What is a heart attack?
A heart attack (also known as a myocardial infarction) occurs when the heart is deprived of oxygen, which can cause damage to the heart muscle:
- This happens when one of the arteries that supply blood to the heart becomes narrowed or blocked.
- The blockage is often caused by a related condition known as coronary artery disease, where a fatty substance known as plaque builds up on heart artery walls over time.
- This plaque can break, and a piece can form a clot that cuts off most or all of the blood supply to the heart.
- Although blockages due to cholesterol buildup is the most common cause of a heart attack, in a minority of cases there can also be other causes.
Are there different types of heart attack?
Yes. There are two major types:
- STEMI: This stands for “ST-elevation myocardial infarction,” and it means that a complete blockage in your coronary artery caused the heart attack. In this kind of heart attack, fast intervention is critical. If the completely blocked artery is not opened quickly enough, this can lead to permanent damage to the heart.
- NSTEMI: This stands for “non-ST-elevation myocardial infarction.” This kind of heart attack often is associated with a partially blocked blood vessel in one or more coronary arteries. While it’s less severe than a STEMI heart attack, an NSTEMI can still cause damage to the heart muscle and should be treated as soon as possible to help ensure the best treatment outcome.
Am I at risk for a heart attack?
It’s important to know your specific risk factors, which fall into two categories:
- Risk factors you can’t change: These include your age, gender and race. It’s important to note that there are no absolutes. For example, older adults are more likely to experience a heart attack, as are men and African Americans, but in some cases others are at higher risk.
Other key risk factors that can’t be changed are your family history and genetics. This includes any congenital heart defects.
- Risk factors that can be managed: These include lifestyle considerations such as diet, exercise, smoking and using other tobacco products, alcohol usage and stress. It also includes any medical conditions that can be controlled, such as obesity, diabetes, high cholesterol or high blood pressure.
In addition, if you’ve already had a heart attack, you are at greater risk of experiencing another one, but you can take some steps to help reduce this risk.
What’s the difference between a heart attack, cardiac arrest and heart failure?
All three of these conditions are related in that they affect the function of the heart and are potentially life-threatening. A simple analogy to make is that of a house, which needs plumbing and electricity, and which has doors and walls. The heart is similar, and the specific conditions vary based on which aspect of the heart gets affected:
- Heart attack: This is a “plumbing issue” caused by the coronary arteries becoming blocked. If the plumbing issue is a major one, then it can also involve the electrical system, and you may experience cardiac arrest (when the heart stops beating unexpectedly), which is also known as a “sudden cardiac arrest.” About 40% of the time, cardiac arrest is the first sign that a heart attack has happened.
- Arrhythmia: This is another “electrical issue,” which is caused by irregular heart rhythms. An arrhythmia can cause the heart to beat too fast or slow, or to stop altogether, also causing cardiac arrest. If a person does not survive this, it leads to “sudden cardiac death.” The most common type of arrhythmia is known as atrial fibrillation, a condition that is also becoming more common in the United States. Age and hypertension (high blood pressure) are the two common risk factors of atrial fibrillation. A timely, accurate diagnosis is important as atrial fibrillation can also increase a person’s risk for stroke.
- Heart failure: This is a “mechanical issue” in the wall of the heart, which causes the heart to become too weak over time to pump enough blood to meet the body’s needs. While heart failure is a gradual condition, a heart attack may be a contributing factor. Certain viruses, uncontrolled diabetes, uncontrolled blood pressure, alcohol and some cancer medications are other potential causes. In addition, extreme emotional stress can cause a “broken heart,” which manifests as chest pain and certain walls in the heart not contracting.
- Valvular heart disease: The “doors” of the heart (i.e., the valves), can be leaky or tight, causing issues with the heart’s function. In aortic stenosis, the aortic valve becomes stiff when it develops age-related calcification (buildup of calcium deposits). Aortic stenosis is a common condition in our aging population.
Will a heart attack cause permanent damage to my heart?
Possibly. When you have a heart attack, it means that heart muscle is being deprived of oxygen. This causes damage to the muscle, which can in turn affect how well your heart is able to pump blood. However, heart muscle can heal, and in some cases the muscle is not damaged enough to affect pumping. In others, the muscle damage can lead to the development of scar tissue on your heart that affects pumping function. Your specific prognosis will depend on:
- The severity of the heart attack
- How quickly you were diagnosed and received initial treatment
- The size and location of any scar tissue that develops during the heart attack
- The effectiveness of your treatment
- Additional factors, such as having diabetes, obesity, cancer or other existing pre-existing medical issues
In addition, you can help to improve your chances of a better recovery and minimize the risk of having another heart attack by pursuing heart-healthy lifestyle changes.
As part of your post-heart attack treatment, your Henry Ford cardiologist will recommend a cardiac rehabilitation program. Studies have shown that people who undergo this type of program after a heart attack have improved outcomes.
What are the most common myths about heart attack?
The most common myth is that people think they are too young to have a heart attack. The reality is that this life-threatening condition can occur in adults of all ages. Even those younger people who don’t have diabetes or high blood pressure may be at an increased risk of having a heart attack if they smoke or make other poor lifestyle choices.
Additionally, many people think they can eat anything they want or avoid exercise because they take medications for high blood pressure or high cholesterol. However, these medications are best supported by a healthy lifestyle, including eating a plant-based diet and getting regular exercise.
How do I know if I’m having a heart attack?
The most common signs of a heart attack for both men and women include:
- Chest pain or discomfort: This may come on suddenly and last for several minutes, or appear gradually. It may also retreat and then come back. Discomfort may include pain, pressure, fullness or a “squeezing” sensation in your chest. In many cases, these symptoms can occur for weeks before the heart attack, but the person doesn’t associate these with heart disease.
- Pain or discomfort in other areas of the upper body: This is known as “referred pain,” because you feel the pain in a location other than its source. In this case, when the coronary artery blockage affects blood flow out of the heart, it causes a downstream effect in one or more areas of the body that needs this blood flow. Pain in the left arm is one of the classic symptoms of referred pain shown in portrayals of heart attack in TV and films. However, you may also feel referred pain in other areas, including your right arm, back, neck or stomach.
- Shortness of breath: You may experience this along with the pain or discomfort, or on its own.
- Other symptoms: These may include lightheadedness, fatigue or breaking out in a cold sweat.
If you or a loved one is experiencing any of these heart attack symptoms, don’t wait. Call 911 right away.
Are there different heart attack symptoms for women?
In some cases. Heart disease is often thought of as a man’s disease, but it’s also the leading cause of death for women in the United States. In addition, while women may experience some of the classic symptoms of a heart attack, there are other signs that they may mistake for something else. For example, women are more likely to experience nausea or jaw pain and may think it’s acid reflux, the flu or another common condition, and delay treatment as a result.
If I have chest pain, does that mean it’s a heart attack?
Angina means chest pain that is brought on by exertion and relieved by rest. There are two major types of angina:
- Stable angina: This type only occurs when you are increasing your heart rate and blood pressure. For example, during exercise or times of high stress.
- Unstable angina: This type is usually escalating in nature, may even happen at rest. Unstable angina is an emergency condition that can lead to a heart attack.
Other life-threatening conditions that can cause chest pain
- Pulmonary embolism: Blood clots in the lungs.
- Aortic dissection: A tear in the body’s largest artery, the aorta. Pain from aortic dissection often is very severe and usually radiates to the back. A common cause is uncontrolled blood pressure.
Other conditions that can cause chest pain (not life-threatening)
You may also experience chest pain from causes that are not heart-related, such as:
- Strain on the chest wall after moving heavy furniture, lifting weights or other strenuous exercise
- Heart burn
- A panic attack. This type of event may look and feel much like a heart attack, but it’s caused by extreme stress, a traumatic event or an existing mental health condition such as depression or anxiety. Panic attacks are not life-threatening, but if you are unsure whether it’s a panic attack or heart attack, err on the safe side and call 911.
Diagnosing the specific cause of chest pain may be challenging in an outpatient facility, and often requires advanced testing in the hospital.
How is a heart attack diagnosed?
As an emergency condition, diagnosis and treatment often overlap in the beginning. Heart attacks typically are diagnosed and treated initially in the hospital through a variety of tests and procedures. However, depending on the severity, treatment may begin in an ambulance even before a full diagnosis. In all cases, the goals during this initial diagnosis and treatment stage are:
- Survival and stabilization, including restoring blood flow to the heart
- Determining if a heart attack occurred, and gaining as much information about the type and size of the event
- Assessing any damage to your heart
- Determining the degree of any coronary artery disease you may have
- Start developing a treatment plan for the best possible outcome, and to help reduce the risk of experiencing another heart attack
What types of tests are used in heart attack diagnosis?
Depending on the specific details and severity of your case, your care team may order one or more of the following tests:
- EKG: Also known as an ECG or electrocardiogram, this noninvasive imaging test is used to measure your heart’s electrical activity. It can help determine that a heart attack has occurred and also the amount of damage to your heart muscle.
- Blood tests: When your heart muscle is damaged during a heart attack, the affected muscle cells are disrupted, releasing their contents into your bloodstream. In the United States, a troponin blood test is used and is extremely sensitive to diagnose cardiac damage. With these measurements, your care team can get more information about your heart attack, including its size and when it happened.
- Echocardiogram: This test uses ultrasound (high-frequency sound waves) to produce images of your heart. It is either noninvasive or minimally invasive depending on the type, and it gives your doctor more information about your heart’s structure and function as it beats and pumps blood, including which of the heart’s walls have been damaged during the heart attack.
- Chest X-ray: This test measures whether a heart attack has caused an enlarged heart or if fluid is accumulating in the lungs.
- Cardiac catheterization: During this diagnostic procedure, a catheter (thin, flexible tube) is inserted through the skin into an artery, usually in the upper thigh or wrist, and then is threaded through the body’s arteries to the heart. Here, a special dye is injected into the coronary arteries to reveal any possible blockages. In STEMI patients where an artery is completely blocked, it is critical to get into the catheterization lab as quickly as possible, to encourage the best possible outcome.
- Heart CT: This test helps with diagnosing calcium scores (calcium buildup in arteries is an early sign of cholesterol buildup). This can also be used to help define blockages in the arteries of the heart. However, this type of test is not conducted during a heart attack.
- Nuclear stress test and heart PET: These tests are used to differentiate symptoms of chest pain and provide more information about blood flow to your heart.
- Heart MRI: This noninvasive test uses a powerful magnetic field and radio waves along with a computer to create several detailed images of your heart muscle, chambers, valves and adjacent blood vessels. It may be used after a heart attack to evaluate if the heart is weak due to damage to the heart muscle, including scarring.
How do you treat a heart attack?
Depending on your case, you may receive some of these treatments as part of your emergency diagnosis:
- Balloon angioplasty and stenting: During this minimally invasive procedure, a catheter with a balloon on its tip is passed through your arteries to a coronary blockage. The balloon is inflated, splitting the plaque and stretching the wall of the coronary artery to allow more blood flow to the heart muscle. After a balloon angioplasty, an artery will not stay open for long on its own. As a result, stents (small devices that work like a scaffold) are used to keep the arteries open.
- One advanced form of this procedure is known as chronic total occlusion percutaneous coronary intervention (CTO PCI), which can treat chronic blockages.
- Traditional bypass surgery: Coronary artery bypass grafting (CABG) restores good blood flow to your heart by creating a bypass around diseased arteries. It works by using other vessels from a healthy part of your body (for example, veins from your leg) to redirect blood flow around the blocked coronary artery.
- Robotic bypass surgery: This advanced procedure offers another minimally invasive alternative to traditional bypass surgery. It uses a sophisticated surgical robot system to perform a CABG procedure with great precision through tiny incisions.
- Thrombolysis: If it’s a suspected heart attack, your care team may inject a clot-busting medication through an IV or a catheter directly to the blockage site. This helps to restore your heart’s blood flow. Thrombolysis is most effective when it’s administered within three hours after a heart attack, so in some cases this treatment may be given even before other test results have come back. After it’s done, your care team will use advanced imaging to determine the effectiveness at breaking up the clot. In addition, after thrombolysis you may still need cardiac catheterization or other treatment methods.
- Other medications: You may be instructed to take aspirin (a blood thinner), even before you arrive at the hospital. In the hospital, your care team may also prescribe other blood-thinning drugs, including anti-platelet medications that help to prevent new clots from forming in your arteries. You may also receive a statin to help control your blood cholesterol, nitroglycerin to help widen blood vessels, medications to help lower your blood cholesterol such as beta blockers and ACE inhibitors, and pain medication.
Am I at greater risk for a second heart attack if I’ve already had one?
Yes. If the blockage in one or more of your coronary arteries has advanced to the point where it causes a heart attack, it means that you’ll need to take some steps to help reduce the risk of having another one. Each heart attack case is different, and your care team will develop a detailed treatment plan. But in general, these steps include:
- Taking any medications from your doctor, as prescribed
- Committing to any cardiac rehabilitation program that’s offered as part of your treatment plan
- Attending any follow-up appointments and undergoing any new diagnostic procedures recommended by your doctor
- Making lifestyle changes
- Controlling any related medical conditions, such as diabetes
If I’ve had a heart attack, should I take it easy?
No, this is a common misconception. While you should get the approval of your doctor before beginning any new exercise program, being active can help to improve blood flow and strengthen your heart. Even something as simple as taking regular walks can help.
In addition, exercise boosts endorphins, which can help to boost your mood. Heart attack survivors may face a range of mental and behavioral health issues that make it difficult to gain the confidence to live a normal life again. Exercise is one key component in this journey.
How can I keep my heart healthy?
With the explosion of online and social media information in recent years, it can be overwhelming to sift through the sometimes conflicting recommendations. The most important steps you can take to keep your heart healthy are the American Heart Association’s “Life’s Simple 7” recommendations:
- Manage your blood pressure
- Control your cholesterol
- Reduce your blood sugar
- Get active
- Eat better
- Lose weight
- Stop smoking
The benefits of a plant-based diet
Some of the best foods we can eat are plants. Whole food plant-based diets provide several benefits that can help to improve your cardiovascular health, including improving cholesterol, lowering blood pressure, decreasing inflammation, eliminating added sugars and boosting fiber intake.
These meals can require more time to prepare than convenience foods, but you can streamline by prepping in bulk and freezing meals for later. Looking for ideas? Check out our healthy recipes.
How to work regular exercise into your schedule
In the past it was recommended that you get 60 to 75 minutes of moderate daily exercise (an unattainable goal for many busy people).
While research still indicates that more exercise is better for your health, you can start small. For example, one recent study has shown that you can help improve your overall health in as little as 11 minutes a day. You can even get more activity into your schedule with “snack-size” workouts that are as short as 5 minutes.
Consider meeting with an athletic trainer if you need support, and get the approval of your doctor before starting any new exercise program.
How can I learn my own risk for heart disease and heart attack?
In addition to lifestyle considerations, other factors may increase your risk for having a heart attack. These include family history, race and age. It’s important to know all of your risk factors, and that there are no absolutes. For example, while older adults are more likely to experience a heart attack.
Talk to your doctor about your risk factors. In addition, you should get a physical once a year to ensure that high blood pressure, elevated cholesterol, diabetes, and other potential heart attack risk factors aren’t missed.
You can also take our short, 5-minute heart risk assessment, which gives you a personalized heart risk report.