Heart attack
Myocardial infarction; MI; Acute MI; ST-elevation myocardial infarction; Non-ST-elevation myocardial infarction; NSTEMI; CAD - heart attack; Coronary artery disease - heart attackMost heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart is starved of oxygen and heart cells die.
The medical term for this is myocardial infarction.
Causes
A substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells.
A heart attack may occur when:
- A disruption in the plaque occurs. This triggers blood platelets and other substances to form a blood clot at the site that blocks most or all of the oxygen-carrying blood from flowing to a part of the heart muscle. This is the most common cause of heart attack.
The cause of heart attack is not always known, but there are well known risk factors.
Heart attack may occur:
- When you are resting or asleep
- After a sudden increase in physical activity
- When you are active outside in cold weather
- After sudden, severe emotional or physical stress, including an illness
Many risk factors may lead to the development of plaque buildup and a heart attack.
Risk factors may lead to the developmen...
Coronary heart disease (CHD) is a narrowing of the blood vessels that supply blood and oxygen to the heart. CHD is also called coronary artery disea...
Read Article Now Book Mark ArticleSymptoms
A heart attack is a medical emergency. If you have symptoms of a heart attack, call 911 or your local emergency number right away.
- DO NOT try to drive yourself to the hospital.
- DO NOT WAIT. You are at greatest risk for sudden death in the early hours of a heart attack.
Chest pain is the most common symptom of a heart attack.
Chest pain
Chest pain is discomfort or pain that you feel anywhere along the front of your body between your neck and upper abdomen.
Read Article Now Book Mark Article- You may feel the pain in only one part of your body OR
- Pain may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back
The pain can be severe or mild. It can feel like:
- A tight band around the chest
- Bad indigestion
Bad indigestion
Indigestion (dyspepsia) is a mild discomfort in the upper belly or abdomen. It often occurs during or right after eating. It may feel like:Heat, bu...
Read Article Now Book Mark Article - Something heavy sitting on your chest
- Squeezing or heavy pressure
The pain most often lasts longer than 20 minutes. Rest and a medicine to relax the blood vessels (called nitroglycerin) may not completely relieve the pain of a heart attack. Symptoms may also go away and come back.
Other symptoms of a heart attack can include:
- Anxiety
Anxiety
Stress is a feeling of emotional or physical tension. It can come from any event or thought that makes you feel frustrated, angry, or nervous. Stres...
Read Article Now Book Mark Article - Cough
Cough
Coughing is an important way to keep your throat and airways clear. But too much coughing may mean you have a disease or disorder. Some coughs are d...
Read Article Now Book Mark Article - Fainting
Fainting
Fainting is a brief loss of consciousness due to a drop in blood flow to the brain. The episode most often lasts less than a couple of minutes and y...
Read Article Now Book Mark Article - Lightheadedness, dizziness
Lightheadedness, dizziness
Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...
Read Article Now Book Mark Article - Nausea and vomiting
Nausea and vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
Read Article Now Book Mark Article - Palpitations (feeling like your heart is beating too fast or irregularly)
Palpitations (feeling like your heart i...
Palpitations are feelings or sensations that your heart is pounding or racing. They can be felt in your chest, throat, or neck. You may:Have an unpl...
Read Article Now Book Mark Article - Shortness of breath
Shortness of breath
Breathing difficulty may involve:Difficult breathing Uncomfortable breathingFeeling like you are not getting enough air
Read Article Now Book Mark Article - Sweating, which may be very heavy
Sweating
Sweating is the release of liquid from the body's sweat glands. This liquid contains salt. This process is also called perspiration. Sweating helps...
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Some people (including older adults, people with diabetes, and women) may have little or no chest pain. Or, they may have atypical symptoms such as shortness of breath, fatigue, and weakness. A "silent heart attack," which can also occur, is a heart attack with no symptoms.
Exams and Tests
Your health care provider will perform a physical exam and listen to your chest using a stethoscope.
- Your provider may hear abnormal sounds in your lungs (called crackles), a heart murmur, or other abnormal sounds.
Heart murmur
A heart murmur is a blowing, whooshing, or rasping sound heard during a heartbeat. The sound is caused by turbulent (rough) blood flow through the h...
Read Article Now Book Mark Article - You may have a fast or uneven pulse.
- Your blood pressure may be normal, high, or low.
You will have an electrocardiogram (ECG) to look for heart damage. Often, certain changes on the ECG indicate you are having a heart attack, although a heart attack can also occur without ECG changes.
Electrocardiogram (ECG)
An electrocardiogram (ECG) is a test that records the electrical activity of the heart.
Read Article Now Book Mark ArticleA blood test can show if you have heart tissue damage. This test can confirm that you are having a heart attack. The test is often repeated over time.
Blood test
A troponin test measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been da...
Read Article Now Book Mark ArticleCoronary angiography may be done right away or later in the course of illness.
Coronary angiography
Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart....
Read Article Now Book Mark Article- This test uses a special dye and x-rays to see how blood flows through your heart.
- It can help your provider decide which treatments you need next.
Other tests to look at your heart that may be done while you are in the hospital:
- Echocardiography with or with stress testing
Echocardiography
An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...
Read Article Now Book Mark Article - Exercise stress test
Exercise stress test
An exercise stress test is used to measure the effect of exercise on your heart.
Read Article Now Book Mark Article - Nuclear stress test
Nuclear stress test
Nuclear stress test is an imaging method that uses radioactive material to show how well blood flows into the heart muscle, both at rest and during a...
Read Article Now Book Mark Article - Heart CT scan or heart MRI
Heart CT scan
A computed tomography (CT) scan of the heart is an imaging method that uses x-rays to create detailed pictures of the heart and its blood vessels. Th...
Read Article Now Book Mark ArticleHeart MRI
Heart magnetic resonance imaging is an imaging method that uses powerful magnets and radio waves to create pictures of the heart. It does not use ra...
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Treatment
IMMEDIATE TREATMENT
- You will be hooked up to a heart monitor, so the health care team can see how regularly your heart is beating.
- You will receive oxygen.
- An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV.
- You may get nitroglycerin and morphine to help reduce chest pain.
- You may receive aspirin, unless it would not be safe for you. In that case, you will be given another medicine that prevents blood clots.
- Dangerous abnormal heartbeats (arrhythmias) may be treated with medicine or electric shocks.
Arrhythmias
An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...
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EMERGENCY PROCEDURES
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart.
Angioplasty
Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart. These blood vessels are called the coronary art...
Read Article Now Book Mark Article- Angioplasty is often the first choice of treatment. It should be done within 90 minutes after you get to the hospital, and usually no later than 12 hours after a heart attack.
- A stent is a small, metal mesh tube that opens up (expands) inside a coronary artery. A stent is usually placed right after or during angioplasty. It helps prevent the artery from closing up again.
You may be given drugs to break up the clot. This is called thrombolytic therapy. It is best if these drugs are given soon after the onset of symptoms, usually no later than 12 hours after it and ideally within 30 minutes of arriving at the hospital.
Thrombolytic therapy
Small blood vessels called coronary arteries supply oxygen carrying blood to the heart muscle. A heart attack can occur if a blood clot stops the flo...
Read Article Now Book Mark ArticleSome people may also have heart bypass surgery to open narrowed or blocked blood vessels that supply blood to the heart. This procedure is also called coronary artery bypass grafting or open heart surgery.
Open heart surgery
Heart surgery is any surgery done on the heart muscle, valves, arteries, or the aorta and other large arteries connected to the heart. The term "ope...
Read Article Now Book Mark ArticleTREATMENT AFTER A HEART ATTACK
After several days, you will be discharged from the hospital.
Discharged from the hospital
A heart attack occurs when blood flow to a part of your heart is blocked long enough that part of the heart muscle is damaged or dies. This article ...
Read Article Now Book Mark ArticleYou will likely need to take medicines, some for the rest of your life. Always talk to your provider before stopping or changing how you take any medicines. Stopping certain medicines can be deadly.
While under the care of your health care team, you will learn:
- How to take medicines to treat your heart problem and prevent more heart attacks
- How to eat a heart-healthy diet
Heart-healthy diet
A heart-healthy diet is low in saturated fat. Saturated fat can increase your bad cholesterol and clog your arteries. A heart-healthy diet also lim...
Read Article Now Book Mark Article - How to be active and exercise safely
Active and exercise safely
A heart attack occurs when blood flow to a part of your heart is blocked long enough that part of the heart muscle is damaged or dies. Starting a re...
Read Article Now Book Mark Article - What to do when you have chest pain
- How to stop smoking
Stop smoking
There are many ways to quit smoking. There are also resources to help you. Family members, friends, and co-workers may be supportive. But to be su...
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Strong emotions are common after a heart attack.
- You may feel sad
- You may feel anxious and worry about being careful about everything you do
All of these feelings are normal. They go away for most people after 2 or 3 weeks.
You may also feel tired when you leave the hospital to go home.
Most people who have had a heart attack take part in a cardiac rehabilitation program.
Support Groups
Many people benefit from taking part in support groups for people with heart disease.
Support groups for people with heart di...
The following organizations are good resources for information on heart disease:American Heart Association -- www. heart. orgCenters for Disease Cont...
Read Article Now Book Mark ArticleOutlook (Prognosis)
After a heart attack, you have a higher chance of having another heart attack.
How well you do after a heart attack depends on several factors such as:
- The amount of damage to your heart muscle and heart valves
- Where that damage is located
- Your medical care after the heart attack
If your heart can no longer pump blood out to your body as well as it used to, you may develop heart failure. Abnormal heart rhythms can occur, and they can be life threatening.
Heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Read Article Now Book Mark ArticleMost people can slowly go back to normal activities after a heart attack. This includes sexual activity. Talk to your provider about how much activity is good for you.
References
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. PMID: 30879355 pubmed.ncbi.nlm.nih.gov/30879355/.
Bohula EA, Morrow DA. ST-elevation myocardial infarction: management. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 38.
Giugliano RP, Braunwald E. Non-ST elevation acute coronary syndromes. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 39.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144: ):e455. PMID: 34709879 pubmed.ncbi.nlm.nih.gov/34709879/.
Scirica BM, Libby P, Morrow DA. ST-elevation myocardial infarction: pathophysiology and clinical evolution. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 37.
Tamis-Holland JE, Jneid H, Reynolds HR, et al. Contemporary diagnosis and management of patients with myocardial infarction in the absence of obstructive coronary artery disease: a scientific statement from the American Heart Association. Circulation. 2019;139(18):e891-e908. PMID: 30913893 pubmed.ncbi.nlm.nih.gov/30913893/.
Heart - section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart - section through the middle
illustration
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Progressive build-up of plaque in coronary artery - illustration
Plaque may build-up in a coronary artery at the site of a tear in the lining of the vessel.
Progressive build-up of plaque in coronary artery
illustration
Acute MI - illustration
A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
Acute MI
illustration
Post myocardial infarction ECG wave tracings - illustration
Various phases can be seen through ECG wave tracings following a heart attack. Hyperacute phase begins immediately after a heart attack. Fully evolved phase starts a few hours to days after a heart attack. Resolution phase appears a few weeks after a heart attack. Stabilized chronic phase is the last phase and typically has permanent pathological changes compared to a normal ECG tracing.
Post myocardial infarction ECG wave tracings
illustration
Posterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Posterior heart arteries
illustration
Anterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Anterior heart arteries
illustration
Heart attack symptoms - illustration
Symptoms of a possible heart attack include chest pain and pain that radiates down the shoulder and arm. Some people (older adults, people with diabetes, and women) may have little or no chest pain. Or, they may experience unusual symptoms (shortness of breath, fatigue, weakness). Women are more likely than men to have symptoms of nausea, vomiting, back or jaw pain, and shortness of breath with chest pain.
Heart attack symptoms
illustration
Jaw pain and heart attacks - illustration
Pain from a heart attack may sometimes radiate to the jaw and teeth. Chest pain is a major symptom of heart attack, but other symptoms such as weakness, shortness of breath, nausea, or vomiting may also occur.
Jaw pain and heart attacks
illustration
Heart bypass surgery - series
Presentation
Heart - section through the middle - illustration
The interior of the heart is composed of valves, chambers, and associated vessels.
Heart - section through the middle
illustration
Heart - front view - illustration
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Heart - front view
illustration
Progressive build-up of plaque in coronary artery - illustration
Plaque may build-up in a coronary artery at the site of a tear in the lining of the vessel.
Progressive build-up of plaque in coronary artery
illustration
Acute MI - illustration
A heart attack or acute myocardial infarction (MI) occurs when one of the arteries that supplies the heart muscle becomes blocked. Blockage may be caused by spasm of the artery or by atherosclerosis with acute clot formation. The blockage results in damaged tissue and a permanent loss of contraction of this portion of the heart muscle.
Acute MI
illustration
Post myocardial infarction ECG wave tracings - illustration
Various phases can be seen through ECG wave tracings following a heart attack. Hyperacute phase begins immediately after a heart attack. Fully evolved phase starts a few hours to days after a heart attack. Resolution phase appears a few weeks after a heart attack. Stabilized chronic phase is the last phase and typically has permanent pathological changes compared to a normal ECG tracing.
Post myocardial infarction ECG wave tracings
illustration
Posterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Posterior heart arteries
illustration
Anterior heart arteries - illustration
The coronary arteries supply blood to the heart muscle. The right coronary artery supplies both the left and the right heart; the left coronary artery supplies the left heart.
Anterior heart arteries
illustration
Heart attack symptoms - illustration
Symptoms of a possible heart attack include chest pain and pain that radiates down the shoulder and arm. Some people (older adults, people with diabetes, and women) may have little or no chest pain. Or, they may experience unusual symptoms (shortness of breath, fatigue, weakness). Women are more likely than men to have symptoms of nausea, vomiting, back or jaw pain, and shortness of breath with chest pain.
Heart attack symptoms
illustration
Jaw pain and heart attacks - illustration
Pain from a heart attack may sometimes radiate to the jaw and teeth. Chest pain is a major symptom of heart attack, but other symptoms such as weakness, shortness of breath, nausea, or vomiting may also occur.
Jaw pain and heart attacks
illustration
Heart bypass surgery - series
Presentation
Review Date: 10/5/2022
Reviewed By: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Internal review and update on 07/23/2023 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.