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Heart attack

Published by Bupa's health information team, December 2006.

This factsheet is for people who have had a heart attack or those who want to know more about them.

Heart disease is the most common cause of death in the UK. In 2004, there were about 231,000 new heart attacks.

• About heart attack
• Symptoms
• What causes heart attacks?
• Who is affected?
• Treating a heart attack
• Rehabilitation
• Prevention
• Further information
• Questions and answers
• Sources

Heart attack animation

About heart attack

Heart attacks happen when a coronary artery carrying oxygen-rich blood to the heart muscle is blocked. If the blood supply is cut off, a part of the heart muscle dies - or infarcts. A heart attack is also known as a myocardial infarction (MI) or coronary thrombosis.

Symptoms

Most heart attacks cause severe pain in the centre of the chest. However, sometimes there are no symptoms at all (silent MI), especially in the elderly and people with diabetes.

The central chest pain is often described as heaviness, squeezing or crushing, and may come on suddenly causing the person to collapse. The pain may spread to the arms, neck, jaw, face, back or stomach. A person having a heart attack may be pale, sweaty and breathless. They might feel or be sick. The symptoms can come on suddenly, but sometimes the pain develops more slowly. The pain sometimes feels like severe indigestion.

Heart attack pain is more persistent than angina and can last for hours. A person who is used to angina will find that the pain of a heart attack will not completely respond to their usual medicine (eg glyceryl trinitrate).

What causes heart attacks?

The underlying cause of most heart attacks is atherosclerosis - where the coronary arteries become narrowed over many years.

Atherosclerosis involves the formation of fatty deposits (plaques) on the walls of the coronary arteries. These plaques are thought to split open (rupture), releasing substances that cause the blood flowing in the coronary artery to clot. Combined, the plaque and blood clot (thrombus) can completely block the coronary artery altogether, causing a heart attack.

Narrowing of coronary arteries without complete blockage may cause angina. For more information, please see the separate Bupa factsheet, Angina.

Who is affected?

Heart attacks are more common in elderly people and, up to the age of 50, are more common in men than women. After that age, the difference between men and women begins to narrow.

In addition to age and sex, there are a number of factors that increase the risk of atherosclerosis and heart attacks. These include:

• smoking
• a family history of heart disease
• an inactive lifestyle (doing less than 30 minutes physical activity per day, on most days)
• diabetes
• obesity
• high blood pressure
• high blood cholesterol

A coronary artery affected by arthrosclerosis

Treating a heart attack

If a heart attack is suspected, emergency medical treatment is vital - getting to a hospital quickly and receiving specialist care greatly improves the chances of survival. If you suspect someone is having a heart attack, call 999 immediately. If the person can swallow, give them a single aspirin tablet to chew, unless you know that they are allergic to it. This thins the blood and can help to prevent the clot that is blocking the coronary artery from spreading.

Before hospital

In response to an emergency call for a suspected heart attack, the ambulance service will send a paramedic as quickly as possible. Their job is to stabilise the person and transport them to a hospital quickly and safely for further treatment. A paramedic may have to resuscitate a very ill person, and give oxygen and pain-relieving drugs.

At hospital

A heart attack is usually confirmed with an electrocardiogram (ECG), which shows the electrical activity of the heart, and blood tests. Oxygen is administered with a face mask and pain relief is given - usually with an injection of diamorphine combined with an anti-sickness medicine. This helps to relieve the pain and relax the patient.

A low dose aspirin, if not already given, is used to thin the blood. Ideally, the person should be transferred to a coronary care unit for specialist medical and nursing care.

At the coronary care unit, or sometimes in the accident and emergency department, a slow intravenous injection of a drug called a thrombolytic (also known as a "clot buster") is usually given to dissolve the clot in the coronary artery. This increases the risk of bleeding so is not given to some people (eg after recent surgery) where it may cause problems. The chances of a full recovery are much better if the clot is dissolved.

Other drugs such as beta-blockers (eg atenolol) or glyceryl trinitrate may also be given to increase blood supply to the heart by widening blood vessels.

Complications

In the first few days after surviving a heart attack, the heart may beat in irregular, abnormally fast or slow rhythms, which are known as arrhythmias. Sometimes a pacemaker - a device inserted under the skin in the chest that sends electrical impulses to the heart - is used to make sure that the heart beats regularly and at a healthy speed.

After an attack, your heart may not be able to pump blood around your body as efficiently as before. This is called heart failure. The larger the area of your heart muscle affected by the heart attack, the more likely heart failure is. For more information, please see the separate Bupa factsheets Arrhythmia and Heart failure.

Other, rarer, complications include blood clots in the lungs, stroke, inflammation of the membrane covering the heart (pericarditis), or a bulging weakness in the heart muscle (aneurysm). After a heart attack you are at a higher risk for further attacks.

Surgery

After a heart attack, you will usually be offered an exercise test. If this suggests that your coronary arteries have narrowed, an angiogram will be carried out. This involves injecting a dye into the blood so that the coronary blood vessels show up on an X-ray. If your arteries are narrowed, you can sometimes be treated with angioplasty or coronary artery bypass grafting.

Angioplasty involves widening the artery by inflating a balloon in the narrowed coronary artery. Sometimes a wire mesh tube called a stent is inserted to hold it open. This procedure is done with a catheter - a long fine tube - which is passed into the body from a vein in the leg. See the Bupa factsheet Angioplasty for more information.

Coronary artery bypass grafting (CABG) is a type of open-heart surgery (the chest is opened). It is sometimes carried out if angioplasty is unsuccessful. It involves rerouting the blood around the affected coronary artery, using a replacement section of a blood vessel - the graft - which is usually taken from a leg vein. This helps people with dangerously narrow coronary arteries, especially if the left side of the heart is not pumping well. For more information, please see the Bupa separate factsheet Coronary artery bypass graft.

Long-term management

People who have had a heart attack may need to take a number of daily medicines over the long term.

A low daily dose of aspirin (around 75mg) is usually recommended for all heart-attack survivors. Then, a range of other medicines may be used to promote blood flow, widen narrowed arteries, to give the heart less work to do or to make it pump more effectively. These include beta-blockers, angiotensin converting enzyme (ACE) inhibitors and glyceryl trinitrate.

Other drugs, called statins, are used to reduce cholesterol levels in the bloodstream.

Rehabilitation

For the best possible recovery after a heart attack, starting a rehabilitation programme is essential. Cardiac rehabilitation programmes usually include an exercise regime devised by a physiotherapist, as well as providing advice on relaxation, lifestyle modification and treatment choices.

Research has shown that exercise in rehabilitation significantly reduces the chances of dying in the years following a heart attack, so this is a critical part of recovery. People who have had a heart attack often worry about the safety of having sex. According to the British Heart Foundation, however, if your recovery is uncomplicated and you are able to briskly climb two flights of stairs without any chest pain or feeling breathless, you can usually safely have sex about two to three weeks after your attack.

Some rehabilitation programmes may also include screening for depression. Depression is common among people following a heart attack and has been linked with a worse outcome, so it is important for it to be treated.

Your hospital may run a rehabilitation programme, which will start around four to six weeks after the heart attack. This usually involves visiting the hospital once or twice a week for six to eight weeks. In addition, the British Heart Foundation (see Further information) and GPs should also have a list of local rehabilitation programmes.

Prevention

The risk of a first - and repeat - heart attack can be reduced by making changes to your lifestyle. Not smoking, losing excess weight, taking regular exercise and sticking to a diet that is low in fat and high in fibre will all reduce your chance of having a heart attack. For more information, please see the Bupa factsheet Looking after your heart.

Further information

• British Heart Foundation
  020 7935 0185
  www.bhf.org.uk

		Heart attack Q&As See our answers to common questions about heart attack, including: How do I know that it's a heart attack and not something else? Can I go back to my normal life after a heart attack? I have been feeling quite anxious and depressed since my heart attack. Is this normal?

Sources

• National Statistics Online.
  www.statistics.gov.uk
  accessed 1 December 2006
• British Heart Foundation Statistics website.
  www.heartstats.org
  accessed 1 December 2006
• Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. 3 ed. Oxford, 2004: 844
• Longmore M, Wilkinson IB, Rajogopalan S. Oxford Handbook of Clinical Medicine. 6 ed. Oxford, 2006: 394
• Clinical knowledge summaries. PRODIGY guidance.
  www.prodigy.nhs.uk
  accessed 1 December 2006

Publication date: December 2006.

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