Cause

A heart attack is caused when not enough blood and oxygen reach part of the heart muscle. This most often happens because blood flow in one or more of the coronary arteries is blocked or reduced.

This blockage or reduction is most often the result of coronary artery disease. In this disease, fatty deposits called plaque (say "plak") build up inside the coronary arteries. If the plaque breaks open, the body tries to repair the artery. A blood clot may form and block or reduce blood flow.

There are other less common causes. A heart attack can be caused by conditions that block or reduce blood flow in a coronary artery. These can include a blocked stent, or a sudden tear or spasm in the artery. Sometimes a heart attack is caused by heart surgery.

What Increases Your Risk

Things that increase your risk for a heart attack include:

• High cholesterol.
• High blood pressure.
• Diabetes.
• Smoking, vaping, or using other tobacco or nicotine products.
• Not enough physical activity.
• Not enough good-quality sleep.
• An unhealthy diet.
• Being overweight or having obesity.
• A family history of early coronary artery disease. This means you have a male family member who was diagnosed before age 55. Or you have a female family member who was diagnosed before age 65.

Your age, sex, and ancestry can also raise your risk. For example, your risk increases as you get older.

Using hormone therapy for menopause and having pregnancy-related problems may raise your risk for a heart attack or stroke.

Most nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the risk of heart attack. This risk is greater if you take NSAIDs at higher doses or for long periods of time.

The use of certain illegal drugs, such as cocaine, also increases the risk of a heart attack.

Lowering Your Risk

A heart-healthy lifestyle and medicines can help lower your risk of a heart attack.

• Quit smoking, vaping, or using other tobacco or nicotine products. If you can't quit, cut back as much as you can. If you need help quitting, talk to your doctor about quit programs and medicines. These can increase your chances of quitting for good. Also try to avoid secondhand smoke and the aerosol mist from vaping.
• Eat heart-healthy foods. These include vegetables, fruits, nuts, beans, lean meat, fish, and whole grains. Limit alcohol, sodium, and sugar.
• Be active. Try for 30 minutes on most days of the week. Ask your doctor what level of exercise is safe for you.
• Stay at a weight that's healthy for you. Talk to your doctor if you need help with your weight goals.
• Manage other health problems. These include high blood pressure, high cholesterol, and diabetes.
• If you think you may have a problem with alcohol or drug use, talk to your doctor.
• Get plenty of sleep. Try to get 7 to 9 hours of sleep each night.
• Take medicines as prescribed. If you're at high risk of a heart attack or stroke and you're at low risk of bleeding, your doctor might talk to you about taking an aspirin every day to lower your risk. Don't start taking daily aspirin without talking to your doctor first.

Symptoms

Symptoms of a heart attack include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, tiredness, nausea, and back or jaw pain.

And people have other ways to describe the pain from a heart attack. It may feel like discomfort, pressure, squeezing, or heaviness in the chest. It may also feel like weight, tightness, or a dull ache. The exact location of the pain is often difficult to point out. The pain may spread down the left shoulder and arm and to other areas.

What Happens

During a heart attack, part of the heart muscle does not get enough blood and oxygen. This part of the heart starts to die.

If only a small amount of heart muscle dies, the heart may still function normally after a heart attack. But if a larger area of the heart is damaged, you may develop other problems. These include heart rhythm problems (arrhythmias), heart failure, heart valve disease, and pericarditis.

When to Call 911

Do not wait if you think you are having a heart attack. Getting help fast can save your life. Even if you're not sure it's a heart attack, have it checked out.

Call 911 or other emergency services immediately if you have symptoms of a heart attack. These may include:

• Chest pain or pressure, or a strange feeling in the chest.
• Sweating.
• Shortness of breath.
• Nausea or vomiting.
• Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
• Lightheadedness or sudden weakness.
• A fast or irregular heartbeat.

Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within 5 minutes, call 911. Do not wait to call for help.

Symptoms can vary. The most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Why wait for an ambulance?

By calling 911 and taking an ambulance to the hospital, you may be able to start treatment before you get to the hospital. If any complications occur along the way, ambulance staff are trained to evaluate and treat them.

If an ambulance is not readily available, have someone else drive you to the emergency room. Do not drive yourself to the hospital.

CPR

If you see someone pass out, call 911 or other emergency services and start CPR (cardiopulmonary resuscitation). The emergency operator can coach you on how to perform CPR.

Exams and Tests

A doctor will take your history, do a physical exam, and check your heart rate, blood pressure, and breathing rate. You will have tests that can help diagnose a heart attack. The tests include the following:

• Electrocardiogram (EKG, ECG). This test measures the electrical signals of the heart. It helps show whether you are having a heart attack.
• Troponin test. This is a blood test that looks for a rise in cardiac proteins. The heart releases these proteins when it is damaged.
• Imaging tests. These tests provide images that show how well the heart is working and how well blood is flowing to the heart muscle. Examples include a CT angiogram, an echocardiogram, and an MRI.
• Coronary angiogram. This test can check blood flow in the coronary arteries.

Treatment Overview

Treatment may start right away if you call 911 when you think you're having a heart attack. You may be told to chew aspirin while you wait for the ambulance. This can help prevent blood clots from getting bigger.

Ambulance and emergency room

Treatment begins in the ambulance and emergency room with aspirin and other medicines. You may get oxygen if you need it. You may get morphine if you need pain relief.

The goal of your care team will be to prevent lasting heart muscle damage by restoring blood flow to your heart as quickly as possible.

You may receive medicines to stop blood clots. They are given to prevent blood clots from getting bigger so blood can flow to the heart. Some medicines will break up blood clots to increase blood flow. You might be given other medicines as well.

Other treatment includes:

• Nitroglycerin. It opens up the arteries of the heart to help blood flow back to the heart.
• Beta-blockers. These drugs lower the heart rate, the blood pressure, and the workload of the heart.

Your test results will help your doctor decide about more treatment. You might have angioplasty or bypass surgery to improve blood flow to your heart.

Other treatment in the hospital

Your doctors and nurses will watch you closely. They will check your heart rate, heart rhythm, and blood pressure and give medicines to make sure you don't have serious complications.

Your doctors will start you on medicines that lower your risk of having another heart attack. Or you may get medicines that lower your risk of having complications and that help you live longer. They include medicine to:

• Lower blood pressure.
• Lower cholesterol.
• Lower the heart's workload.
• Prevent blood clots from forming and causing a heart attack.

Cardiac rehabilitation (rehab) might be started in the hospital or soon after you go home. It can help you have a heart-healthy lifestyle which can lead to a stronger heart and better health. Cardiac rehab can help you feel better and reduce your risk for future heart problems. If cardiac rehab has not already been offered to you, ask your doctor if it's right for you.

Lifestyle changes

Heart-healthy lifestyle changes are part of treatment for anyone who has had a heart attack. Even though you take medicine, lifestyle changes can also keep your heart and your body healthy.

A heart-healthy lifestyle includes:

• Not smoking, vaping, or using other tobacco or nicotine products.
• Eating heart-healthy foods.
• Being active.
• Staying at a weight that's healthy for you.
• Managing other health problems such as diabetes and high blood pressure.

Self-Care

When you leave the hospital after a heart attack, you can then take steps to improve your heart health and help prevent another heart attack.

Medicines

Taking medicine correctly can lower your risk of having a heart attack or dying from coronary artery disease. Some of the medicines your doctor may prescribe include:

• Aspirin and other antiplatelet medicines. These are used to prevent blood clots.
• Statins and other medicines. These are used to lower high cholesterol.
• ARBs or ACE inhibitors. These are used to lower blood pressure and reduce the workload on your heart.
• Beta Blockers. These are used to slow the heart rate and and reduce the workload on your heart.

If you have been taking hormone therapy for menopause, talk with your doctor about whether it's right for you. It might raise the risk of a heart attack in some people.

Cardiac rehab

Taking part in a cardiac rehabilitation (rehab) program can help lower your risk of having another heart attack. A cardiac rehab program is designed for you and supervised by doctors and other specialists.

This type of program helps you recover from a heart attack. It also helps you take steps to prevent another one. In the program, a team of health professionals provides education and support to help you build new, healthy habits.

A heart-healthy lifestyle

Healthy lifestyle changes can help lower your risk of having another heart attack. And they may help you feel better and live longer. Here are some things you can do.

• Quit smoking, vaping, or using other tobacco or nicotine products. This is one of the best things you can do for your heart and your overall health. Quitting can reduce the risk of another heart attack. Also avoid secondhand smoke and the aerosol mist from vaping.
• Be active.
  • Before you start activity, talk to your doctor to find out how much is safe for you. Increase your activity a little bit at a time, as your doctor approves.
  • Get at least 30 minutes of activity on most days of the week. Physical activity, like walking, can help you lose weight, lower your blood pressure, and improve your cholesterol.
• Eat heart-healthy foods. These include fruits and vegetables, whole grains, and protein sources such as legumes, nuts, fish, lean meats and poultry, and low-fat or fat-free dairy. Avoid processed foods. Eat foods low in sodium (salt), sugar, saturated fat, and trans fat.
• Stay at a weight that's healthy for you. Being overweight makes you more likely to have high blood pressure, heart problems, and diabetes. These conditions make a heart attack more likely. Talk to your doctor if you need help losing weight.

Other health problems

• Manage other health problems. You can help lower your chance of having a heart attack by managing other health problems that you might have. Health problems such as diabetes, high blood pressure, and high cholesterol can increase your risk of a heart attack. If you think you may have a problem with alcohol or drug use, talk to your doctor. This includes prescription medicines (such as amphetamines and opioids) and illegal drugs (such as cocaine and methamphetamine). Your doctor can help you figure out what type of treatment is best for you.
• Avoid infections such as COVID-19, colds, and the flu. Get the flu vaccine every year. Get a pneumococcal vaccine shot. If you have had one before, ask your doctor whether you need another dose. Stay up to date on your COVID-19 vaccines.
• Get help for depression. Depression is a medical problem that needs treatment. Getting treatment can help you stay healthy.

Your angina symptoms

After a heart attack, you may have stable angina. Here's what you can do:

• Pay attention to your symptoms. Then you can see what causes them and what is typical for you.
• Know how to manage angina. Most people can control their symptoms by taking medicine or changing their activities.
• Know when to contact your doctor or get help right away. Contact your doctor if your stable angina symptoms seem worse but still follow your typical pattern. You can predict when symptoms will happen, but they may come on sooner, feel worse, or last longer. Call 911 right away if you have angina symptoms that do not follow your typical pattern. For example, your symptoms may happen at rest or not go away with nitroglycerin. It may mean you are having a heart attack.

Other steps to stay healthy

• Manage stress. Stress can be bad for your heart and might make your symptoms worse.
• Seek help for sleep problems. Sleep apnea is a common problem in people who have heart disease.
• Find emotional support. Support from friends and family is important whether you are recovering from a heart attack or are changing your lifestyle so you can avoid one.
• Have sex when you're ready. Sex is part of a healthy life. And it can be safe for people who have heart problems. Your doctor can help you know if your heart is healthy enough for sex.
  • Talk with your doctor before trying a medicine for erection problems. Some can cause serious problems if you also use a nitrate medicine, such as nitroglycerin.
  • Consider resuming sex gradually. You can start with ways of being intimate that are easy on your heart, like kissing and caressing.

Medicines

After a heart attack, medicines help lower your risk of having another one. These medicines include:

• ACE inhibitors or ARBs. These are types of blood pressure medicines.
• Statins and other cholesterol medicines. These lower cholesterol.
• Aspirin and other antiplatelets. These medicines prevent blood clots from forming in your blood vessels. This can help prevent a heart attack.
• Beta-blocker medicines. These are a type of blood pressure and heart medicine.

All medicines can cause side effects. So it is important to understand the pros and cons of any medicine you take. It is also important to take your medicines exactly as your doctor tells you to.