Overview
A heart attack (myocardial infarction) occurs when one of the coronary arteries that supply the heart muscle becomes blocked, depriving part of the heart muscle of oxygen and causing damage. It is one of the leading causes of death.
Every minute is important. Early intervention (within 90 minutes) saves lives and minimizes heart damage.
Symptoms
Classic symptoms:
- Chest pain or pressure (usually in the left chest, lasting more than 15-20 minutes)
- Pain radiating to the left arm, shoulder, jaw, or back
- Shortness of breath
- Cold sweat
- Nausea, vomiting
- Dizziness, lightheadedness
- Extreme fatigue
- Palpitations
- Anxiety, fear of death
Different symptoms in women, elderly, and diabetic patients:
- Classic chest pain may be absent
- Back or jaw pain
- Extreme fatigue (starting days before)
- Digestive complaints (nausea, indigestion)
- Shortness of breath as the only symptom
Causes
Most heart attacks are due to atherosclerosis in the coronary arteries. Fatty plaques in the artery walls rupture; a clot forms over them and blocks the artery.
Other causes:
- Coronary artery spasm
- Some drugs (cocaine)
- Spontaneous coronary dissection
- Embolism
- Severe extreme stress
Risk Factors
Non-modifiable:
- Age (over 45 for men, over 55 for women)
- Sex (more common in men)
- Family history
- Ethnicity
Modifiable:
- High blood pressure
- High cholesterol
- Diabetes
- Smoking
- Obesity
- Sedentary lifestyle
- Stress
- Unhealthy diet
- Excessive alcohol
- Drug use
- Sleep apnea
Complications
- Arrhythmia (especially ventricular fibrillation)
- Heart failure
- Cardiogenic shock
- Heart wall rupture
- Heart valve problems
- Thromboembolism
- Sudden cardiac death
Emergency: Call Emergency Services Immediately
If you suspect a heart attack:
- Call emergency services (do not drive to the hospital yourself)
- Sit the person down or place them in a comfortable position
- Loosen tight clothing
- If conscious, have the person chew aspirin (300 mg)
- If nitroglycerin has been previously prescribed, give it sublingually
- If the person is unconscious and pulseless, start CPR
- Use an automated external defibrillator (AED) if available
Diagnosis and Treatment
Diagnosis:
- ECG (immediately, critical)
- Blood tests (troponin, CK-MB)
- Echocardiography
- Coronary angiography (definitive diagnosis and treatment)
Treatment:
- Emergency: Aspirin, antiplatelet (clopidogrel, ticagrelor), anticoagulant, oxygen, pain relief
- Reperfusion: Primary percutaneous coronary intervention (angio + stent) — gold standard
- Thrombolytic therapy: Clot-busting drug if angio is not available
- Coronary bypass surgery: For severe multivessel disease
Long-term treatment:
- Antiplatelet (aspirin, clopidogrel) for life
- Statin (cholesterol)
- Beta blockers
- ACE inhibitors
- Cardiac rehabilitation
Prevention
- Keep your blood pressure under control
- Monitor your cholesterol regularly
- Manage diabetes
- Quit smoking
- Maintain a healthy weight
- Exercise regularly (150 minutes per week)
- Follow a Mediterranean diet (vegetables, fruits, fish, olive oil)
- Avoid excessive salt, saturated fat, and sugar
- Limit alcohol
- Manage stress
- Have regular check-ups
- Learn the symptoms of a heart attack