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What Is a Heart Attack? Symptoms, Causes, Diagnosis, Treatment, and Prevention

A heart attack, or myocardial infarction, occurs when there is a blockage in a coronary artery, affecting the flow of oxygen-rich blood to your heart.

Having a heart attack is a medical emergency. Blocked or reduced blood flow to your heart damages the heart muscle. If blood flow is not restored quickly, the heart muscle will begin to die.

Symptoms of a heart attack can vary greatly from person to person. They’re likely to be more severe if you’re having a massive heart attack, in which a blood clot completely blocks an artery leading to your heart.

Common heart attack symptoms include:

  • Chest pain (angina)
  • Pain or discomfort in your jaw or neck
  • Pain or discomfort in your arms, shoulders, or back
  • Indigestion or sense of choking
  • Shortness of breath
  • Sweating, especially a cold sweat
  • Nausea or vomiting
  • Light-headedness or dizziness
  • Weakness
  • Anxiety
  • Rapid or irregular heartbeat

Heart Attack Symptoms in Men vs. Women

While heart attack symptoms can vary widely, men and women typically experience some general differences.

Women are more likely to experience vague or atypical symptoms, such as fatigue, sleep disturbances, anxiety, shortness of breath, or pain in their arms, back, neck, jaw, or stomach without chest discomfort.

 Women may also experience indigestion or a sense of pressure or discomfort in their chest, rather than pain.

It’s especially important for women to look out for potential signs of a heart attack that might not fall under classic symptoms and to seek immediate medical treatment immediately if concerned.

Most heart attacks are caused by coronary artery disease (CAD), in which your arteries become narrowed and hardened due to the buildup of a fatty substance called plaque.

Plaque is a combination of fat, cholesterol, and other substances that can build up in the inner lining of your artery walls. This buildup is known as atherosclerosis, a hardening of the arteries.

Blood flow to your heart can become completely cut off or severely reduced when a blood clot gets lodged in any artery that has been previously narrowed by a buildup of plaque.

Less commonly, heart attacks may be caused by a spasm, or tightening, of a coronary artery. Spasms may be related to smoking, high blood pressure, alcohol withdrawal, recreational stimulant drugs, or exposure to extreme cold or stress.

Preventing a heart attack starts with understanding your risks. There are three common risk factors for heart disease that can put you at greater risk for a heart attack:

Other risk factors also increase your likelihood of having a heart attack:

  • Being male age 45 or older
  • Being female age 55 or older
  • Obesity
  • Diabetes
  • Family history of heart disease
  • Lack of physical activity
  • Stress
  • Use of recreational stimulant drugs (including cocaine and amphetamines)
  • Autoimmune diseases (such as rheumatoid arthritis and lupus)

You can lower your heart attack risk by not smoking, staying physically active, eating a heart-healthy diet, and keeping your weight, blood pressure, and cholesterol under control.

When you arrive at the hospital, you’ll be asked about your symptoms and history of heart disease. You’ll also be monitored and given these initial tests to see if you’re having a heart attack:

  • Electrocardiogram (ECG or EKG)
  • Blood tests

An ECG can detect whether electrical signals from your heart are abnormal, indicating a heart attack in progress or evidence of an old heart attack.

Blood tests can detect proteins or enzymes that enter your bloodstream when your heart is damaged from a heart attack.

If a heart attack is confirmed, doctors may order additional imaging tests to help guide your treatment:

Types and Prognosis of Heart Attack

Heart attacks are divided into types based on severity.

STEMI Heart Attack This is the deadliest type of heart attack. It happens when a coronary artery is completely blocked.

STEMI is short for ST segment elevation myocardial infarction. This refers to changes that can be seen on an ECG or EKG.

Sometimes called a massive heart attack, a STEMI heart attack causes significantly reduced blood flow to the heart. Areas of the heart muscle quickly begin to die after a massive heart attack.

NSTEMI Heart Attack This type of heart attack happens when blood flow to your heart through a coronary artery is severely restricted but may not be entirely blocked.

NSTEMI stands for non-ST segment elevation myocardial infarction.

Sometimes called a mild heart attack, an NSTEMI heart attack usually causes less damage to the heart than a STEMI heart attack.

Silent Heart Attack Some people have a heart attack with mild, brief symptoms or even no noticeable symptoms at all, which is why it’s known as a silent heart attack.

Although they don’t involve severe symptoms, silent heart attacks are far from harmless. They can cause permanent damage to the heart muscle.

Silent heart attacks account for about 45 percent of all heart attacks.

 Silent heart attacks are more common among women than men. Perhaps this is because women tend to have atypical symptoms with heart attacks that may go unnoticed or ignored.

If you experience symptoms that may indicate a heart attack for longer than five minutes, it’s important to seek emergency medical attention immediately.

Don’t delay treatment by waiting to see if your symptoms go away. Even if your symptoms let up or change, there may be ongoing damage to your heart.

The sooner treatment is administered, the less likely a heart attack is to cause significant or long-lasting damage to your heart muscle.

Unfortunately, many people delay treatment for a heart attack by several hours, increasing the risk of long-term disability or death.

Depending on your treatment needs, you may need to be hospitalized for a heart attack for several days or longer.

Once you arrive at a hospital after experiencing heart attack symptoms, doctors will confirm a heart attack through a combination of heart monitoring, blood tests, and imaging tests.

You may be started right away on an intravenous (IV) clot-busting drug, which will help dissolve the blood clot that caused your heart attack.

More commonly, you will undergo a procedure to open up your blocked artery and keep it open, known as coronary angioplasty and stenting.

In certain cases, you may require bypass surgery, in which a heart surgeon uses blood vessels from other areas of your body to restore blood flow around blocked arteries to your heart.

Medication Options

When you call 911 and report your symptoms, you may be instructed to take aspirin. Emergency medical personnel may also give you aspirin immediately.

Once your treatment begins, you may receive the following IV drugs to treat a heart attack:

Thrombolytics Known as clot-busting drugs, these medications help dissolve blood clots that are blocking blood flow to your heart.

Antiplatelet Drugs Also known as platelet aggregation inhibitors, these drugs prevent new clots and stop existing ones from growing.

Other Blood Thinners You may receive drugs such as heparin to reduce the formation of blood clots.

Nitroglycerin This drug helps your blood vessels widen (dilate) and can help improve blood flow to your heart, in addition to reducing chest pain (angina).

Beta Blockers These drugs help relax your heart muscle and lower blood pressure, potentially limiting heart muscle damage.

ACE Inhibitors These drugs also help lower blood pressure, meaning your heart has to work less hard.

Pain Relievers If you’re in pain, you may be given morphine or another drug.

Invasive and Surgical Procedures

In addition to treatment with drugs, you may need to undergo a procedure to restore blood flow to your heart:

Coronary Angioplasty and Stenting This common procedure involves inserting a long, narrow tube (catheter) into your coronary artery, inflating a tiny balloon in the area of a blockage, and leaving a mesh tube (called a stent) to keep it open.

Coronary Artery Bypass Surgery For more severe artery blockages, such as those typically seen in a massive heart attack, you may need to undergo surgery in which blood vessels are sewn around a blocked artery. Ideally, this is done a few days after your heart attack, but it may also need to be done more urgently.

Cardiac Rehabilitation

After initial treatment has been given and the patient has stabilized, most hospitals offer cardiac rehabilitation as part of the recovery process after a heart attack. This is a medically supervised exercise and education program that typically begins while you’re in the hospital and continues for several weeks or months after you go home.

Cardiac rehabilitation focuses on three main goals: exercise counseling and training, education for heart-healthy living, and stress reduction.

You can help prevent a heart attack by managing certain risk factors and making healthy lifestyle choices.

It’s important to keep tabs on your blood pressure, cholesterol levels, and body weight, and make lifestyle modifications or get medical treatment when any of these reaches an unhealthy level.

 If you have diabetes, it’s also important to manage your blood sugar well.
A heart-healthy lifestyle can help you prevent a heart attack. It involves not smoking, getting enough physical activity, and following a heart-healthy diet that’s rich in fruits, vegetables, fiber, healthy fats, and lean sources of protein.

 You should drink alcohol in moderation, if at all, and try to reduce or manage stress.

Your doctor may also prescribe certain medications to reduce your heart attack risk. These may work by reducing your blood’s ability to clot, lowering your blood pressure, or improving your cholesterol levels.

Exercise and Heart Attack Prevention

Some research suggests that getting enough exercise may not only help prevent a heart attack but also increase your chances of survival. A study found that people who exercised regularly were half as likely to die when they had a heart attack than those who were sedentary. It even appears that the more intense the exercise, the better the odds were of surviving a heart attack.

One possible explanation for this connection is that when you exercise a lot, extra blood vessels may grow around the heart. Known as collateral blood vessels, they provide a way for blood to flow even if an artery gets blocked.

Exercise may also help lower your blood pressure, as well as raise levels of HDL (“good”) cholesterol.

Certain complications may arise after a heart attack, depending on the location and extent of damage to your heart.

Arrhythmia

Arrhythmias happen when the electrical signals that control heartbeats become abnormal or disorganized.

 An arrhythmia may cause heart palpitations or an irregular heartbeat, possibly leading to serious medical problems.

Sudden Cardiac Arrest

An electrical disturbance can cause your heart to stop beating altogether. This condition can be fatal without immediate treatment.

Heart Failure

Damage to your heart from a heart attack or coronary heart disease can make the muscle weaker, impacting its ability to pump enough blood. This may be a temporary or permanent problem.

Valve Problems

A heart attack may damage one of the four valves that keep blood flowing in the correct direction through your heart.

Valve problems can lead to an abnormal heart murmur when a doctor listens to your heart, as well as fatigue, dizziness, shortness of breath, and swelling in your ankles and feet.

Depression

A heart attack can be a scary, stressful, life-changing event.

Depression is common after a heart attack, along with fear and anger.

 If depression interferes with your sleeping or eating, or if you feel worthless or have thoughts of suicide, reach out to your doctor and people close to you.

Life After a Heart Attack

A heart attack is often a devastating event that severely disrupts your life. Still, many people find ways to live a full, enjoyable life after having one.

Some people experience their heart attack as a wake-up call that they need to make certain lifestyle changes.

Eating habits may need to be changed after a heart attack, along with lifestyle factors like stress and physical activity.

Recovering from a heart attack can be physically and emotionally taxing, with some people experiencing depression stemming from their limitations.

It’s important to reach out for any help you need to deal with recovery-related challenges.

Can You Have Sex After a Heart Attack?

A heart attack can take a toll on your romantic relationships and sex life, but that doesn’t mean you should give up on sex afterward.

It may take some recovery time before you can resume sexual activity, and you may need to make certain modifications to your sexual practices.

Impaired sexual function is common after a heart attack, yet many people are reluctant to discuss this problem with their doctor. You may improve your sexual function by working on your overall fitness and endurance.

Many doctors tout the benefits of sex and intimacy for heart attack survivors, such as stress reduction, improved emotional well-being, and lower blood pressure.

Someone in the United States has a heart attack every 40 seconds, and 1 in 5 heart attacks is silent, meaning that the person isn’t aware of it and doesn’t seek immediate medical attention.

About 805,000 people in the United States have a heart attack each year. Out of these, about 605,000 are the person’s first heart attack, while 200,000 are in people who have previously had one.

The average age for a first heart attack is 66 for men and 72 for women.

Fewer than 10 percent of heart attacks are fatal.

 This rate has dropped in recent decades, likely due to wider use of aggressive treatments in the early stages of a heart attack.

Still, the broader category of heart disease is the leading cause of death in the United States, accounting for about 695,000 deaths each year, or 1 in 5 of all deaths annually.

While the overall risk of heart disease varies among different racial and ethnic groups in the United States, there is less data on heart attacks specifically.

Black Americans have the highest rate of cardiovascular disease in the United States, with approximately 47 percent affected. That number is expected to increase to 50 percent by the year 2035.

Non-Hispanic Black Americans have the highest rate of death from heart disease, at 208 per 100,000 people.

 The next highest death rates are found in non-Hispanic white Americans, at 169 per 100,000, Hispanic Americans at 114 per 100,000, and Asian Americans at 86 per 100,000.
Researchers have found that among U.S. hospitals with sufficient data, the rate of death from heart attacks in Black patients was nearly identical to that of white patients. But the hospital readmission rate for Black patients was 4.3 percentage points higher than for white patients.

Heart attacks are usually caused by CAD, which can lead to these other symptoms and events that are sometimes mistaken for a heart attack.

Angina (Chest Pain)

While a heart attack often causes chest pain, this symptom can also be caused by CAD even if you’re not having a heart attack. It’s important to seek immediate medical attention if your angina gets worse or comes with other symptoms.

Cardiac Arrest

Cardiac arrest is a life-threatening arrhythmia that causes sudden loss of heart function and is deadly unless normal heart rhythm is restored within a few minutes. It happens when the heart’s electrical system malfunctions.

Heart Failure

When your heart’s pumping action can’t keep up with your body’s need for oxygen and other nutrients that blood delivers, it’s known as heart failure. This serious, chronic condition can often be managed with medications and lifestyle changes.

WomenHeart
This national patient-centered organization is dedicated to helping women with heart disease. Its website is full of information on preventing, diagnosing, and treating heart disease in women, and boasts nearly 100 patient support groups in 30 states.

American Heart Association Support Network
Connect with fellow heart attack survivors in online forums supported by the AHA. You can share your story or get answers to your questions about managing heart health. The AHA also offers online support for caregivers helping out a loved one who has had a heart attack.

Additional reporting by Ashley Welch.

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