A heart attack, also known as myocardial infarction or coronary thrombosis, happens when a coronary artery (a blood vessel that supplies the heart with blood) carrying oxygen-rich blood to the heart is blocked. If the blood supply is completely blocked, part of the heart muscle may be starved of oxygen, can become damaged and may die.
This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.
The risk of having a heart attack increases as you get older and is more common among men than women.
You're more likely to have a heart attack if you:
- 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
If you have a heart attack, you will most likely feel pain or discomfort in the centre of your chest. This central chest pain is often described as a sensation of heaviness, tightness or squeezing, and may come on suddenly causing you to collapse. The pain may feel like bad indigestion.
Other symptoms may include:
- pain spreading to the jaw, neck, arms, 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, life-threatening heart rhythms may develop, which is why a heart attack is a medical emergency.
If you suspect that you or someone you're with is having a heart attack, call for emergency help immediately.
Complications from a heart attack can vary widely from person to person. Some people may have few complications, whereas others may have many.
In the first few days of surviving a heart attack you may have an irregular heart beat, known as arrhythmia. You may also get angina, which is pain or discomfort in the chest after having a heart attack.
A heart attack can damage your heart muscle and cause your heart's pumping action to be weaker, making it more difficult to pump enough blood and oxygen around the body. This is known as heart failure. The larger the area of your heart muscle damaged by a heart attack, the more likely you are to have heart failure.
It's also common for people to feel low or depressed after having a heart attack. You may be worried about having another heart attack or concerned about your recovery. If you're worried about how you’re feeling, speak to your GP for advice.
It's very rare but other complications may include blood clots in the lungs, rupture of the heart muscle, inflammation of the membrane covering the heart (pericarditis), or a bulging weakness in the heart muscle (aneurysm).
When you get to hospital, a doctor or nurse will ask you about your symptoms and examine you. He or she will also ask you about your medical history. You may have:
- 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
- an ECG - this checks the electrical actvity of your heart and helps to diagnose any partial or complete blockages of your coronary arteries
- a coronary angiogram – a test that uses an injection of a special dye into the blood vessels to make them clearly visible on X-ray images
- an echocardiogram – this uses ultrasound (sound waves) to show the pumping action of your heart and valves
Emergency medical treatment is vital – getting to hospital quickly and receiving specialist care greatly improves your chance of survival. If you have some aspirin, chew a single tablet, unless you know that you're allergic to it. Aspirin reduces blood clots and can help to prevent the clot that is blocking the artery from spreading.
In response to an emergency call for a suspected heart attack, the ambulance service will send a paramedic as soon as possible. Sit and rest in a position that is most comfortable until the paramedics arrive. He or she will give you initial treatment and provide transport to a hospital quickly and safely for further treatment. You may also be given oxygen and medicines for pain relief.
During or after a heart attack, you may have an irregular heart beat, known as arrhythmia. The most serious form of this is called ventricular fibrillation. This is when the electrical activity of the heart becomes chaotic and the heart stops pumping, and quivers or ‘fibrillates’ instead. This is known as a cardiac arrest and the paramedic may need to use a defibrillator, which gives a large electric shock through the wall of your chest and can restore a regular heartbeat.
Your treatment will depend on how severe your heart attack was. 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.
- 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 having a stroke so you may not be given these if you're at an increased risk of this, for example if you have recently had surgery.
- A coronary angioplasty. This can be done as an emergency procedure (also known as a primary angioplasty) or as a planned procedure. A coronary angioplasty aims to widen your artery by inflating a balloon in your narrowed or blocked coronary artery. A wire mesh tube called a stent is usually inserted to hold the coronary artery open.
Sometimes a coronary angioplasty isn't possible, for example if the blockages in your arteries are too long for a stent or they’re difficult to get to, 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 the 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 aspirin, antiplatelets (eg clopidogrel or prasugrel), statins (eg simvastatin), angiotensin-converting enzyme (ACE) inhibitors (eg ramipril), and beta-blockers (eg propranolol). A fish oil capsule (Omacor) may also be given.
Your risk of further heart attacks can be reduced by taking these medicines. Always read the patient information leaflet that comes with your medicine.
For the best possible recovery after a heart attack, you can start a cardiac rehabilitation programme. These usually include an exercise regime devised by a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility), along with advice on relaxation, lifestyle and treatment choices. A cardiac rehabilitation programme usually lasts between 11 and 16 sessions and ideally begins when you’re admitted to hospital and continues after you leave.
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, for 30 minutes at least five days a week
- eating a low-fat and high-fibre diet with 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 chances of having another one.
1. How do I know that it's a heart attack and not something else?
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. So don't risk it. If you get any chest pain that is heavy or tight, or if it spreads to your throat and arms, call for emergency help immediately.
The symptoms of a heart attack can vary from person to person. Some people have severe chest pain that makes them collapse whereas other people may feel unwell but have no pain at all.
However, common symptoms of a heart attack may include:
- pain in the centre of your chest that may feel like pressure or tightness
- pain spreading to your jaw, neck, arms, 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 chance you or someone else will have of making a full recovery.
2. Can I go back to my normal life after a heart attack?
Most people can lead a normal life after a heart attack. However, this will depend on how severe your heart attack was, the treatment you received and how well you recovered. It will also depend on the type of work that you do and the activities you have planned.
A heart attack damages part of the heart muscle. After a heart attack, your body replaces the damaged part of the muscle with scar tissue. Within two or three months your heart could be working as well as it did before your heart attack. However, this isn't the case for everyone. If your heart attack caused severe damage to your heart muscle, your heart's pumping action may not be as good as it was before. You may find that you become breathless, tired and have swollen ankles. This is called heart failure and it may mean you have to make some changes to your lifestyle.
After your heart attack you're likely to be offered a cardiac rehabilitation programme. Some people may find that they aren't able to do as much as they previously did. However, attending a cardiac rehabilitation programme will increase your chances of getting back to life as before as quickly as possible.
If you recover well from your heart attack and have no complications such as heart failure or a blood clot, you can gradually start to return to life as before. The following are some things you may need to bear in mind.
- You will usually be able to start driving again after four weeks. If you drive large goods vehicles or passenger-carrying vehicles, you will need to have further tests, such as an exercise ECG. Your return to driving will depend on the results of these tests.
- You will probably be able to return to work within six weeks, unless your job is physically demanding in which case it may take longer. 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. Generally it's safe to start having sex again if you can climb two flights of stairs briskly without becoming breathless or getting chest pain.
3. I have been feeling quite anxious and depressed since my heart attack. Is this usual?
It's common for people to feel anxious, depressed and frightened after having a heart attack. Most people start to feel better as they recover, but some people 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.
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 you need.
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.
- Coronary heart disease statistics 2010. British Heart Foundation Statistics Website. www.heartstats.org, published 18 October 2010
- Myocardial infarction. eMedicine. www.emedicine.medscape.com, published 24 June 2010
- Heart attack. American Heart Association. www.heart.org, accessed 21 March 2011
- Wyatt JP, Illingworth RN, Graham CA, et al. Oxford handbook of emergency medicine. 3rd ed. Oxford: Oxford University Press, 2006:72–79
- Heart attack. British Heart Foundation. www.bhf.org.uk, accessed 3 March 2011
- Cardiac arrhythmias in coronary heart disease. Scottish Intercollegiate Guidelines Network (SIGN). February 2007. www.sign.ac.uk
- Myocardial infarction – secondary prevention. Clinical Knowledge Summaries. www.cks.nhs.uk, published December 2007
- Acute coronary syndromes (ACS). The Merck Manuals. www.merckmanuals.com, published December 2007
- ST-elevation myocardial infarction. BMJ Best Practice. www.bestpractice.bmj.com, accessed 21 March 2011
- Joint Formulary Committee. British National Formulary. 60th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2010
- Acute coronary syndromes. Scottish Intercollegiate Guidelines Network (SIGN), February 2007. www.sign.ac.uk
- Longmore M, Wilkinson IB, Rajagopalan S. Oxford handbook of clinical medicine. 6th ed. Oxford: Oxford University Press, 2004:120–23
- Ventricular fibrillation. American Heart Association. www.heart.org, published 4 March 2011
- Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction. National Institute for Health and Clinical Excellence (NICE), October 2002. www.nice.org.uk
- Coronary angioplasty. British Heart Foundation. www.bhf.org.uk, published May 2009
- Post myocardial infarction. Secondary prevention in primary and secondary care for patients following a myocardial infarction. National Institute for Health and Clinical Excellence (NICE), May 2007. www.nice.org.uk
- Heart attack - heart information series number 7. British Heart Foundation. www.bhf.org.uk, published September 2006
- For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Driver and Vehicle Licensing Agency. www.dft.gov.uk, published August 2010
Talk to us
Contact our health management consultant to get details and advice.2517 5860