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Heart attack

A heart attack is a serious medical condition which happens when the blood supply to part of your heart gets blocked. Your heart muscle may then become damaged because of lack of oxygen. The medical name for a heart attack is myocardial infarction, or MI.

A heart attack can be life-threatening: phone 999 and ask for an ambulance if you think you, or someone near you, may be having one. The sooner you get treatment for a heart attack, the better your chances of survival.

How a heart attack occurs
Blocked coronary arteries can't supply blood and oxygen

Details

  • What is a heart attack What is a heart attack

    Heart attacks are usually caused by coronary heart disease (CHD). This is where the coronary arteries which supply your heart muscle develop build-ups of fatty deposits called plaques. Parts of these plaques may break off and cause a blood clot to form which blocks your artery.

    About 175,000 people in the UK have a heart attack each year. The risk of having a heart attack increases as you get older – most people who have a heart attack are over 60. They’re more common in men than in women up to the age of 70, after which men and women have the same risk.

  • Symptoms Symptoms of a heart attack

    The symptoms of a heart attack can vary from person to person. It isn’t always obvious that you’re having a heart attack. Often people wait too long before calling for help because they aren’t sure what’s happening.

    If you have a heart attack, you’ll most likely feel pain or discomfort in the middle of your chest. This pain is often described as a sensation of heaviness, tightness or squeezing, or it may feel like bad indigestion. The pain doesn’t always come on suddenly, as you might expect. For some the pain may be mild, and come on slowly. It may stay constant, or may go away and come back.

    Other symptoms may include:

    • pain spreading to your jaw, neck, arms (usually your left arm), back or stomach
    • feeling breathless
    • feeling sweaty, light-headed or dizzy
    • feeling sick or vomiting

    You’re more likely to have these other symptoms if you’re a woman.

    A heart attack may not necessarily come ‘out of the blue’ as a sudden event. Two out of three people have symptoms such as breathlessness and fatigue for days or even weeks before their heart attack. Sometimes you may not have any obvious symptoms, especially if you’re elderly or have diabetes.

    During a heart attack, you may develop life-threatening heart rhythms – this is why it’s a medical emergency.

    If you suspect that you or someone you’re with is having a heart attack, call for emergency medical help immediately

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  • Diagnosis Diagnosis of a heart attack

    Either in the ambulance or when you get to hospital, a doctor, nurse or paramedic will ask you about your symptoms. You’ll have an ECG (electrocardiogram) as soon as possible to check the electrical activity of your heart. This can often show whether or not you’re having a heart attack.

    Other tests that your doctor may recommend, either immediately or over the next few days in hospital, are described here.

    • A physical examination – this involves measuring your blood pressure, listening to your heart and monitoring your heart rate.
    • Blood tests to check for any damage to your heart muscle. These will include a test for a chemical called troponin, which is produced when heart muscle is damaged. Troponin can take between three and 12 hours to appear in your blood. Because of this delay your doctor will repeat the test at intervals to check for changes.
    • Further ECGs – sometimes an ECG can initially be normal even if you’ve had a heart attack so you may need to have the test again.
    • A chest X-ray. This will help your doctor see whether there might be a cause for your chest pain other than a heart attack.
    • A coronary angiogram – your doctor will give you an injection of a special dye into your coronary arteries to make them clearly visible on X-rays. This test can show where there are blockages or narrowings in your coronary arteries.
    • An echocardiogram – this uses ultrasound (sound waves) to show the pumping action of your heart and valves. It can detect any damage to your heart muscle.
  • Treatment Treatment of a heart attack

    Emergency medical treatment is vital. Getting to hospital quickly and receiving specialist care greatly improves your chance of survival. If aspirin is readily available, chew a single 300mg tablet, unless you know you’re allergic to it. Aspirin helps to reduce blood clots.

    In response to an emergency call for a suspected heart attack, paramedics will come to you as soon as possible. Sit and rest in the position that is most comfortable until the paramedics arrive. They’ll give you some initial treatment, such as medicines to relieve any pain and aspirin if you haven’t had any yet. They’ll probably do an ECG.

    An ambulance will take you to a hospital for further tests and treatment. You may be taken to a specialist heart attack centre rather than your local hospital, even if this is further away. This is because these centres specialise in important emergency treatment that can reduce damage to your heart muscle.

    During or after a heart attack, you may have an irregular heartbeat, known as arrhythmia. The most serious form of this is called ventricular fibrillation (VF). This is when the electrical activity of your heart becomes chaotic and your heart stops pumping and quivers or ‘fibrillates’ instead.

    A person having a cardiac arrest will suddenly lose consciousness and stop breathing. Without treatment this leads to death within minutes. If someone is there who can give immediate CPR (cardiopulmonary resuscitation) this can keep oxygen circulating around your body until medical help arrives. If you have a cardiac arrest the paramedic may need to use a device called a defibrillator. A defibrillator gives a large electric shock through the wall of your chest and can restore a regular heartbeat. Defibrillators are now often kept in public places where trained members of the public may also be able to use them.

    Hospital treatment

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

    There are two commonly used ways to restore blood flow in a blocked artery. However, In some types of heart attack doctors won’t offer either of these treatments because they don’t help in all circumstances.

    • A coronary angioplasty (also known as a primary angioplasty or percutaneous coronary intervention (PCI)). This can be done as an emergency procedure to treat a heart attack, or your doctor may offer it as a planned procedure afterwards. A coronary angioplasty aims to widen your narrowed or blocked coronary artery by inflating a balloon inside it. Your doctor will usually also insert a wire mesh tube called a stent to hold your coronary artery open.
    • Thrombolysis. This is an injection to break down the clot in your coronary artery, sometimes called a ‘clot buster’. The medicine is given through an injection into a vein in your arm. However, thrombolytic medicines can increase your risk of bleeding and stroke. So your doctor may not offer them if you’re at an increased risk of this, for example if you’ve recently had surgery.

    These treatments work best when given as soon as possible after your symptoms start.

    Sometimes a coronary angioplasty doesn’t work, 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 your narrowed or blocked coronary artery.

  • After treatment of a heart attack After treatment of a heart attack

    After a heart attack, you may need to take medicines regularly for a long time. The medicines your doctor may offer you include:

    You can reduce your risk of further heart attacks by taking these medicines if your doctor recommends them. Always read the patient information leaflet that comes with your medicine and ask your doctor if you have any questions.

    As well as offering you medication, your doctor will encourage you to reduce any risk factors such as quitting smoking. You will also be advised to take part in a cardiac rehabilitation programme. This is an organised, structured way of giving you the motivation and support to help you recover from your heart attack and prevent another one. You should receive information about this while you’re in hospital, where a member of the cardiac rehabilitation team may visit you.

    Cardiac rehabilitation programmes usually start about two to six weeks after you leave hospital. They’re run in a variety of places including hospitals, community centres and leisure centres. You’ll probably have a couple of sessions a week for about two months. Programmes vary but they’ll usually include exercise together with advice on relaxation, lifestyle and treatment choices. The exercises will be devised by a specialist nurse or physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). They’ll assess you to see what it’s safe for you to do.

    You’ll probably have regular sessions with other people on the programme during which you can get advice and information from healthcare professionals. Going to cardiac rehabilitation sessions can make you feel more confident about looking after your health. They also give you a chance to meet other people who’ve been through a similar experience, which you may find helpful.

    See our FAQs below to find out more about life after a heart attack.

  • Causes Causes of a heart attack

    The underlying cause of most heart attacks is coronary heart disease due to atherosclerosis. This is a condition in which your coronary arteries become narrowed over many years as fatty deposits (plaques) build up on the walls. These plaques can split, or their tops can wear away. This leads to the release of substances that cause the blood in your coronary artery to clot to try to mend the damaged artery wall. Together the plaque and blood clot can completely block your coronary artery, stopping blood flow to your heart muscle and causing a heart attack.

    Image showing a coronary artery affected by atherosclerosis

    You’re more likely to have coronary heart disease, and therefore a heart attack, if you:

    There are ways you can help yourself by reducing many of these risks – see our section on prevention of heart attack below.

    We know that you’re also more likely to have a heart attack if one of your parents have had one. Your risk is even higher if both your parents have had a heart attack, or if either had a heart attack before they were 50. If you’re in this situation, there’s obviously nothing you can do to change this risk. So it’s even more important that you do what you can to reduce your other risks of heart attack by making lifestyle changes.

  • Complications Complications of a heart attack

    More than two out of three people who have a heart attack survive. If you have a heart attack this means some of your heart muscle has been damaged and this can cause complications. These will be different for everyone. Ask your doctor about the possible complications you might have in your own circumstances.

    In the first few days after a heart attack you may have an irregular heartbeat, known as arrhythmia. You may also get angina after having a heart attack. Angina is when you get pain or discomfort in your chest, especially on exertion. 

    A heart attack can damage your heart muscle and cause it to become weaker. This means it’s more difficult for your heart to pump enough blood and oxygen around your body. This is known as heart failure. The larger the area of your heart muscle that is damaged by a heart attack, the more likely you are to have heart failure. Getting treatment as soon as possible after a heart attack is important for limiting the damage to your heart muscle.

    It’s also common to feel low or depressed after having a heart attack. You may be worried about having another one or concerned about your recovery. If you’re feeling anxious, speak to your doctor for advice. See our FAQs below for more information. 

    Other, uncommon complications include:

    • a blood clot in the deep veins of your legs (deep vein thrombosis, DVT) that can move to your lungs (pulmonary embolism)
    • tearing (rupture) of your heart muscle
    • inflammation of the covering of your heart (pericarditis)
    • a bulging weakness in your heart muscle (aneurysm)
    • having another blockage in the same, or a different coronary artery
  • Prevention Prevention of heart attack

    You can reduce your risk of developing coronary heart disease and having a heart attack by adopting a healthy lifestyle. If you’re over 40 your GP may offer you a health check called a cardiovascular risk assessment. They use information about your health, family history and lifestyle, together with your blood pressure and cholesterol measurement, to work out your risk of developing coronary heart disease. This will give you an idea of your risk of heart attack over the next ten years.

    If you smoke, the single best thing you can do to reduce your chance of having a heart attack is to stop.

    Other helpful lifestyle changes you can make include:

    • losing excess weight
    • doing regular physical activity – the recommended amount for adults is 30 minutes on at least five days a week
    • eating healthily – a low-fat and high-fibre diet. Eat at least five portions of fruit and vegetables a day and two portions of fish (one oily) a week
    • drinking alcohol sensibly. Not regularly drinking more than three to four units of alcohol a day for men or two to three units a day for women

    Even if you’ve previously had a heart attack, these measures can still reduce your risk of having another one.

    If you have coronary heart disease, and/or have had a heart attack already, your doctor may offer you medicines to reduce your risk of further heart attacks. It’s important that you take these as prescribed. Ask your doctor or your pharmacist if you have any questions about your medicines or how they can help you.

  • How a heart attack occurs How a heart attack occurs

    Play video
    How a heart attack occurs
    Blocked coronary arteries can't supply blood and oxygen
  • FAQ: Getting back to normal After a heart attack, can I go back to my life as it was before?

    Many people make a full recovery after having a heart attack and enjoy many more active years. Others find that they can’t do as much as they used to before. It’s important to remember that your recovery may take several months as your body needs time to heal. Your best chance of getting back to normal is to follow your doctor’s advice about lifestyle changes and take any medications that they prescribe.

    Explanation

    How long it takes you to recover after a heart attack varies depending on your age, the amount of damage to your heart and what treatment you had. Rest is important, but it’s also good to start to build up your activities gradually and take part in social events if you enjoy them.

    After your heart attack your doctor will offer you a cardiac rehabilitation programme (see our section above, ‘After treatment of a heart attack’). It’s important that you follow the advice that you receive in these sessions, for example about healthy eating, stopping smoking and doing regular exercise. People who attend their cardiac rehabilitation programme get fitter and recover more quickly.

    Other things you may need to bear in mind are explained here.

    • Driving. You shouldn’t drive for at least four weeks after a heart attack and then only if your doctor says it’s safe. If you drive large goods vehicles or passenger-carrying vehicles, you must tell the DVLA. You won’t be able to drive them for at least six weeks. You’ll then need to have further tests which will determine when you can go back to driving. Contact your motor insurer so that you’re aware of their recommendations in your circumstances.
    • Work. Most people can return to work after having a heart attack. How long this takes will vary from person to person. It will depend on your heart condition, what treatment you had and what work you do. You’ll probably be able to return to work within six weeks if your work involves light duties. If your job is physically demanding, you may need to take some more time to recover before you can go back. Talk to your GP and your employer about what is best for you.
    • Sex. You can start to have sex again once you feel ready to do so. If you haven’t had any problems with your recovery, this will probably be after about four weeks, but wait until you feel ready.
  • FAQ: How to be sure you're having a heart attack How do I know I’m having a heart attack and not something else?

    There’s no way to know for certain whether you’re having a heart attack or whether your symptoms are caused by something else. Only a doctor will be able to tell you once they’ve done some tests. So it’s important not to take unnecessary risks. Get to know the possible symptoms of a heart attack. Then if you think that you or someone you’re with is having a heart attack, call for emergency help immediately.

    Explanation

    The symptoms of a heart attack can vary from person to person. See our section ‘Symptoms of a heart attack’ above.

    A common symptom of a heart attack is pain. You may have chest pain that’s so severe it causes you to collapse or you may feel unwell but have no pain at all. You may have:

    • pain in the middle of your chest that may feel like pressure or tightness
    • pain that spreads to your jaw, neck, arms (usually your left arm), back or stomach

    If you’re having a heart attack you may also have other symptoms, or you may have these without the pain. These other symptoms include:

    • breathlessness or wheezing
    • feeling light-headed or dizzy
    • feeling sick or vomiting
    • sweating, with skin that looks pale

    You may mistake the pain of a heart attack for bad indigestion, which is one of the reasons many people ignore it.

    If you think you or someone you’re with is having a heart attack, get emergency help immediately. Don’t wait. The sooner you get medical help the better the chance of surviving and making a full recovery.

  • FAQ: Feeling anxious after a heart attack I have been feeling quite anxious and depressed since my heart attack. Is this usual?

    Yes, it’s common for people to feel anxious, depressed and frightened after having a heart attack. You’re likely to start to feel better as you recover, but it’s possible that you may become depressed. If this happens you can have treatment. So if you’re worried about the way you’re feeling, speak to your GP or nurse for help and advice.

    Explanation

    Feeling anxious, frightened and unhappy after a heart attack is common and a normal reaction to a stressful event. You’ll probably have ‘good days’ and ‘bad days’, perhaps for between two and six months after your heart attack. You may have poor sleep, poor concentration, and lack of energy. It should improve as time goes by.

    However, you may find that this normal emotional response doesn’t go away, and becomes more serious. You may develop depression. If this happens, you’re more likely to have further heart problems, so it’s vital you get the right help and support.

    The main signs and symptoms of depression are:

    • low mood, lack of interest in life
    • losing or gaining weight
    • either sleeping a lot or not at all
    • tiredness and lack of energy
    • feeling worthless
    • being agitated or unable to concentrate
    • thoughts of dying or suicide

    If you have any of these, talk to your GP or nurse about getting help and advice. Depression can be treated.

    Your partner, family and friends are also likely to be affected by your heart attack. It’s important to talk about how you feel and to involve your family and friends in your rehabilitation.

  • Other helpful websites Other helpful websites

    Further information

    Sources

    • Non-ST-elevation myocardial infarction. BMJ Best Practice. www.bestpractice.bmj.com, published 6 May 2015
    • ST-elevation myocardial infarction. BMJ Best Practice. www.bestpractice.bmj.com, published 21 April 2015
    • Myocardial infarction. Medscape. www.emedicine.medscape.com, published 1 April 2015
    • Acute myocardial infarction management. PatientPlus. www.patient.co.uk/patientplus.asp, published 7 March 2013
    • Complications of acute myocardial infarction. PatientPlus. www.patient.co.uk/patientplus.asp, published 20 June 2014
    • Acute Coronary Syndromes (ACS). Merck. www.merckmanuals.com, published May 2013
    • Acute coronary syndromes (including myocardial infarction). Quality standard. National Institute for Health and Care Excellence (NICE), September 2014. www.nice.org.uk
    • MI – secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction. National Institute for Health and Care Excellence (NICE), November 2013. www.nice.org.uk
    • Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease. National Institute for Health and Care Excellence (NICE) July 2014. www.nice.org.uk
    • Map of Medicine. Acute coronary syndrome (ACS). International View. London: Map of Medicine; 2015 (Issue 2)
    • Heart attack. British Heart Foundation. www.bhf.org.uk, accessed 20 August 2015
    • Cardiac arrest. British Heart Foundation. www.bhf.org.uk, accessed 20 August 2015
    • Coronary angiogram. British Heart Foundation. www.bhf.org.uk, accessed 20 August 2015
    • Primary angioplasty for a heart attack. British Heart Foundation, 2014. www.bhf.org.uk, accessed 20 August 2015
    • Having heart surgery. British Heart Foundation, 2013. www.bhf.org.uk, accessed 20 August 2015
    • Angina. British Heart Foundation, 2013. www.bhf.org.uk, accessed 20 August 2015
    • Cardiac rehabilitation. British Heart Foundation, 2013. www.bhf.org.uk, accessed 20 August 2015
    • Heart attack. American Heart Association. www.heart.org, published 15 May 2015
    • Chow C, Islam S, Bautista L et al. Parental history and myocardial infarction risk across the world. J Am Coll Cardiol 2011; 57(5):619–27. doi:10.1016/j.jacc.2010.07.054
    • Alcohol units and guidelines. Change4Life. www.nhs.uk, accessed 25 August 2015
    • Heart attack (myocardial infarction) and driving. GOV.UK. www.gov.uk, published 12 November 2014
    • DVLA at a glance guide to the current medical guidelines (for medical practitioners). Driver and Vehicle Licensing Agency. www.gov.uk, published November 2014
    • Depression. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published July 2015
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