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Heart attack

Myocardial infarction; MI; Acute MI; ST-elevation myocardial infarction; Non-ST-elevation myocardial infarction; NSTEMI; CAD - heart attack; Coronary artery disease - heart attack

Most 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.

Images

Heart - section through the middle
Heart - front view
Progressive build-up of plaque in coronary artery
Acute MI
Post myocardial infarction ECG wave tracings
Posterior heart arteries
Anterior heart arteries
Heart attack symptoms
Jaw pain and heart attacks

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:

The cause of heart attack is not always known, but there are well known risk factors.

Heart attack may occur:

Many risk factors may lead to the development of plaque buildup and a heart attack.

Symptoms

A heart attack is a medical emergency. If you have symptoms of a heart attack, call 911 or your local emergency number right away.

Chest pain is the most common symptom of a heart attack.

The pain can be severe or mild. It can feel like:

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:

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.

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.

A 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.

Coronary angiography may be done right away or later in the course of illness.

Other tests to look at your heart that may be done while you are in the hospital:

Treatment

IMMEDIATE TREATMENT

EMERGENCY PROCEDURES

Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to the heart.

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.

Some 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.

TREATMENT AFTER A HEART ATTACK

After several days, you will be discharged from the hospital.

You 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:

Strong emotions are common after a heart attack.

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.

Outlook (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:

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.

Most 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.

Related Information

Atherosclerosis
Stress and your health
Risks of tobacco
High blood pressure in adults - hypertension
Diabetes
Arrhythmias
Ventricular tachycardia
Heart failure
Cardiogenic shock
Pericarditis
Lipoprotein-a
Metabolic syndrome
Implantable cardioverter-defibrillator
Cholesterol - what to ask your doctor
Heart failure - what to ask your doctor
High blood pressure - what to ask your doctor
Heart attack - what to ask your provider
Taking warfarin (Coumadin, Jantoven) - what to ask your doctor
Taking warfarin (Coumadin)
Cholesterol - drug treatment
Heart attack – discharge
Angioplasty and stent - heart - discharge

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/.

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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.

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