Over time, the plaque narrows the arteries decreasing blood flow through them. When the blood flow decreases enough, the heart muscle does not get enough oxygen and nutrients, causing chest pain.

A piece of plaque can break off the sides of the artery. A blood clot can form on the plaque, stopping blood flow through the artery and causing chest pain and a heart attack.

Other less common causes of a heart attack are:

• Coronary artery spasm
• Spontaneous coronary artery dissection (SCAD)
• Coronary artery embolism

There are several heart attack risk factors. Some of these are within your control, while others are not. The risk factors you can control are:

• Diet
• Exercise
• Smoking
• High blood pressure
• High cholesterol
• Diabetes

Risk factors outside a person's control are age, family history, and infections.

Testing to Diagnose a Heart Attack

When someone comes into an emergency department with heart attack symptoms, the healthcare providers will immediately provide care and testing. There are three primary tests for diagnosing a heart attack:

• Electrocardiogram (EKG): An EKG is a test that looks at the heart's electrical rhythm. This test takes only a few minutes and can tell the healthcare provider if there is any injury to part of the heart muscle.
• Blood tests: A blood test measuring the levels of troponin in the blood is the gold standard for determining if any damage (termed injury) to the heart muscle has occurred. This test can be normal very early after a heart attack starts but will turn positive or abnormal within an hour or two. It is very sensitive to the recent occurrence of a heart attack.
• Imaging Tests: A chest X-ray, CT, or echocardiogram (echo) can look at the heart and help a healthcare provider determine if it works effectively.

Heart Attack Treatment

Every moment matters when someone is having a heart attack. Treatment should start as soon as possible.

Medications

Several medications can treat a heart attack. One of the most common is aspirin. Aspirin will not break up any existing blood clots, but it will help prevent the formation of new or larger clots.

Nitroglycerin is another medication that makes it easier for your heart to get blood through your body.

Thrombolytics are medications for breaking up blood clots. This medication enters the body through an IV when a blood clot causes a heart attack. Thrombolytics also pose a risk of bleeding. The medicine will work throughout the entire body and does not know to focus only on the heart.

Non-Surgical Intervention

Percutaneous intervention (PCI) or angioplasty is a non-surgical procedure that helps reinstate blood flow through the coronary arteries. It is a cardiac catheterization procedure that guides a tube through an artery into the coronary arteries. A stent may be placed during the procedure to help keep the artery open.

Surgical Intervention

Coronary artery bypass grafting (CABG) is a surgical procedure for improving blood flow to the heart when the coronary arteries become severely narrowed and in emergencies.

Recovery From a Heart Attack

Recovery after a heart attack will vary from person to person based on the severity of the heart attack and how soon they received treatment.

Cardiac rehabilitation is a program healthcare providers and medical staff organize to help patients recover and prevent another heart attack. The program provides education, exercise information, and lifestyle training. Hospitals and outpatient facilities offer it, and insurance often covers it.

How to Prevent a Heart Attack

Heart attacks are not always preventable. But you can make lifestyle changes to reduce your risk. These changes include regular exercise, quitting smoking, a healthy diet, and stress reduction.

If someone has already had a heart attack, their healthcare provider will likely prescribe certain medications to prevent another one from happening. These medications include:

• Antiplatelet agents: Most people who have had stenting will take two antiplatelet agents for at least one month up to 12 months. These drugs help prevent clots from forming within the stent. Aspirin is usually one of these. A cardiologist will choose the second from one of many possible choices.
• ACE inhibitors: Decrease blood pressure and make it easier for the heart to pump.
• Beta-blockers: Treat irregular heartbeats and make the heart pump easier.
• Statins: Because the vast majority of heart attacks are related to atherosclerotic plaque triggered by high levels of low-density lipoprotein (LDL) cholesterol and high apo B levels, it is extremely important to begin medications that will lower these levels, thereby preventing further cardiac events. Statins are the most effective and safest tool for accomplishing this. If you have had a problem with statins, there are numerous alternatives available for lowering these levels.
  

Life After a Heart Attack: Outlook

A heart attack is a life-threatening situation with a surprisingly high survival rate. A 2021 study found approximately 90% of people with a heart attack survived past the one-year mark. The rehabilitation programs and support from healthcare providers after a heart attack can help ease patients back into their normal routines and lifestyles.