Patient information from the BMJ Group

Heart attack
If you've had a heart attack, it probably came as a big shock to you. Fortunately,
excellent heart attack treatments are now available. This leaflet gives you
information about heart attacks. You'll also learn about how you can recover and
stay healthy afterwards.

We've brought together the best and most up-to-date research about heart attacks
to see what treatments work. You can use our information to talk to your doctor
and decide which treatments are best for you.

What happens when you have a heart attack?

Your heart pumps blood around your body. It carries oxygen and energy to your muscles.
Your heart is made of muscle, and needs a good blood supply to keep pumping.

When you have a heart attack, one of the blood vessels that carries blood to your heart
gets blocked by a blood clot. So part of the heart doesn't get enough oxygen. This often
causes bad chest pain and makes you breathless. If the blood supply is cut off for too
long, part of the heart will die.

You'll have had emergency treatment in hospital to open up the blood vessel and get
the blood flowing again. This is done by medicines, or by an operation called an
angioplasty. These treatments can limit the damage to your heart.

Then doctors keep a close watch over you to see if you develop any other problems.
These can include having an irregular heart beat, or problems with how well your heart
pumps. If a large amount of your heart muscle has been damaged by the heart attack,
your heart may not pump so well as before. This is called heart failure.

The most risky time is the few hours after the heart attack. Once you are beyond that,
you'll probably spend four or five days resting in hospital. During this time, doctors will
do more tests to try to find out exactly what happened. They'll find out which part of your
heart has been damaged, and how much.

If all goes well, you'll probably go home about a week after your heart attack.

Having a heart attack is a big shock, especially if you were in good health beforehand.
You may wonder why it happened to you. Heart attacks are caused by blood clots which
form in your arteries. Doctors don't know exactly why they cause problems for some
people and not others.

But you're more likely to have problems if your arteries are narrow because of clumps
of fat on the artery wall. Doctors call this atherosclerosis. Lots of people get it as they
get older. If you have atherosclerosis in the arteries leading to your heart, this is called
heart disease. You might have heart disease for many years without knowing it. A heart
attack might be the first sign of trouble.

BMJ Publishing Group Limited 2012. All rights reserved.

page 1 of 5
 Heart attack

Heart attacks happen more often to men, from middle age onwards. You are more likely
to have a heart attack if you have high blood pressure or high cholesterol (fat) in your
blood, if you are overweight, smoke, or you don't take much exercise. A family history
of heart attacks is also important. But sometimes heart attacks happen to people without
any of these things.

What happens when you go home?

When you go home from hospital, you can start gradually getting back to your normal
life. If you live alone, it may help to have someone stay with you for a few weeks, to help
you adjust.

You may feel anxious about what you can and can't do. The key is to take it slowly. You
will gradually be able to walk further and do more, without getting tired and breathless.

It's normal to feel tired, anxious, angry or low, after a stressful event like a heart attack.
But if your low mood continues, talk to your doctor. People often become depressed after
a heart attack, and there are treatments that may help you.

Most people who live through a straightforward heart attack can return to their normal
level of activity within six weeks. Younger people are usually back at work within three
months.

Many areas run cardiac rehabilitation programmes. These are programmes where you
get support from specialist nurses to help you recover. Before you leave hospital, you
and your doctors should discuss how you can join a programme. If your doctors don't
mention it, ask.

What treatments work?

There are lots of good treatments to help cut your risk of having another heart attack.
Medicines are important. But you can also make changes yourself that will help you live
a longer, healthier life.

Things you can do for yourself

Before you leave hospital, make sure you understand what has happened to you. Talk
about your heart attack, test results and drugs with your doctors.

Learning about your heart attack and the treatment you need is an important part of
getting better and lowering your risk of future trouble. Your hospital doctors, your GP
and your specialist nurses can all help you learn more.

If you smoke, try hard to stop. Smoking narrows the arteries and makes you more
likely to have another heart attack. Get help from a health professional, like your GP.
There are lots of treatments that can help you stop. You might not stop on your first try.
But it's important to keep trying. It could save your life.

Exercise improves stamina, strength, and makes you feel good. Over time, exercise
makes your heart work better. It can also help you lose weight, if you need to.Your doctor

BMJ Publishing Group Limited 2012. All rights reserved.

page 2 of 5
 Heart attack

or cardiac rehabilitation team can help you put together a safe exercise programme. You
may need to be supervised at first. Many people can continue to exercise safely on their
own after a few weeks.

Taking part in a cardiac rehabilitation programme can help you recover from your
heart attack and keep your heart healthy. Cardiac rehabilitation will help you get better
faster, get fit and make changes to your diet and lifestyle to reduce your risk of having
another heart attack.You may also learn to manage stress or depression, if you feel bad.
Research shows that people who survive a heart attack and then go on a cardiac
rehabilitation programme are likely to live longer.

Everyone is different, so the rehabilitation team at your hospital will plan a programme
that suits you. It may last six weeks, six months, or even longer.You need to be committed
to taking part in the programme for it to work properly.

Medicines to prevent another heart attack

If you've had a heart attack, you will probably go home from hospital with lots of new
medicines. This can be confusing. If you're not sure what they all are, ask your doctor.
The medicines you are most likely to take are listed below. You will probably need to
take them for many months, and maybe years.

Aspirin makes your blood less sticky, so you are less likely to get a blood clot that could
cause a heart attack. Research shows taking one low-dose aspirin every day cuts your
risk of having another heart attack by about a third. If you're allergic to aspirin or can't
take it for some other reason, your doctor may give you another drug to stop your blood
clotting, for example clopidogrel (Plavix) or dipyridamole (Persantin).

Beta-blockers slow your heart down and make it beat less strongly. Because it's working
less hard, it needs less oxygen. This reduces your risk of having another heart attack.
There are lots of different types. Some common ones are atenolol (Tenormin), carvedilol
(Eucardic) and metoprolol (Lopresor).

Statins reduce the amount of cholesterol in your blood. They reduce the risk of heart
attacks for most people. People who are at highest risk of having another heart attack
seem to benefit the most. Some names of statins are atorvastatin (Lipitor), pravastatin
(Lipostat) and simvastatin (Zocor).

ACE inhibitors keep your blood vessels from getting narrower. They are especially
useful if your heart is not pumping as well as it used to. They should reduce your risk of
another heart attack. But they're not used for everyone. Some names of ACE inhibitors
are captopril (Capoten) and enalapril (Innovace).

All these drugs can cause side effects. As you read this, remember you won't get all of
them. If you are troubled by side effects, talk to your doctor. You may be able to switch
to another medicine, or a lower dose.

Aspirin can cause stomach upsets. Also, because it makes your blood less sticky, you
may find cuts bleed for longer. There is a small chance you could get bleeding from the
stomach. But this is not very likely, because the dose of aspirin is low.

BMJ Publishing Group Limited 2012. All rights reserved.

page 3 of 5
 Heart attack

Beta-blockers lower your blood pressure. This can make you feel tired, and you might
feel dizzy if you stand up quickly. Some men find beta-blockers make it difficult for them
to get an erection. And beta-blockers can make some lung problems worse. If you have
asthma or chronic bronchitis, make sure your doctor knows before you take beta-blockers.

Most people don't get side effects from statins. But they can cause muscle pain or
damage. Tell your doctor if you get muscle pain when taking statins. Some people taking
statins have had liver and kidney damage, but doctors are not sure that the statins caused
the problems.

Many people find ACE inhibitors can cause a dry cough. They may also cause low blood
pressure and kidney problems.

Other treatments

Some people who have a heart attack have an operation called an angioplasty, to widen
the artery that got blocked. It can be done as an emergency operation, instead of
dissolving the blood clot with drugs.

If you didn't have an angioplasty, but tests show that your heart arteries are narrow, you
might have an angioplasty at a later stage. This can reduce your chances of having chest
pain (angina) and of having another heart attack. Or you might have an angioplasty if
you start getting chest pain after you've gone home from hospital.

To carry out an angioplasty, a surgeon feeds a thin deflated balloon into your heart artery,
through a tube into a blood vessel in your groin. When the balloon is in the right place,
the surgeon inflates it, so it widens the artery. Then it's taken out again. Sometimes a
small metal tube (called a stent) will be inserted, to keep the artery open.

Antiplatelet agents plus aspirin. This combination of treatment is given to make your
blood less sticky, so you are less likely to get a blood clot that could cause another heart
attack. Reseach shows that taking an antiplatelet agent plus aspirin reduces your risk of
having another heart attack or a stroke. Some common names of antiplatelet agents are
clopidogrel (Plavix), prasugrel (Effient), and ticagrelor (Brilique).

What will happen to me?

How you get along after a heart attack depends on how much of your heart has been
damaged. Your recovery also depends on how well you stick with your drug treatment
and your plans to have a more healthy life.

Some people who have had a heart attack get chest pain (angina) and feel short of breath
from time to time.

Angina happens when your heart needs more blood, for example when you exercise or
go out in the cold. It goes away with rest. Your doctor can give you medicine to help with
angina pain.

BMJ Publishing Group Limited 2012. All rights reserved.

page 4 of 5
 Heart attack

Shortness of breath may mean your heart is not pumping as well as before the heart
attack. About 6 in 10 people who've had a heart attack say they get short of breath
occasionally.

About one-third of people who have heart attacks say they feel depressed soon afterward.
If you feel depressed, talk to your doctor. There are effective treatments for depression.

Doctors look at four things to predict how well you'll do after a heart attack:

Is your heart pumping properly?

Where has your heart been damaged? Attacks that damage the front of your heart
are more dangerous than those that affect the back or base of your heart.

What was your blood pressure and how fast was your heart beating when you were
admitted to hospital? If you had low blood pressure and your heart was beating
quickly, you probably had a serious heart attack.

How old are you? The older you are, the more likely it is that your heart attack was
dangerous. Two-thirds of people who die of coronary heart disease (which includes
heart attacks) are 75 or older.

Remember that you are over the first hurdle: you survived your heart attack. Now you
have the chance to make changes that can help you live a longer, healthier life.

Where to get more help

The British Heart Foundation is a registered UK charity that provides advice and support
to people with heart conditions, including people who've had a heart attack. You can
telephone the charity on 08450 708070 or visit its website (http://www.bhf.org.uk).

This information is aimed at a UK patient audience. This information however does not replace medical advice.
If you have a medical problem please see your doctor. Please see our full Conditions of Use for this content.
For more information about this condition and sources of the information contained in this leaflet please visit the Best
Health website, http://besthealth.bmj.com . These leaflets are reviewed annually.

BMJ Publishing Group Limited 2012. All rights reserved.

Last published: Dec 18, 2012
page 5 of 5