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Heart attack

Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
Next review due January 2021

A heart attack is a serious medical condition which happens when the blood supply to part of your heart gets blocked. Your heart muscle then becomes 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.

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 with blood and oxygen, develop build-ups of fatty deposits called plaques. These plaques may rupture, which causes a blood clot to form over them. This may then block 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, and men tend to get them at a younger age than women. The average age for a person having a first heart attack is 65 for men and 72 for women. However, heart attacks can happen in much younger people, even in their 20s and 30s if they have other problems such as very high cholesterol. See our FAQ below about heart attacks in young people for more information.

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 pressure, tightness or squeezing, or it may feel like bad indigestion. Some people say it’s a feeling of something heavy, like an elephant sitting on their chest. The pain doesn’t always come on suddenly, as you might expect. For some, the pain may be mild, and come on slowly.

Other symptoms may include:

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

You’re more likely to have these other symptoms, rather than the typical central chest pain if you’re a woman. See our FAQ below about heart attacks in women.

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.

See our infographic on how to spot a heart attack (PDF, 0.7MB) or click on the icon below.

Infographic showing how to spot a heart attack

Cardiac arrest

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. If this happens, you’re having a cardiac arrest and you’ll become unconscious and stop breathing. This is a medical emergency.

If you suspect that you or someone you’re with is having a heart attack, call 999 for emergency medical help immediately.

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.

Your doctor will examine you – listening to your heart, taking your blood pressure and checking your heart rate. Other tests that your doctor may recommend, either immediately or over the next few days in hospital, are described here.

  • Blood tests to check for any damage to your heart muscle. These will include a test for a protein 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 be normal at first 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. It also checks for fluid in your lungs, which might happen if your heart isn’t working well after 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 damage to your heart muscle, and how this might have affected how well it works.

Treatment of a heart attack

Emergency medical treatment for a heart attack is vital, so call 999. Getting to hospital quickly greatly improves your chance of survival.

Before you get to hospital

If aspirin is readily available, chew a single 300mg tablet unless you know you’re allergic to it. Aspirin helps to reduce blood clots. The aspirin should be chewed because that lets it work more quickly than if it’s swallowed.

Paramedics will come to you as soon as possible after a 999 call for suspected heart attack. Sit and rest in the position that’s most comfortable until they 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.

Treatment of cardiac arrest

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 a defibrillator can be used. A defibrillator is a device which gives a large electric shock through the wall of your chest to restore a regular heartbeat. If you have a cardiac arrest, the paramedic may need to use a defibrillator. Defibrillators are now often kept in public places where members of the public may also be able to use them.

Hospital treatment

Your treatment will depend on how severe your heart attack is and how long it is since your symptoms started. Your doctor may recommend treatment to restore blood flow to the affected heart muscle. There are two main ways to do this.

  • A coronary angioplasty (also known as a primary angioplasty or percutaneous coronary intervention (PCI)). This is the most common way to restore blood flow. It 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. In some types of heart attack doctors won’t offer either of these treatments because they don’t help in all circumstances.

Occasionally a coronary angioplasty doesn’t work, or isn’t suitable for you. Your doctor may then offer you a procedure called 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

Medicines

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

  • antiplatelet medicines, which help prevent clots. Your doctor will probably recommend aspirin, either alone or along with another antiplatelet medicine
  • statins to help keep your cholesterol low
  • angiotensin-converting enzyme (ACE) inhibitors to improve blood flow to your heart muscle
  • beta-blockers, which help lessen your chance of having another heart attack

Taking these medicines if your doctor recommends them reduces your risk of another heart attack. Always read the patient information leaflet carefully that comes with your medicine. If you have any questions about your medicines or how to take them, ask your pharmacist.

As well as offering you medication, your doctor will encourage you to take steps to reduce any risk factors such as quitting smoking. See our section on prevention of a heart attack below for other lifestyle changes which may help.

Cardiac rehabilitation

If you’ve had a heart attack, your doctor will probably recommend you take part in a cardiac rehabilitation programme. This aims to help you recover from your heart attack and get back to as full a life as possible afterwards. Cardiac rehabilitation can also reduce your risk of dying after a heart attack so it’s an important part of your treatment.

You should be told about cardiac rehabilitation while you’re in hospital, where a member of the cardiac rehabilitation team may visit you.

Cardiac rehabilitation programmes usually start about four to six weeks after you leave hospital. They’re usually run in hospitals, community centres or leisure centres. Programmes vary in how many weeks they run for, but you’ll probably have a couple of sessions a week. Before you start, a cardiac rehabilitation specialist will talk with you and agree the best programme for you. This will usually include time for you to learn about your condition and its treatment, and what to look out for in future. It will also include exercise together with advice on relaxation, lifestyle choices and taking your medicines. The exercises will be set for you by a specialist nurse or physiotherapist (a health professional who specialises in maintaining and improving movement and mobility).

Going to cardiac rehabilitation sessions can make you feel more confident about looking after your health. They also let you 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 of a heart attack

The underlying cause of most heart attacks is coronary heart disease due to atherosclerosis. This is when 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.

Problems with the heart and blood vessels (cardiovascular diseases) tend to run in families. You’re more likely to have cardiovascular disease, which can lead to a heart attack, if one of your close relatives has (or had) it. This is particularly true if the relative was a male under 55 or a female under 65 when they got heart trouble. If you’re in this situation, it’s important that you do what you can to reduce your other risks of heart attack by making lifestyle changes.

Complications of a heart attack

The good news is that more than two out of three people who have a heart attack survive.

If you have a heart attack, 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.

If you have a heart attack, complications may include the following.

  • Arrhythmia (abnormal heart rhythms). Your heart may beat too fast, or too slowly, or the rhythm may become irregular. Arrhythmias can be life-threatening.
  • Angina, pain or discomfort in your chest which carries on after your heart attack, especially when you’re active or exercising. This is a sign of reduced oxygen supply to your heart.
  • Heart failure, when it’s more difficult for your heart to pump enough blood and oxygen around your body. This is because the heart attack can damage your heart muscle and make it weaker.
  • Depression or feeling low. You may be worried about having another heart attack 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:

Prevention of a heart attack

You can reduce your risk of developing coronary heart disease and having a heart attack by adopting a healthy lifestyle.

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:


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

If you’re over 40, your GP may offer you a health check called a cardiovascular risk assessment. They’ll ask you about your health, family history and lifestyle. They’ll then use this information, 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 10 years.

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. If you have any questions about your medicines or how to take them, ask your pharmacist.

Frequently asked questions

  • We often think of men having heart attacks, but it’s important to know that women get them too. For every 100 people who have a heart attack, 40 are women. Twice as many women die of a heart attack as die of breast cancer each year.

    Although most people, men and women, have the well-known symptom of crushing chest pain, women are more likely to have fewer typical symptoms. These include:

    • chest pain which is sharp, burning or aching
    • pain in your upper back, arm, neck or jaw
    • unusual tiredness or weakness
    • shortness of breath
    • dizziness
    • indigestion

    Women tend to wait longer before calling for emergency medical help when they have heart attack symptoms. This may be because they don’t think it could possibly be a heart attack, or they don’t want to cause a fuss. This delay can have a big effect on whether you survive a heart attack.

    So the message is – women have heart attacks too. If you think you’re having a heart attack, don’t delay. Call 999 for emergency medical attention.

  • 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. It’s also really important to go to your cardiac rehabilitation sessions where you’ll get lots of help, advice and support for your recovery.

    Here are some other things you may need to bear in mind during your recovery.

    • 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. You should aim to rest before you get too tired.
    • 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 tasks. If your job is physically demanding, you may need to take some more time to recover before you can go back. Talk to your doctor and your employer about what’s 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.

    See our next FAQ for advice about driving after you’ve had a heart attack.

  • If you’ve had a heart attack, you should contact your motor insurer so that you’re aware of their recommendations. The law about driving after a heart attack is given here. Rules vary according to what type of licence you have, and your treatment.

    Car or motorcycle licence

    You don’t have to tell the Driver and Vehicle Licensing Agency (DVLA) that you’ve had a heart attack, but there are some restrictions on your driving.

    After your heart attack you should stop driving for:

    • one week if you had a coronary angioplasty, it was successful and you don’t need any more surgery
    • four weeks if you had an angioplasty but it wasn’t successful
    • four weeks if you had a heart attack but didn’t have angioplasty

    If you’re not sure, check with your doctor.

    Bus, coach or lorry licence

    If you drive large goods vehicles or passenger-carrying vehicles, you must tell the DVLA you’ve had a heart attack. You won’t be able to drive these vehicles for at least six weeks. You’ll then need to have further tests which will determine when you can go back to driving them. 

  • 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 -–see our section ‘symptoms of a heart attack’ above. 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.

  • 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 ‘less good days’, perhaps for between two and six months after your heart attack. You may have problems sleeping and feel irritable a lot. This should improve as time goes by.

    However, you may find that this normal emotional response doesn’t go away and your feelings may begin to interfere with your quality of life. Have a look at our information on depression for symptoms to look out for. If you think this might be affecting you, talk to your GP or nurse about getting help and advice because 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.

  • Heart attacks are most common in older adults, and are usually linked to having coronary heart disease. The average age that someone has a first heart attack is 65 for men and 72 for women. It’s much less common for people under the age of 45 to have a heart attack but it does happen. It’s hard to be certain about how many younger people have coronary heart disease, and so are at risk of a heart attack. One estimate is that, for every 100 people with coronary heart disease, only three are under 40.

    Men, and especially those who smoke, may be more at risk of having coronary heart disease leading to a heart attack at a relatively young age. You’re also more likely to have a heart attack as a younger adult if heart disease runs in your family.

    Other, rarer causes of heart attacks in younger adults include:

    • using cocaine as a recreational drug, especially when combined with smoking
    • spontaneous coronary artery dissection (SCAD), where there’s a tear in the artery to the heart muscle. This is more common in women
    • medical conditions which cause the blood to clot more readily, including antiphospholipid syndrome and nephrotic syndrome

    You may have heard news stories about young, fit people collapsing with a ‘heart problem’, often while exercising. This may sometimes be reported as a heart attack. However, it’s most likely to be due to an abnormality of the heart which affects the heart rhythm and stops it pumping properly. This may cause a cardiac arrest – see our sections on symptoms and treatment above to find out more about cardiac arrest. This heart abnormality may have been present since birth.

    If one of your close relatives has had a heart attack at an early age, mention this to your GP. They can discuss with you whether this may affect your own risk of having a heart attack. 


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  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, January 2018
    Expert reviewer, Dr Tim Cripps, Consultant Cardiologist
    Next review due January 2021



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