Some people mistake a heart attack for a symptom of the flu or reflux

disease, which causes heartburn.

A quarter of all heart attack victims die before reaching a hospital;

others have life-threatening complications while in the hospital. Serious
complications include stroke, persistent heart arrhythmias (irregular
heartbeats), heart failure, formation of blood clots in the legs or heart,
and aneurysm, or bulging, in a weakened heart chamber. But those who
survive the initial heart attack and are free from major problems a few
hours later stand a better chance of full recovery.

Recovery is always a delicate process, because any heart attack

weakens the heart to some degree. But generally, you can resume a
normal life. Depending on the severity of your heart attack, you may
experience:

 Heart failure, where the heart doesn't pump well enough to meet
the body's needs
 Arrhythmias or abnormal heart rhythms
 Cardiac arrest or sudden cardiac death, where the heart stops
beating
 Cardiogenic shock, where the heart is so damaged from the heart
attack that a person goes into shock, which may result in damage
of other vital organs like the kidneys or liver
 Death

Symptoms
Symptoms of a heart attack can include:

 Chest discomfort that may last more than a few minutes or go

away and come back; it may feel like squeezing, fullness,
pressure, or pain.
 Pain or discomfort in the upper body, including arm, left shoulder,
back, neck, jaw, or below the breastbone
 Difficulty breathing or shortness of breath (with or without chest
pain)
 Sweating or "cold sweat"
 Indigestion, heartburn, nausea, or vomiting
 Light-headedness, dizziness, or extreme weakness
 Anxiety or rapid or irregular heartbeats
A heart attack is a medical emergency. If you think you are having a
heart attack, you need immediate medical care and should call 911. If
you have no history of aspirin allergy or bleeding, emergency response
may ask you to chew one 325 mg aspirin slowly.

Do not try to drive to the hospital unless you have no other option.
Ambulance personnel can start care as soon as they arrive.

Get medical help right away if:

 You or someone you are with has signs of a heart attack.

 You have chest pain (angina) that no longer responds to
medication; this may indicate that a heart attack is underway.
 Your angina attacks become more frequent, prolonged, and severe
or happen at rest; as angina worsens, the risk of heart attack goes
up.
 You take aspirin to prevent heart attacks, and your stool looks
black and tarry. This may mean gastrointestinal bleeding and could
be a sign that aspirin has thinned your blood too much.

What Causes a Heart Attack?

Most heart attacks are the result of coronary artery disease, also known
as atherosclerosis or "hardening of the arteries," a condition that clogs
coronary arteries with fatty, calcified plaques over time. The typical
trigger for a heart attack is often a blood clot that blocks the flow of
blood through a coronary artery.

In the early 1980s, researchers confirmed that the trigger for nearly all
heart attacks is not the obstructive plaque itself, but the sudden
formation of a blood clot -- like a scab -- on top of plaque that cuts off
blood flow in an already narrowed vessel. This is called "plaque rupture."
Contrary to prior belief, doctors now recognize that the less severe
plaques are the cause of most heart attacks: It's the milder blockages
that rupture and then cause the blood clot to form.

Heart attacks may also be caused by coronary artery spasm, where a

heart artery is temporarily constricted, although this is a fairly rare
cause.
New research shows that inflammation also plays a role in the evolution
of heart attacks. It appears that the coronary artery walls become
inflamed over time, further increasing the buildup of fatty plaques.

Risk Factors
While the step-by-step process leading to a heart attack is not fully
understood, major risk factors for coronary artery disease are well-
known. You can control some of them, including high blood pressure,
high cholesterol, obesity, smoking, and a sedentary lifestyle. Stress is
also said to raise the risk, and exertion and excitement can act as
triggers for a heart attack.

Another important risk factor is family history. A family history of heart

disease can increase risk at earlier ages in both men and women.

Men older than 50 with a family history of heart disease are predisposed

to heart attack. High levels of estrogen are thought to protect
premenopausal women fairly well, but the risk of heart attack increases
significantly after menopause.

Doctors are learning more about the risk factors specific for women,
such as preeclampsia and gestational diabetes. Autoimmune diseases
and inflammatory diseases, that are more prevalent in women, also
increase the risk.

Diagnosis
A cardiologist, or heart specialist, relies on various tests to diagnose a
heart attack. These tests can also identify sites of blockage as well as
tissue damage.

Your doctor can assess for heart damage using an ECG, which also is
able to monitor the heart's electrical activity. Together with blood tests
an ECG provides data for an initial assessment of your condition. Your
doctor can also use images of the heart and coronary arteries done with
angiograms and radioisotope scans to locate specific areas of damage
and blockage.

With ultrasound tests called echocardiograms, your doctor can evaluate

your heart's function, see if the heart muscle has been damaged, and
visualize your valve function. With such data, your doctor can decide on
proper treatment and anticipate potential complications.

Treatment
If you have a heart attack, you will need emergency procedures to
restore blood flow to your heart and become stabilized. Then, you will
usually stay in the hospital in special coronary care units (CCU) for at
least 24 to 36 hours. Standard drug therapy may include:

 Vasodilators such as nitroglycerine to expand blood vessels

 Beta-adrenergic blocker drugs to calm the heart
 Aspirin to reduce clotting activity
 Other types of blood thinners to prevent clots from forming and for
breaking up those that are already there.
 Intensive therapy with a statin medicine.
 A painkiller such as morphine

In some cases, your doctor may also use clot-dissolving drugs like tPA
or tenecteplase (TNKase). These drugs work best if given within a few
hours of the beginning of a heart attack. And they are the first choice if
emergency angioplasty is not available. Sometimes, your doctor may
use them if there is a delay in angioplasty. Your doctor might do
emergency angioplasty, and possibly surgery, to remove a clot, reopen
a clogged artery, or bypass blocked arteries.

Once past the critical phase of a heart attack, you will continue to
receive:

 Beta blockers to slow the heart

 Nitrates to increase heart blood flow
 Blood thinners to prevent further blood clotting
 Statins to lower the LDL cholesterol

In the hospital, electrocardiogram machines are used to monitor your

heart and watch for rhythm problems. If your heart starts beating too
fast or too slow, your doctor may give you medications. Some people
are fitted with pacemakers. If you have a dangerous arrhythmia known
as ventricular fibrillation, your doctor may use electric shock to restore
the normal rhythm. People who show signs of congestive heart
failure receive a variety of medications to decrease strain on the heart
and encourage the heart to beat more forcefully.

Recovery
Doctors urge people recovering from a heart attack to get back on their
feet as quickly as possible. Doing so reduces the chances of blood clots
forming in the deep veins of your legs. These clots could travel through
your circulatory system and lodge in your lungs, creating a blockage.

Doctors usually recommend gentle exercise, nothing that requires

significant exertion. If you begin exercise soon after a heart attack, it
can help you improve your heart function and overall well-being. You
should also take part in a cardiac rehabilitation program with monitored
exercise and lifestyle modification. It’s a critical piece to recovery.

Long-term recovery from heart attack requires psychological and

lifestyle adjustments. Habits you need to quit include:

 Smoking
 Heavy drinking
 Eating high-fat foods
 Being inactive and sedentary

As a preventive measure, most heart attack survivors take a daily

aspirin tablet to thin the blood. Your doctor may also prescribe other
drugs.

Some people need invasive procedures to improve blood flow to the

heart over the long term. The two most common procedures are:

 Angioplasty, a catheter technique that widens clogged arteries by

breaking up plaques. Stents are often placed to hold the artery
open.
 Coronary bypass surgery, which diverts blood flow around clogged
arteries

Lifestyle After a Heart Attack

Regular aerobic exercise greatly improves your chances of preventing or
recovering from a heart attack. Check with your doctor before starting
any kind of exercise program. If you already have a heart condition,
your doctor will probably schedule a stress test before you begin
an exercise program. The test can help them decide how much exertion
is safe for you.

After a heart attack, you should exercise with other people rather than

alone during the first months of recovery. Many community health and
recreation centers offer physician-supervised cardiac rehabilitation
programs.

Mind/Body Medicine After a Heart Attack

Reducing stress may be one of the risk factors that you can control to
help prevent a heart attack and aid your recovery. Many techniques
promote relaxation, such as meditation, biofeedback, and yoga.
Relaxation also can help relieve pain, which you may have during your
recovery period.

People with a positive attitude about recovery tend to do much better.

You may find that a particular mind/body technique helps you to focus
on positive thoughts. You may also find, as many others have, that
sharing thoughts and emotions with a support group is extremely
beneficial.

Depression is also associated with heart disease. Discuss any signs of

depression with your doctor. Untreated depression can interfere with
your recovery.

Nutrition and Diet After a Heart Attack

The basic goals of a heart-healthy diet are to keep salt, sugar,
and saturated fat to a minimum to control your cholesterol, blood
pressure, and weight. You should eat magnesium-rich foods such as
nuts, beans, bran, fish, and dark green vegetables. Magnesium protects
the heart directly and indirectly by stabilizing heart rate, reducing
coronary artery spasm, and combating such conditions
as atherosclerosis and high blood pressure.

Much evidence suggests that unstable chemical compounds known as

free radicals make your body more vulnerable to heart attack by striking
the heart and coronary arteries and promoting atherosclerosis. You can
help your body neutralize free radicals with antioxidants like vitamins A,
C, and E. Fruits, vegetables, and grains supply many
antioxidant vitamins. Your doctor probably won’t recommend vitamin
supplements, as they have been shown not to be beneficial.  But it’s
critical for you to get vitamins and nutrients from a balanced diet.

Omega-3 fatty acids have received a lot of attention for being heart
healthy because they lessen inflammation in the body. You can get
omega-3s from olive oil, canola oil, walnuts, and flax seed. However,
omega-3 fatty acids are probably best known for being in certain types
of fish like salmon, tuna, herring, and mackerel. 

Eating root vegetables such as carrots may also help prevent heart
attack. These vegetables lower your cholesterol over the long term and
reduce blood-clotting activity.