Heart Attack

Heart disease is the No. 1 cause of death in the United States for both men and women.

These numbers, courtesy of the Centers for Disease Control and Prevention, reveal the depth of coronary heart disease in this country:

  • Every 42 seconds, someone in the United States has a heart attack.

  • Every year, an estimated 735,000 Americans have a heart attack.

  • One in four deaths each year in the United States is attributed to heart disease. (That’s a total of 610,000 heart-related deaths annually.)

A heart attack (medical term: myocardial infarction) is the heart without oxygen. The flow of oxygen-rich blood becomes blocked by cholesterol, fat or other materials that produce a waxy plaque, clogging the arteries leading to the heart. The disrupted blood flow can damage or kill part of the heart muscle.   

Dr. Talhat Azemi, a Hartford HealthCare cardiologist, on the warning signs of a heart attack:

Symptoms

One of every five heart attacks causes damage without the person knowing it. But more often, a heart attack results in varying degrees of discomfort:

  • Chest pain: Pain or discomfort in the center or left side of the chest that lasts for a few minutes or recurs.
  • Pain beyond the chest area: Pain or discomfort spreads to the arms, back, neck or jaw.
  • Shortness of breath.
  • Heartburn, indigestion, nausea.
  • Fatigue that can last for days (particularly with women).
  • Cold sweat.
  • Dizziness or light-headedness.

A heart attack isn’t necessarily sudden and dramatic, punctuated by excruciating chest pain. The first sign for some people is sudden cardiac arrest, but others exhibit mild or no symptoms. The mild symptoms could last for weeks.

If you have angina, recurrent pain or discomfort caused by temporarily reduced blood flow to the heart, consider it a possible preview of a heart attack.

Don’t ignore the warning signs of a heart attack. Dial 9-1-1 or have someone drive you to the nearest emergency department. (And don’t hesitate because you might feel embarrassed if it’s not a heart attack!)

Take nitroglycerin, if prescribed by a doctor monitoring an existing heart condition. Aspirin also can reduce damage during a heart attack by preventing clotting and allowing more oxygenated blood to reach the heart.

Dr. Heather Swales, a Hartford HealthCare cardiologist, on how men and women can experience different heart-attack symptoms:

Causes

Coronary heart disease causes most heart attacks when oxygen-rich blood can no longer reach the heart, blocked by the waxy buildup of plaque in the coronary arteries.

The plaque buildup, called atherosclerosis, can take years to become substantial enough to cause a blockage in the arteries. And only then does it happen when part of the plaque ruptures, forming a blood clot on the surface. The bigger the clot, the greater the blockage of blood flowing to the heart.

Without treatment, the part of the heart muscle usually nurtured by the now-blocked artery can die, replaced by scar tissue.

A coronary artery spasm, unrelated to plaque buildup, can also cause a heart attack by blocking blood flow through the artery.

Possible causes of a spasm:

  • Cigarette smoking.
  • Use of illicit drugs, such as cocaine.
  • Extreme cold temperatures.
  • Emotional stress.
  • Treatment

To avoid serious damage to the heart muscle, prompt treatment of a heart attack is critical. That starts with calling 9-1-1 as soon as you notice the symptoms.

At a hospital, treatment typically starts immediately, even before a diagnosis:

Aspirin: Prevent blood-clotting.

Nitroglycerin: Improve blood flow through the coronary arteries.

Thrombolytics: Help dissolve a blood clot.

Oxygen: Increases oxygen in your lungs that can be delivered to your blood.

Antiplatelet agents: Prevent new blood clots and limit the size of existing clots.

Beta blockers: Slows heartbeat, lowering blood pressure. This makes it easier for the heart to function.

ACE inhibitors: Also lower blood pressure, reduce stress on heart.

Statins: Regulates or lowers you blood cholesterol, increasing your odds of not having another heart attack.

Tests

Dr. George Spivack, a Hartford HealthCare cardiologist, describes some of the tests your doctor might request to determine if the symptoms you're experiencing are related to a heart attack:

Blood tests: Cholesterol, fat, protein and sugar levels.

Chest X-ray: A view of the heart and lungs reveal a reason for the chest pain.

Electrocardiogram: By reviewing the heart’s electrical activity, your doctor can determine if the heart lacks oxygen, if the blood flow through it is diminished and if, in fact, you’re having a heart attack.

Stress test: Walk on a treadmill as your blood pressure and electrocardiogram readings are monitored.

Coronary angiography: Dye and X-ray imaging give a good picture of what’s happening inside your coronary arteries.

Medical Procedures

If medication and lifestyle changes fail, your doctor might treat angina with either angioplasty or coronary artery bypass surgery.

Angioplasty/stenting: A tiny balloon inserted into the narrowed artery, then inflated, widens the artery. A stent, a wire mesh coil, often is used to keep the artery open.

Coronary artery bypass surgery: A healthy blood vessel from another part of your body (arm, chest or leg), connected to heart arteries, bypasses the blocked or narrowed artery.

Cardiac Rehabilitation

An exercise program for heart-attack patients: 

Cardiac rehabilitation helps patients lose weight, lower their cholesterol, improve diabetes and reduce anxiety and depression after heart-related illnesses and procedures.

Why is cardiac rehab so important? These programs are designed to help patients regain strength and stay healthy with supervised exercise sessions, education on nutrition, medication and general lifestyle changes and choices.

For more information on the Hartford Hospital Cardiac Rehabilitation program, one of only a handful in the state accredited by the American Association of Cardiovascular Rehabilitation, click here.

What You Can Do

A healthful diet, regular exercise, reducing stress and quitting smoking can help you recover from a heart attack and maybe prevent another.

First, pay attention to conditions that contribute to a heart attack:

  • Diabetes.
  • High blood pressure.
  • High blood cholesterol.
  • Chronic kidney disease.
  • Peripheral artery disease (narrowing of the peripheral artery, which supplies blood to the limbs).

Now follow the advice you’ve ignored for so long:

  • Don’t smoke.
  • Exercise regularly.
  • Follow a diet that’s good for your heart, low in saturated fat, trans fats, cholesterol and sodium.
  • If overweight or obese, dedicate yourself to maintaining a healthful weight.
  • Reduce stress.

In An Emergency

Knowing hands-only CPR can save a life. Dr. Paul Thompson, co-physician-in-chief of the Hartford HealthCare Heart & Vascular Institute, tells you how easy it is (follow the beat of a song he suggests in this segment from "The Rob Dibble Show"):