Heart attack

A heart attack is caused by a clot or block in one or more of the arteries that feed the heart with blood. If the heart muscle does not receive oxygen from the blood, it will die. If you do have a heart attack, you must get prompt medical attention.

What causes heart attacks?

Every year around 275,000 people (1) in the UK have a heart attack. A heart attack is also called a myocardial infarction or a coronary thrombosis.

Your heart pumps blood around your body, but the heart itself also needs a constant supply of blood to supply the heart muscle with oxygen and keep it healthy.

If your heart has its blood supply cut off, that section of your heart muscle may become permanently damaged. A heart attack can happen when one of the coronary arteries is blocked - by a blood clot for instance.

Controllable heart attack risk factors:

There are a number of controllable risk factors that make you more likely to have a heart attack:

Uncontrollable heart attack risk factors:

How do you know when you've even had a heart attack?

Chest pain is one of the commonest symptoms of having a heart attack. This can start with mild discomfort, or you could have severe pain in the centre of your chest, and a feeling your chest is being crushed, leaving you breathless.

The pain may stay with you, or it may be intermittent, but when you do have it, moving around or resting won't lessen it. The pain usually spreads down the left arm and often rises to the jaw.

Other common symptoms include shortness of breath, sweating, nausea and vomiting, feeling dizzy, coughing, having a grey complexion or a blue tinge to your skin (low oxygen levels) and feeling restless or unwell.

Not everyone who has a heart attack feels severe pain, for some it is barely noticeable. This is known as a 'silent' heart attack and is most common in people who are over 75 (2), or who have diabetes. Some people don't discover they've had a heart attack until they have a medical examination for another reason.

What do you do if you or someone else has a heart attack?

If you think that you - or anyone else - might be having a heart attack, call 999 immediately, because the sooner treatment is given the more effective it is. Many people who have heart attack can be treated successfully, if they get immediate medical help.

While you're waiting for help, chew an aspirin if available; this will stop the blood clot that's blocking your artery from getting any bigger.

If you're with someone who appears to have had a heart attack and they aren't breathing or responding to you, give cardiopulmonary resuscitation (CPR) if you can. CPR involves 'rescue breathing' which you may know as the kiss of life, and chest compression - pressing down on the chest above the heart, to keep the circulation and breathing going. It can save lives. For more information about the CPR technique, visit the St. John's Ambulance website.

What medical help will I have?

If your heart isn't beating (cardiac arrest), the ambulance crew will use a defibrillator machine to get it going again. The device delivers an electric shock to your heart to try to get it beating properly again.

You may be monitored on an electrocardiograph (ECG), to check that your heart rhythm has returned to normal. If you haven't already had aspirin, the ambulance crew may then give you a single 300mg dose to reduce the risk of further blood clots.

There are two other drugs you may be given when you are having a heart attack. Thrombolytic drugs are 'clot-busters' and dissolve the clot blocking your coronary artery. This means that blood starts flowing to the affected part of your heart muscle again. Getting the blood flow going again within a couple of hours can reduce the damage to your heart muscle significantly. You may also be given an injection of morphine, a strong painkiller, or you may have oxygen or nitrous oxide and oxygen (Entonox) through a mouthpiece, to help ease your pain.

There are several other drugs that may be necessary to stabilise your heart rhythm after a heart attack.

What kinds of tests will I have?

When you arrive at hospital, the medical team will measure your blood pressure, check your heart rate and your symptoms, take your medical history, attach you to an ECG (if you aren't already being monitored) and do some blood tests.

By looking at all the results, your doctors will be able to know if you've had a heart attack, if your heart muscle has been damaged and how badly it has been damaged.

What's the treatment for a heart attack?

Treatment varies from person to person, depending on the results of the tests.

The most important treatment is an injection of a drug that dissolves the blood clot and so restores blood flow to the heart. A common drug used in the UK is streptokinase. To be effective this should be given as soon as possible, unless there are medical reasons not to give it, such as allergy.

Another treatment is a drug to stop the small particles in our blood (platelets) from causing clots. Anti-platelet drugs make blood less sticky, so it's less likely to form a clot, reducing the risk of having another heart attack. Aspirin is an example of an anti-platelet drug, as is clopidogrel.

Other drug treatments:

Will I need an operation?

Your doctors may also consider carrying out an operation, called a coronary angioplasty, which widens narrowed arteries and reduces the risk of another blockage forming. They may even suggest a Coronary Artery Bypass Graft (CABG), where a section of vein from your leg is used to bypass the blocked section of artery in your heart.

Will I make a good recovery?

Your rate of recovery after a heart attack depends on how much damage the heart has sustained. The British Heart Foundation says that about half of people who have a heart attack die within 28 days, while those who die within 28 days of having a heart attack, three quarters die within the first 24 hours (3).

Even if you feel well, it's important to look after your health after a heart attack. There is plenty of advice and help available to guide you through your recovery, both in hospital and once you've returned home.

It's not unusual to feel anxious or depressed following a heart attack. If you feel like this, the medical team at the hospital, the cardiac rehabilitation team, cardiac nurses and your GP will all be able to answer your questions, as well as offer you advice and support. You can also call the British Heart Foundation's Heart Helpline on 08450 70 80 70 for advice, or join one of their heart support groups.

Can I help myself to avoid another heart attack?

Stay active. While you're in hospital your medical team and the hospital physiotherapist will produce an exercise plan that's right for you - starting very gently and building up steadily.

Physical activity is vital to your recovery. It will strengthen your heart, improve your overall health and cut your risk of another heart attack, so it's important that you keep it up.

After a heart attack, some people experience a tight or heavy feeling in their chest, especially when they exercise. This is a symptom of angina. If you feel this, you should see your GP as soon as you can.

Eating well is also important to reduce your risk of another heart attack. Cut back on fats in your diet, especially saturated fats, which contribute to high cholesterol levels.

Omega-3 polyusaturated fats can help prevent coronary heart disease. Oily fish are the best source of omega-3 fats, and the British Heart Foundation suggests that you try to eat two to three portions of oily fish a week.

Make sure your daily diet includes wholegrains and pasta, olive oil, at least five portions of fruit and vegetables a day, and chicken rather than red meat.

Tips to avoid heart attack

All of these steps can help to improve your health and are sensible preventative measures, reducing your risk of a range of health problems, including a heart attack.

How soon can I go back to work?

This will depend on how well you feel, both physically and mentally, and on the type of work you do. Many people do return to their jobs, some as early as six weeks after a heart attack.

Talk to your GP or someone on your cardiac rehabilitation team, and be honest about the type of work you do, and how much heavy physical activity is involved. Going back to work too soon can put you at greater risk of another heart attack.

When can I start having sex again?

Having sex can be a concern for both partners after one of them has had a heart attack. The general rule is that you can start having sex again when you feel the time is right - often about four weeks (5) after your heart attack.

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