What is Heart Attack?

heart attack occurs when blood flow to a section of heart muscle becomes blocked. If the flow of blood isn’t restored quickly, the section of heart muscle becomes damaged from lack of oxygen and begins to die.
Heart attack is a leading killer of both men and women in the United States. But fortunately, today there are excellent treatments for heart attack that can save lives and prevent disabilities. Treatment is most effective when started within 1 hour of the beginning of symptoms. If you think you or someone you’re with is having a heart attack, call 9–1–1 right away.

Overview
Heart attacks occur most often as a result of a condition called coronary artery disease (CAD). In CAD, a fatty material called plaque (plak) builds up over many years on the inside walls of the coronary arteries (the arteries that supply blood and oxygen to your heart). Eventually, an area of plaque can rupture, causing a blood clot to form on the surface of the plaque. If the clot becomes large enough, it can mostly or completely block the flow of oxygen-rich blood to the part of the heart muscle fed by the artery.
During a heart attack, if the blockage in the coronary artery isn’t treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.
Severe problems linked to heart attack can include heart failure and life-threatening arrhythmias (irregular heartbeats). Heart failure is a condition in which the heart can’t pump enough blood throughout the body. Ventricular fibrillation is a serious arrhythmia that can cause death if not treated quickly.

Outlook

Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. CAD, which often results in a heart attack, is the leading killer of both men and women in the United States.
Many more people could recover from heart attacks if they got help faster. Of the people who die from heart attacks, about half die within an hour of the first symptoms and before they reach the hospital.

Reduce Heart Attack Risk

You can reduce your risk of having a heart attack—even if you already have coronary heart disease (CHD) or have had a previous heart attack. The key is to take steps to prevent or control your heart disease risk factors.
Six Key Steps To Reduce Heart Attack Risk
Taking these steps will reduce your risk of having a heart attack:
1 .Stop smoking
2. Lower high blood pressure
3. Reduce high blood cholesterol
4. Aim for a healthy weight
5. Be physically active each day
6. Manage diabetes

Heart Diseas and Medication

Sometimes, medications may be needed to help prevent or control coronary heart disease (CHD) and so reduce the risk of a first or repeat heart attack. But, if medications are needed, lifestyle changes still must be undertaken.
If prescribed, take medications as directed by your health care provider.
Drugs used to treat CHD include:
Aspirin – Aspirin helps to lower the risk of a heart attack for those who have already had one. It also helps to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure such as coronary angioplasty. (More on aspirin and heart attack)
Because of its risks, aspirin is not approved by the Food and Drug Administration for preventing heart attacks in healthy individuals. It may be harmful for some persons, especially those with no risk of heart disease. Patients must be assessed carefully to make sure the benefits of taking aspirin outweigh the risks. Talk to your doctor about whether taking aspirin is right for you. (For details on the use of aspirin to prevent heart attacks, please visit the FDA Web site.)
Digitalis – makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms.
ACE (angiotensin converting enzyme)
inhibitor – stops the production of a chemical that makes blood vessels narrow and is used to help control high blood pressure and for damaged heart muscle. It may be prescribed after a heart attack to help the heart pump blood better. It is also used for persons with heart failure, a condition in which the heart is unable to pump enough blood to supply the body's needs.
Beta blocker – slows the heart and makes it beat with less contracting force, so blood pressure drops and the heart works less hard. It is used for high blood pressure, chest pain, and to prevent a repeat heart attack.
Nitrates (including nitroglycerine) – relaxes blood vessels and stops chest pain.
Calcium channel blocker – relaxes blood vessels and is used for high blood pressure and chest pain.
Diuretic – decreases fluid in the body and is used for high blood pressure. Diuretics are sometimes referred to as "water pills."
Blood cholesterol-lowering agents – decrease LDL cholesterol levels in the blood.
Thrombolytic agents–also called "clot busting drugs," they are given during a heart attack to break up a blood clot in a coronary artery in order to restore blood flow. (More on these and heart attack)
Drugs can cause side effects. If side effects occur, report them to your doctor. Often, a change in the dose or type of a medication, or the use of a combination of drugs can stop the side effect.
To learn more about medications for CHD and its risk factors:
High blood pressure medications.
Drug section of "Your Guide to Lowering High Blood Pressure" Web page
High blood cholesterol medications.
Drug section of "Live Healthier, Live Longer" Web page

Heart Attack Warning Signs

A heart attack is a frightening event, and you probably don't want to think about it. But, if you learn the signs of a heart attack and what steps to take, you can save a life–maybe your own.
What are the signs of a heart attack? Many people think a heart attack is sudden and intense, like a "movie" heart attack, where a person clutches his or her chest and falls over.
The truth is that many heart attacks start slowly, as a mild pain or discomfort. If you feel such a symptom, you may not be sure what's wrong. Your symptoms may even come and go. Even those who have had a heart attack may not recognize their symptoms, because the next attack can have entirely different ones.
Women may not think they're at risk of having a heart attack–but they are. Learn more about women and heart attack.
It's vital that everyone learn the warning signs of a heart attack. These are:
Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.
Learn the signs–but also remember: Even if you're not sure it's a heart attack, you should still have it checked out. Fast action can save lives-maybe your own.
After you learn more about heart attack, try a brief quiz to see if you know what to do if you or someone else has warning signs

Heart Attack Treatments

AHA Recommendation
When a heart attack occurs, you must recognize the signals and respond immediately. Time is critical. When an artery to the heart (coronary artery) is blocked, the heart muscle doesn't die instantly. But damage increases the longer the artery stays blocked. Delay may increase heart damage and reduce your chance of survival. It also lessens the chance of preserving heart muscle. This increases the risk of disability.
Anyone who has heart attack warning signs should call 9-1-1 immediately. People who pass out before reaching the emergency room should receive cardiopulmonary resuscitation (kar"de-o-PUL'mo-nair-e re-sus"ah-TA'shun) (CPR).

Background
Most communities have an emergency cardiovascular care system that can respond quickly. This prompt care dramatically reduces heart damage. In fact, 88 percent of heart attack survivors under age 65 can return to their usual work. Prompt care isn't the only reason so many heart attack survivors recover so quickly, but it's an important one.
If a victim gets to an emergency room fast enough, reperfusion (rep"er-FU'zhun) therapy may be done. This increases blood supply to the heart muscle. It's done with drugs to dissolve clots (thrombolysis), balloon angioplasty (PCI [formerly called PTCA]) or surgery. The sooner any of these techniques occur, the more likely the patient will benefit.
Thrombolysis (throm"bo-LI'sis) involves injecting a clot-dissolving agent, such as streptokinase, urokinase or tPA (tissue plasminogen activator), to dissolve a clot in a coronary artery and restore blood flow. For best effect, these drugs must be used within a few (usually 3) hours of a heart attack.
If this treatment isn't done immediately after a heart attack, percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG) may be done later to improve blood supply to the heart muscle. Once part of the heart muscle dies, its function can't be restored. However, function may be restored to areas with decreased blood flow.

Testing for a Heart Attack

If you think you’re having a heart attack, get help at once. Don’t wait to be sure. Call 9-1-1 right away. Delay can be deadly.

Once you get help, you will undergo tests to see if a heart attack has actually occurred. Some tests are done at the hospital, while others can be done by emergency medical personnel who come in an ambulance. (Tests and treatments done by emergency medical personnel.)

Key heart attack tests are:

Electrocardiogram (ECG or EKG). This is a graphic record of the electrical activity of the heart as it contracts and relaxes. The ECG can detect abnormal heartbeats, some areas of damage, inadequate blood flow, and heart enlargement.

Blood test. A blood test will be done routinely to check for enzymes or other substances that are released when cells begin to die. These are "markers" of the amount of damage to your heart.

Nuclear scan. This test shows areas of the heart that lack blood flow and are damaged. It also can reveal problems with the heart’s pumping action. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records whether the nuclear material is taken up by the heart muscle (healthy areas) or not (damaged areas). The camera also can evaluate how well the heart muscle pumps blood. This test can be done during both rest and exercise, enhancing the usefulness of its results.

Coronary angiography (or arteriography). This test is used to check blockages and narrowed areas inside coronary arteries. A fine tube (catheter) is threaded through an artery of an arm or leg up into the heart. A dye that shows up on X ray is then injected into the blood vessel, and the vessels and heart are filmed as the heart pumps. The picture is called an angiogram or arteriogram.