Heart attack

More than a million people in the U.S. suffer a heart attack each year, and about half of them die. It’s imperative to get emergency treatment if you suspect a heart attack. The teams at Atrium Health Floyd and Harbin Clinic can help treat heart attacks and discover the underlying reasons why you might have had one.

What is a heart attack?

A heart attack is what happens when the heart does not receive enough oxygen-rich blood, usually due to blockage. 85% of damage to the heart is suffered in the first two hours. Survivors often suffer permanent heart damage when they don’t get help immediately.

A person having a heart attack may not always experience pain or pressure in the chest. You should be alert for the following:

• A sharp pain that occurs with coughing or breathing
• Pain that spreads above the jawbone or into the lower body
• Difficult or labored breathing

If you or someone you know may be having a heart attack, don’t wait. Call 911 immediately. 

What causes a heart attack?

A heart attack happens when the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked and the heart can’t get oxygen. Most heart attacks occur as a result of coronary heart disease, a condition in which a waxy substance called plaque builds up inside the coronary arteries, decreasing blood flow to the heart. 

Atherosclerosis

Over years, the plaque buildup results in a condition known as atherosclerosis. An area of plaque may eventually rupture inside an artery, causing a blood clot to form on the plaque’s surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn’t treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems. 

Coronary artery spasm

A less common cause of heart attack is a severe spasm of a coronary artery, which cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren’t affected by atherosclerosis. What causes a coronary artery to spasm isn’t always clear but may include:

• Certain drugs, such as cocaine
• Cigarette smoking
• Emotional stress or pain
• Exposure to extreme cold 

Heart attack symptoms

The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they’ve had a heart attack. A second heart attack may not have the same symptoms as the first. For this reason, it is important for everyone to know the most common symptoms:

• Chest discomfort, such as pressure, squeezing or pain
• Shortness of breath
• Discomfort in the upper body (arms, shoulder, neck or back)
• Nausea, vomiting, dizziness, lightheadedness or sweating
• Breaking out in a cold sweat
• Chronic fatigue
• Nausea and vomiting
• Light-headedness or sudden dizziness

Heart attack diagnosis

A doctor will diagnose a heart attack based on symptoms, test results, and medical and family history. Possible tests include:

• Electrocardiogram (EKG): An electrocardiogram is a simple, painless test that detects and records the heart’s electrical activity. It can show signs of heart damage due to coronary heart disease and signs of a previous or current heart attack.
• Blood tests: During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. Higher than normal levels of these proteins suggest a heart attack.
• Coronary angiography: Coronary angiography is a test that uses dye and special x rays to show the insides of the coronary arteries. This test often is done during a heart attack to help find blockages. 

Heart attack risk factors

Certain risk factors make a heart attack more likely. Some are beyond an individual’s control. For example, men over 45 and women over 55 (or post-menopausal) are at higher risk for heart attack. Other risk factors are easier to fix, such as:

• Smoking
• High blood pressure
• High blood cholesterol
• Obesity or being overweight
• Eating foods high in saturated fat, trans fat, cholesterol or sodium
• Lack of routine physical activity
• High blood sugar due to insulin resistance or diabetes

Less manageable risk factors of heart attacks include your age, having a family history of heart disease, and preeclampsia.

Risk of a repeat heart attack

Those who have previously had a heart attack are at a higher risk for another. Knowing the difference between angina and a heart attack is important. Angina is chest pain that occurs in people who have coronary heart disease. The pain from angina usually occurs after physical exertion and goes away in a few minutes when you rest or take medicine as directed. The pain from a heart attack usually is more severe than the pain from angina. Heart attack pain doesn’t go away when you rest or take medicine.

The symptoms of a second heart attack may not be the same as those of a first heart attack. If it is unclear whether pain is from a heart attack or angina, call 911.

Heart attack recovery

Many people survive heart attacks and live active, full lives. Fast help can limit damage to the heart. Less heart damage improves the chances of a better quality of life after a heart attack.

Medical follow-up

After a heart attack, treatment for coronary heart disease will help prevent another heart attack. Improved diet, increased physical activity, maintaining a healthy weight and quitting smoking may all be parts of pivoting to a healthier lifestyle following a heart attack.

Most people who don’t have chest pain or discomfort following a heart attack can safely return to most of their normal activities within a few weeks, and most can begin walking right away.

Heart attack prevention

Lowering risk factors, such as pivoting to a healthier lifestyle and seeking ongoing medical care, can help prevent a heart attack. However, when a heart attack is a possibility, it’s important to have an emergency action plan. Knowing the symptoms of a heart attack and when to call 911 can help increase the odds of survival.

Heart attack treatment

Early treatment for a heart attack can prevent or limit damage to heart muscle. Acting fast by calling 911 at the first symptom of a heart attack is essential. The teams at Atrium Health Floyd and Harbin Clinic can begin diagnosis and treatment even before a patient arrives at the hospital. Certain treatments usually begin even before the diagnosis is confirmed, including:

• Aspirin to prevent further blood clotting
• Nitroglycerin to reduce your heart’s workload and improve blood flow
• Oxygen therapy
• Treatment for chest pain

Once the diagnosis of a heart attack is confirmed or strongly suspected, doctors start treatments promptly to try to restore blood flow through the blood vessels supplying the heart.

• Clot-busting medicine: Thrombolytic medicines, also called clot busters, are used to dissolve blood clots that are blocking the coronary arteries. To work best, these medicines must be given within several hours of the start of heart attack symptoms. Ideally, the medicine should be given as soon as possible.
• Pacemaker: A pacemaker is a device implanted close to the heart to keep it beating at the right speed and rhythm. It's usually used for hearts that beat too slowly or irregularly.
• Balloon angioplasty: Following a heart catheterization, a balloon-tipped catheter is inserted into the narrowed blood vessel. The balloon is inflated to open the blood vessel and improve blood flow.
• Abdominal aortic aneurysm repair: This surgical procedure is used to repair an aneurysm found in the aorta where it passes through the abdomen. An aneurysm is a weak and bulging area of a blood vessel.
• Atherectomy: Plaque is shaved away from the blood vessel wall to increase blood flow.
• Balloon pump placement: This is a device inserted into the heart for a short time to help the heart pump blood until a long-term treatment can be given or the short-term problem is resolved.
• Defibrillator placement: A defibrillator sends an electrical shock to the heart when a dangerous heart rhythm is detected or a person's heart has stopped beating. An internal defibrillator is implanted in the body.
• Heart rhythm conversion: This procedure introduces an electrical charge to the heart to help the heart return to normal rhythm.
• Pericardial window surgery: A small part of the pericardium, a fluid sac that surrounds the heart, is removed to allow excess fluid to drain.
• Stent placement: A flexible mesh tube, or stent, is mounted onto a balloon catheter and inserted into the narrowed area of the artery. The balloon is inflated to open the stent and flatten the plaque. The stent remains to hold the artery open. 

Other treatments for heart attack include

• Cardiac rehabilitation
• Heart-healthy lifestyle changes
• Medical procedures
• Medicines