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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

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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:

In either case, there is not enough blood flow to the heart muscle and heart muscle dies.

The cause of heart attack is not always known.

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 (the older adults, people with diabetes, and women) may have little or no chest pain. Or, they may have unusual symptoms such as shortness of breath, fatigue, and weakness. A "silent heart attack" is a heart attack with no symptoms.

Exams and Tests

A 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. Most of the time, certain changes on the ECG indicate you are having a heart attack. Sometimes these changes are not present, even though other tests indicate you have had a heart attack. This can be called non-ST elevation myocardial infarction (NSTEMI).

A blood test can show if you have heart tissue damage. This test can confirm that you are having a heart attack. You will likely have this test 3 times over the first 6 to 12 hours.

Coronary angiography may be done right away or when you are more stable.

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 to 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 and/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

Hardening of the arteries
Stress and your health
Risks of tobacco
High blood pressure - adults
Diabetes
Arrhythmias
Ventricular tachycardia
Heart failure - overview
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 doctor
Taking warfarin (Coumadin, Jantoven) - what to ask your doctor
Taking warfarin (Coumadin)
Cholesterol - drug treatment
Heart attack - discharge
Angioplasty and stent - heart - discharge

References

Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228. PMID: 25260718 www.ncbi.nlm.nih.gov/pubmed/25260718.

Anderson JL. ST segment elevation acute myocardial infarction and complications of myocardial infarction. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 73.

Bohula EA, Morrow DA. ST-elevation myocardial infarction: Management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 59.

Giugliano RP, Braunwald E. Non-ST elevation acute coronary syndromes. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 60.

O'Gara PT, Kushner FG, Ascheim DD, et al; American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):485-510. PMID: 23256913 www.ncbi.nlm.nih.gov/pubmed/23256913.

Scirica BM, Libby P, Morrow DA. ST-elevation myocardial infarction: pathophysiology and clinical evolution. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier ; 2019:chap 58.

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Review Date: 6/18/2018  

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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