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Heart attack

A heart attack, also known as myocardial infarction or coronary thrombosis, happens when one of your coronary arteries becomes blocked. A coronary artery is a blood vessel that supplies your heart with oxygen-rich blood. The blockage is usually caused by a build-up of fatty deposits (plaques). Part of this blockage can break off and cause a blood clot to form and block your artery. This stops blood and oxygen from getting to your heart leading to damage to your heart muscle. This is a heart attack.

About 200,000 people in the UK have a heart attack each year. The risk of having a heart attack increases as you get older. They are more common in men than women up to the age of 70, after which there is no difference in risk.

You’re 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
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Palpitations or heart attack?
Dr Paul Zollinger-Read
Image showing a coronary artery affected by atherosclerosis

Details

  • Symptoms Symptoms of a heart attack

    If you have a heart attack, you will 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 may come on suddenly causing you to collapse.

    Other symptoms may include:

    • pain spreading to your jaw, neck, arms (usually your left arm), 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’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 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 and examine you. You will 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 you may have, either immediately or over the next few days in hospital, are described here.

    • 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. These will include a test for a chemical called troponin, which is produced when heart muscle is damaged. Troponin can take up to six hours to appear in your blood and you may have the test repeated at intervals to check for changes.
    • Further ECGs – sometimes an ECG can be normal even if you have had a heart attack so you may need to have the test again.
    • A chest X-ray.
    • A coronary angiogram – you will have 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.
  • Treatment Treatment of a heart attack

    Emergency medical treatment is vital. Getting to hospital quickly and receiving specialist care greatly improve your chance of survival. If aspirin is available, chew a single tablet, unless you know you’re allergic to it. Aspirin reduces blood clots and can help to prevent the clot that is blocking your artery from spreading.

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

    You will then be taken 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 you can only have important emergency treatment that can reduce damage to your heart muscle at these centres.

    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. This is when the electrical activity of your heart becomes chaotic and your heart stops pumping and quivers or ‘fibrillates’ instead. This is known as a cardiac arrest and the paramedic may need to use a defibrillator. A defibrillator 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 is. Once you arrive at hospital, your doctor will decide on the best treatment for you.

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

    • A coronary angioplasty. This can be done as an emergency procedure (also known as a primary angioplasty or a percutaneous coronary intervention (PCI)) or as a planned procedure. A coronary angioplasty aims to widen your narrowed or blocked coronary artery by inflating a balloon in it. A wire mesh tube called a stent is usually inserted to hold your coronary artery open.
    • 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 stroke so you may not be given them if you’re at an increased risk of this, for example if you have recently had surgery.

    Sometimes a coronary angioplasty isn’t possible, for example if the blockages in your arteries are too severe, 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 a heart attack, you may need to take medicines regularly for a long time. Medicines you may be prescribed include antiplatelets, such as aspirin, along with other, stronger antiplatelet medicines (eg clopidogrel, prasugrel or ticagrelor), statins (eg atorvastatin or simvastatin), angiotensin-converting enzyme (ACE) inhibitors (eg ramipril) and beta-blockers (eg bisoprolol). You may also be prescribed fish oil capsules (eg Omacor).

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

    For the best possible recovery after a heart attack, you will be advised to follow a cardiac rehabilitation programme – you should receive information about this while you’re in hospital. These programmes vary but they will usually include an exercise regime devised by a specialist nurse or physiotherapist (a health professional who specialises in maintaining and improving movement and mobility), along with advice on relaxation, lifestyle and treatment choices.

    You will have regular sessions with other people on the programme during which you can get advice and information from healthcare professionals. You will probably have these a couple of times a week for about two months. Ideally the programme will begin when you’re in hospital and continue after you leave.

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    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including heart treatment.

  • Causes Causes of a heart attack

    The underlying cause of most heart attacks is 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, which 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 and causing a heart attack.

    Image showing a coronary artery affected by atherosclerosis

  • Complications Complications of a heart attack

    Complications will be different for everyone who has a heart attack. You may have very few or you may develop many.

    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.

    A heart attack can damage your heart muscle and cause it to become weaker, making it more difficult 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.

    Other, very rare complications include:

    • a blood clot in your lungs
    • tearing of your heart muscle
    • inflammation of the covering of your heart (pericarditis)
    • a bulging weakness in your heart muscle (aneurysm)
  • Prevention Prevention of heart attack

    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 – the recommended amount for adults is 30 minutes on at least five days a week
    • eating a low-fat and high-fibre diet with at least five portions of fruit and vegetables a day and two portions of fish (one oily) a week
    • not drinking more than four units of alcohol a day for men or three units a day for women

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

  • 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
  • FAQs FAQs

    After a heart attack can I go back to my life as it was before?

    Answer

    The extent to which you can return to living your life as you did before a heart attack will depend on how severe your heart attack was, the treatment you received and how well you recovered. It will also depend on your previous lifestyle and the type of work that you do.

    Explanation

    A heart attack damages part of your heart muscle. After a heart attack, your body replaces the damaged part of the muscle with scar tissue, which doesn’t work as efficiently as healthy tissue. The greater the amount of damaged heart tissue, the harder it will be for your heart to pump blood around your body. If your heart attack was very severe and there is serious damage to a large part of your heart, you may develop heart failure – symptoms include feeling breathless, tired and having swollen ankles.

    After your heart attack you’re likely to be offered a cardiac rehabilitation programme. 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. You may find that you can’t do as much as you could previously but sticking with a cardiac rehabilitation programme will increase your chance of getting back to life as normal as before your heart attack.

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

    • Contact the Driver and Vehicle Licensing Agency (DVLA) and your motor insurer so that you’re aware of their recommendations. 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 and you will need to have further tests, such as an exercise ECG. When you can go back to driving will depend on the results of these tests.
    • You will probably be able to return to work within six weeks. 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.
    • 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.

    How do I know I’m having a heart attack and not something else?

    Answer

    There is no way to know for certain whether you’re having a heart attack or whether the pain is something else. Only a doctor will be able to tell you once he or she has done some tests. Therefore, it’s important not to take any risks. If you or someone you’re with get any chest pain that is heavy or tight, or if it spreads to your throat or arms, call for emergency help immediately.

    Explanation

    The symptoms of a heart attack can vary from person to person. You may have chest pain that is so severe it causes you to collapse or you may feel unwell but have no pain at all.

    Common symptoms of a heart attack include:

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

    If you have any of these symptoms, you may be having a heart attack. It’s also very easy to mistake the pain of a heart attack for bad indigestion, which is the one of the reasons many people don’t report it to their GP.

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

    I have been feeling quite anxious and depressed since my heart attack. Is this usual?

    Answer

    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 and need treatment. 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 to be expected. Usually your feelings improve as you start to feel better and able to do more for yourself. If you do develop depression, you’re more likely to have further heart problems, therefore 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.

    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.

  • Resources Resources

    Further information

    Sources

    • Myocardial infarction. eMedicine. www.emedicine.medscape.com, published 11 April 2013
    • Heart attack. British Heart Foundation.www.bhf.org.uk, published 1 September 2011
    • Cardiac arrhythmias in coronary heart disease. Scottish Intercollegiate Guidelines Network (SIGN), published February 2007. www.sign.ac.uk
    • Acute coronary syndromes (ACS). The Merck Manuals. www.merckmanuals.com, published December 2007
    • Acute coronary syndromes (heart attack; myocardial infarction; unstable angina). The Merck Manuals. www.merckmanuals.com, published February 2008
    • Heart attacks and exercise afterwards. British Cardiac Patients Association. www.bcpa.co.uk, published 2012
    • Ventricular fibrillation. American Heart Association. www.heart.org, published 5 September 2012
    • Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction. National Institute for Health and Care Excellence (NICE), published October 2002. www.nice.org.uk
    • Post myocardial infarction. Secondary prevention in primary and secondary care for patients following a myocardial infarction. National Institute for Health and Care Excellence (NICE), published May 2007. www.nice.org.uk
    • Post-myocardial Infarction Depression Clinical Practice Guideline Panel. AAFP guideline for the detection and management of post-myocardial infarction depression. Ann Fam Med 2009; 7:71–79. doi:10.1370/afm.918
    • Depression. Clinical Knowledge Summaries. cks.nice.org.uk, published February 2010
    • DVLA at a glance guide to the current medical guidelines (for medical practitioners). Driver and Vehicle Licensing Agency. www.dft.gov.uk, accessed 18 February 2013
    • Sex and heart conditions. British Heart Foundation. www.bhf.org.uk, accessed 18 February 2013
    • Cardiac rehabilitation. British Heart Foundation. www.bhf.org.uk, published 1 July 2010
    • Heart attack information and symptoms. APS Foundation of America. www.apsfa.org, published November 2010
    • About heart attacks. American Heart Association. www.heart.org, published October 2012
    • Heart attack (myocardial infarction) and driving. GOV.UK. www.gov.uk, published April 2013
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    Produced by Polly Kerr, Bupa Health Information Team, April 2013.

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