Understanding Heart Attacks

Every year, about 735,000 Americans have a heart attack. Most often, heart attacks are the result of coronary artery disease (CAD), or coronary heart disease. CAD occurs when a waxy substance, called plaque, builds up, narrowing your coronary arteries. Your coronary arteries are responsible for supplying oxygen-rich blood to your heart.

The plaque that gathers in your coronary arteries has a shell that is hard and rigid on the outside, and softer in the inside. When the hard outside of the plaque cracks, it causes a blood clot to form on the plaque. If the blood clot becomes too large, it can completely block the blood flow in the coronary artery. The blockage of blood flow keeps the heart from getting the oxygen its needs, leading to the death of heart muscle cells. This is a heart attack.

Though less common, heart attacks can also be caused by a severe coronary spasm, which cuts off the blood flow to an artery. These spasms may happen in coronary arteries that do not have plaque build up.

What are Risk Factors of a Heart Attack?

Risk factors for a heart attack you can control include:

• High blood pressure
• High blood cholesterol
• Smoking
• High blood sugar
• Overweight and obesity
• Unhealthy diet (high in saturated fat, trans fat, sodium, and cholesterol)

Risk factors for a heart attack that you cannot control are as follows:

• Age (risk of heart attack increases for women and men after ages 45 and 55, respectively)
• Family history of heart disease

Symptoms of a Heart Attack

Heart attack symptoms can vary from person to person. They don’t all happen with sudden chest pain that we often see in TV shows or movies. In fact, some people will have a heart attack with no symptoms. These “silent” attacks can occur in anyone, but most happen in people with diabetes.

Heart attack symptoms include:

• Discomfort, pressure, heaviness or pain in the chest, arm, or below the breastbone; may feel like heartburn or indigestion
• Radiating discomfort to the back, jaw, throat, or arm
• Sweating, nausea, vomiting or dizziness
• Shortness of breath, or weakness
• Rapid or irregular heartbeats

During a heart attack, symptoms will last 30 minutes or longer and are not relieved by the use of nitroglycerin underneath the tongue.

What Should I Do if I Have a Heart Attack?

If you believe that you or someone that you are with is having a heart attack, call for emergency treatment, or 911. A heart attack is a medical emergency, and the longer you wait to treat it, the more damage to your heart, and a reduced chance of survival.

How is a Heart Attack Diagnosed?

• An electrocardiogram (ECG or EKG) will be used to determine how much damage has occurred and where it has occurred
• Blood tests may be done to measure cardiac enzyme levels. While normally found inside of the cells in your heart, when the heart muscle cells are injured, the contents of the cells, including the enzymes, are released into the bloodstream. By measuring these, doctors can determine the size of the attack and when it started.
• An echocardiography is an imaging test used during and after an attack to learn how the heart is functioning, and what parts are not functioning normally. This includes looking at the structures of the heart to determine if they have been injured.
• Cardiac catheterization can be used if medication is not helping to relieve the symptoms of the attack. This can be used to help your doctor to see the blocked artery and determine what is their next course of action to treat the blockage.

Treatment for a Heart Attack

Some treatments can be started right away even before confirmation of a heart attack. These immediate treatments include:

• Aspirin to prevent further blood clotting that could worsen the heart attack
• Nitroglycerin may be used to treat a heart attack because nitrates help to dilate the coronary arteries, increasing blood flow
• Thrombolytic medicines, also known as clot busters, are used to dissolve clots blocking the coronary arteries.

Other treatment options for a heart attack include:

• Angioplasty and stent placement is when the doctor inserts a long, thin tube into the narrowed area of an artery. A wire with a deflated balloon will be inserted and inflated to push the deposits against your artery walls. A stent may be left in the artery to keep it open.
• Coronary artery bypass surgery Using a vessel from another part of your body, a surgeon will create a bypass around blocked coronary arteries to allow blood to move around. This may help to restore blood flow to the heart muscle.

Your doctor may prescribe medications to help lower blood pressure, break up clots, thin your blood, or decrease your heart’s workload. Your doctor may also recommend cardiac rehabilitation to help you recover from an attack, or prevent another one.

Other treatment options include making healthy lifestyle changes such as healthy eating, stress management, physical activity, maintaining a healthy weight, and eliminating drinking alcohol and smoking.