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Myocardial infarction is the technical name for a heart attack. A heart attack occurs when an artery leading to the heart becomes completely blocked and the heart doesn’t get enough blood or oxygen. Without oxygen, cells in that area of the heart die (called an infarct).
A heart attack is a medical emergency. If you, or someone you know, has any of the symptoms below, call 9-1-1 immediately. If you get prompt medical treatment, you can limit damage to your heart. Waiting even 10 minutes can be fatal. Although heart attack is the leading cause of death in the United States, up to 95% of people who are hospitalized with a heart attack survive.
Most heart attacks are caused by blood clots, which are caused by atherosclerosis (stiffening and narrowing of the arteries). High blood fats (triglycerides) and LDL or “bad” cholesterol form plaque inside arteries, narrowing the passageway and reducing the amount of blood that can flow through. Your lifestyle plays a crucial role in preventing a heart attack or recovering from one. Eating a heart-healthy diet and getting at least 30 minutes of exercise 5 days a week (or more) can greatly reduce your risk of heart attack.
Signs and Symptoms
Women may experience different symptoms than men. In women, along with chest pain, symptoms can include:
Heart attacks happen when an artery supplying your heart with blood becomes blocked. Without blood, the heart doesn’t get enough oxygen and cells in the heart start to die.
The most common cause of blocked arteries is atherosclerosis. No one knows the exact cause of atherosclerosis. But most researchers believe it begins with an injury to the innermost layer of the artery, known as the endothelium. The following factors are thought to contribute to the damage:
Once the artery is damaged, blood cells called platelets build up at the site to repair the injury. Over time, fats, cholesterol, and other substances also accumulate, which thickens and hardens the artery wall. The amount of blood that flows through the artery dwindles, and oxygen supply to organs also decreases. Blood clots may also form, blocking the artery.
Rarely, a spasm in a coronary artery (one that supplies blood to the heart) stops blood flow and can cause a heart attack.
The following risk factors increase your chances of developing atherosclerosis:
Also, people who have elevated homocysteine, C-reactive protein (CRP), and fibrinogen levels seem to have an increased risk of heart attack. These are markers of inflammation. But researchers aren't sure whether they contribute to heart disease or occur when you have heart disease. High homocysteine can be treated with folic acid. More research in these areas is currently underway.
If you think you are having a heart attack, don’t wait to be sure. Call 911 immediately. Treating a heart attack quickly can save your life, while delay can be fatal. In the emergency room, a doctor will ask you about your symptoms and perform a physical examination. The doctor will immediately run tests to determine your heart function. They may include:
Other tests include:
You can reduce your risk of heart attack by:
If you have high cholesterol, diabetes, or high blood pressure, follow your doctor’s instructions to keep these risk factors under control. You may need medications in addition to lifestyle changes. If you don't have heart disease yet or have not had a heart attack despite these risk factors, aggressive control can help prevent a heart attack. And, if you already have heart disease, aggressive control of these risk factors can prevent further heart attacks or other problems related to heart disease.
The goal when treating a heart attack is to restore blood flow to the affected area of the heart immediately, to preserve as much heart muscle and heart function as possible. If your doctor has prescribed nitroglycerin, take it while you are waiting for emergency medical personnel to arrive. Once at the hospital, your doctor may use drug therapy, angioplasty (using one of several methods to clear the blocked blood vessel, such as inflating a balloon inside it or holding it open with a device called a stent), and surgery.
Once you have been treated for a heart attack, making changes in your lifestyle (especially in your diet and exercise habits), and taking medications as prescribed are very important for avoiding recurrent heart attacks and even death. Although certain herbal remedies as well as relaxation techniques may also be used, they should never be used alone to treat a heart attack. A heart attack always requires emergency medical attention.
Making lifestyle changes can improve many of your risk factors for heart disease, including high cholesterol, high blood pressure, extra weight, high homocysteine, and elevated C-reactive protein. Cardiac rehabilitation programs generally involve teaching you about diet, physical activity, and relaxation techniques. To keep your risk factors low, you will need to follow the healthy habits taught in cardiac rehab, such as exercise and eating properly, for the rest of your life.
When you arrive at the hospital, you will likely be given medication to help your body cope with, or ward off, damage from the heart attack, including:
After you recover, other drugs are used to lower your risk of having another heart attack. They include:
ACE inhibitors -- widen blood vessels and make it easier for your heart to pump blood. Side effects can include chronic cough. ACE inhibitors include:
Beta-blockers -- slows heart rate, thus lowering blood pressure. These drugs include:
Statins -- help lower cholesterol. People who are pregnant or have liver disease should not take statins. They include:
Niacin (nicotinic acid) -- In prescription form, is sometimes used to lower cholesterol. Dietary supplements of niacin should not be used instead of prescription niacin, as it can cause side effects. Take niacin for high cholesterol only with your doctor's supervision.
Bile acid sequestrants -- lowers cholesterol; people who have high levels of triglycerides (fats in the blood) should not take bile acid sequestrants. These drugs include:
Fibric acid derivatives -- lower triglycerides and moderately lower LDL cholesterol. They include Gemfibrozil (Lopid).
Anticoagulants (blood thinners) -- help keep clots from forming. Your doctor may prescribe aspirin, warfarin (Coumadin), or Clopidogrel (Plavix)
Percutaneous coronary intervention (PCI) -- In primary PCI, the doctor performs a coronary angiogram (injecting dye into the arteries) to see where the artery is blocked. The doctor then performs balloon angioplasty (widening an artery with a balloon), often with stent placement, to keep the artery open.
Coronary artery bypass graft (CABG) -- This surgery bypasses the blocked arteries by using a graft of another blood vessel (usually from your arm or leg) to restore blood flow to the heart.
Nutrition and Dietary Supplements
Healthy eating habits can help reduce high cholesterol, high blood pressure, and excess weight -- three of the major risk factors for heart disease. The American Heart Association (AHA) has developed dietary guidelines that help lower fat and cholesterol intake and reduce the risk of heart disease and heart attack. The AHA does not recommend very low fat diets, because new research shows that "good" fats, such as those found in olive oil, are good for your heart.
Many fad diets are popular. But they may not help you lose weight and keep it off. And in some cases, they may not even be healthy. Any healthy diet will include a variety of foods. If a diet bans an entire food group (such as carbohydrates), it's probably not healthy.
The AHA recommends the following for healthy eating:
In addition, the AHA also recommends eating 2 servings of fatty fish (such as salmon or lake trout) per week; holding sodium (salt, including salt already added to food) to 2,400 mg per day or less; and limiting alcohol intake to one drink a day for women and two for men.
Diets for People with High Blood Pressure
People with high blood pressure especially need to lower the amount of sodium in their diet. The DASH diet (Dietary Approaches to Stop Hypertension) emphasizes a diet rich in fruits, vegetables, and low-fat or nonfat dairy products that provide high intake of potassium, magnesium, and calcium sources. Sodium intake should be between 1,500 mg to 2,400 mg per day (the lower, the better). Weight loss, regular exercise, and limiting alcohol are also very important factors for lowering blood pressure.
The Mediterranean Style Diet concentrates on whole grains, fresh fruits and vegetables, fish, olive oil, and moderate wine consumption. The Mediterranean Style Diet is not low fat; it is low in saturated fat, but high in monounsaturated fat. It appears to be heart healthy: In a long-term study of 423 patients who had a heart attack, those who followed a Mediterranean Style Diet had a 50 to 70% lower risk of recurrent heart disease compared with people who received no special dietary counseling.
Vitamins and Supplements
Some supplements may help lower your risk factors for heart attacks, such as high blood pressure or high cholesterol. Most do not work as well as prescription medications. But some can be used along with prescription medications in your treatment. If you have had a heart attack, or are at high risk of having one, ask your doctor before taking any supplements. Your physician should manage your heart disease, and you should not take supplements without your physician's approval. Many supplements can have negative interactions with medications used to treat heart disease.
Herbs should not be used in place of emergency medical attention for a heart attack, nor should they be used by themselves to lower your risk of heart attack after you've had one. However, certain herbs can be used along with prescription medications in your treatment, although many can interact with a variety of medications. The herbs below have the potential to interact with several different medications. It is critical that you consult your physician before adding any herbs to your regimen. If you have had a heart attack, or are at high risk of having one, ask your doctor before taking any herbs.
Homeopathy should not be used instead of immediate medical attention for a heart attack. However, homeopathy may be used to help reduce the risk of heart disease. Although few studies have examined the effectiveness of specific homeopathic remedies, professional homeopaths would recommend appropriate therapy to lower high blood pressure and cholesterol. Before prescribing a remedy, homeopaths take into account your constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for you as an individual.
Acupuncture may be helpful in reducing some risk factors for heart disease. Some studies show that it can help people who want to stop smoking, and it may help some people lose weight and lower their blood pressure.
Massage and Physical Therapy
Although few studies have examined the effectiveness of massage therapy for heart disease, massage has a relaxing effect and can reduce stress-related hormone levels. Lowering stress hormone levels can lower cholesterol and blood pressure, reducing your risk of heart disease. In addition, relaxation techniques may help you make lifestyle changes such as eating healthy, quitting smoking, and exercising. At least one study found that massage can lower blood pressure.
Prognosis and Complications
After a heart attack, a person's prognosis depends on how damaged the heart is. If the person is alive 2 hours after an attack, he or she has a good chance for survival, but may experience complications such as:
However, the good news is that heart attacks are not always disabling, especially when there are no complications. In fact, a full recovery is possible that allows you to do all the things you used to do, including sexual activity. Going through cardiac rehabilitation and committing to positive lifestyle changes can improve your chances of recovery.
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Review Date: 1/21/2014
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.
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