Heart Attack Podcast Transcript

Welcome to the National Heart, Lung, and Blood Institute podcast on heart attack. This podcast will discuss what a heart attack is and the causes, risk factors, and signs and symptoms of a heart attack. It also will discuss how heart attacks are diagnosed and treated, how they can be prevented, and what to expect after a heart attack.

More information is available on the NHLBI Web site at www.nhlbi.nih.gov or by calling the NHLBI Health Information Center at 301–592–8573.

What Is a Heart Attack?

A heart attack occurs when blood flow to part of the heart muscle becomes blocked. If the flow of blood isn't restored quickly, that part of the heart will become damaged from lack of oxygen, and it will begin to die.

Heart attacks are usually the result of a condition called coronary artery disease. In coronary artery disease, a fatty material called plaque builds up over many years on the inside walls of the coronary arteries. These are the arteries that supply blood and oxygen to your heart. Eventually, an area of plaque can rupture, causing a blood clot to form. 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.

If the blockage isn't treated quickly, the heart muscle will begin to die and be replaced by scar tissue. This damage to the heart may not be obvious, or it may cause severe or long-lasting problems, such as heart failure or arrhythmias. Sometimes the damage is fatal.

Heart attacks are a leading killer of both men and women in the United States. Each year, about 1.1 million people in the United States have heart attacks, and almost half of them die. Fortunately, today there are excellent treatments that can save lives and prevent disabilities.

Acting fast at the first sign of heart attack symptoms can save your life and limit damage to your heart. Treatment works best when started within 1 hour of the beginning of symptoms.

The most common heart attack symptoms are chest discomfort or pain, which lasts for more than a few minutes or goes away and comes back; upper body discomfort in the arms, back, neck, jaw, or stomach; shortness of breath with or before chest discomfort; nausea; vomiting; lightheadedness or fainting; and breaking out in a cold sweat.

If you think you or someone you know may be having a heart attack:

• Call 9–1–1 within a few minutes of the start of symptoms. Don't wait any longer than 5 minutes.
• If your symptoms stop completely in less than 5 minutes, still call your doctor.
• Only take an ambulance to the hospital. Going in a private car can delay treatment.
• Take a nitroglycerin pill if your doctor has prescribed this type of medicine.

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. Acting fast may save your life!

What Causes a Heart Attack?

Heart attacks are usually the result of coronary artery disease. Coronary artery disease is the buildup over time of a material called plaque on the inner walls of the coronary arteries. Eventually, a section of plaque can break open, causing a blood clot to form at the site. A heart attack occurs if the clot becomes large enough to cut off most or all of the blood flow through the artery.

The blockage prevents oxygen-rich blood from reaching the part of the heart muscle fed by the artery. This can cause damage to the heart muscle. If the blockage isn't treated quickly, the damaged heart muscle begins to die.

Sometimes heart attacks are the result of problems with the very small, microscopic blood vessels of the heart. This condition is called microvascular disease, and it's believed to be more common in women than in men.

Another less common cause of heart attack is a severe spasm, or tightening, of a coronary artery that cuts off blood flow through the artery. This can happen even if you don't have coronary artery disease. It's not always clear what causes the spasm, but sometimes it can be related to taking certain drugs, such as cocaine; emotional stress or pain; exposure to extreme cold; or cigarette smoking.

Who Is At Risk for a Heart Attack?

Certain risk factors make it more likely that you will develop coronary artery disease and have a heart attack. Some of these risk factors can be controlled, and others can't.

Major risk factors for heart attack that you can control include smoking, high blood pressure, high blood cholesterol, overweight and obesity, physical inactivity, and diabetes.

Risk factors for heart attack that you can't control are age and family history of coronary artery disease. Risk increases for men older than 45 years and for women older than 55 years (or after menopause). Your risk also increases if your father or a brother was diagnosed with coronary artery disease before age 55, or if your mother or a sister was diagnosed with coronary artery disease before age 65.

Certain coronary artery disease risk factors tend to occur together. When this happens, it's called metabolic syndrome. In general, a person with metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone without metabolic syndrome.

What Are the Signs and Symptoms of a Heart Attack?

Not all heart attacks begin with a sudden, crushing pain as you often see on TV or in the movies. The warning signs and symptoms of a heart attack aren't the same for everyone. Many heart attacks start slowly as mild pain or discomfort. Some people don't have symptoms at all, which is called a silent heart attack.

Sometimes the signs and symptoms of a heart attack happen suddenly, but they can also develop slowly, over hours, days, and even weeks before a heart attack occurs.

The most common symptom of a heart attack is chest pain or 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. It can be mild or severe. Sometimes the pain feels like indigestion or heartburn.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina is pain in the chest that occurs in people with coronary artery disease, usually when they're active. Angina pain typically lasts for only a few minutes and goes away with rest. Angina that doesn't go away or that changes from its usual pattern may indicate the beginning of a heart attack and should be checked by a doctor right away.

Other common signs and symptoms that a person can have during a heart attack include:

• Upper body discomfort in one or both arms, the back, neck, jaw, or stomach,
• Shortness of breath with or before chest discomfort, and
• Nausea, vomiting, lightheadedness or fainting, and breaking out in a cold sweat.

Not everyone having a heart attack experiences the typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. However, the more signs and symptoms you have, the more likely it is that you're having a heart attack.

Acting quickly when you notice heart attack signs and symptoms can prevent damage to your heart and may save your life. Know the warning signs of a heart attack so you can act fast to get treatment.

Call 9–1–1 for help within 5 minutes if you think you may be having a heart attack or if your chest pain doesn't go away as it usually does when you take prescribed medicine.

Don't drive yourself or anyone else to the hospital. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

The sooner you get emergency help, the less damage there will be to your heart.

How Is a Heart Attack Diagnosed?

The diagnosis of heart attack is based on your symptoms, your personal and family medical history, and the results of diagnostic tests. Some of the tests used include an electrocardiogram, also called an EKG; blood tests; and coronary angiography.

An EKG detects and records the electrical activity of the heart. Certain changes in the way electrical waves appear on an EKG are strong evidence of a heart attack. An EKG also can show if you're having arrhythmias, which a heart attack or another condition can cause.

Blood tests also are helpful for diagnosing a heart attack. During a heart attack, heart muscle cells die and burst open, letting certain proteins out in the bloodstream. Blood tests can measure the amount of these proteins. Higher than normal levels of these proteins in the bloodstream are evidence of a heart attack.

Commonly used blood tests include troponin, creatine kinase, and serum myoglobin. Blood tests are often repeated to check for changes over time.

Coronary angiography is a special x-ray exam of the heart and blood vessels. It's often done during a heart attack to help pinpoint blockages in the coronary arteries.

For this test, the doctor passes a thin, flexible tube, called a catheter, through an artery in your arm or upper thigh and threads it to your heart. A dye that can be seen on x ray is injected into the bloodstream through the tip of the catheter. The dye lets the doctor study the flow of blood through the heart and blood vessels.

If a blockage is found, another procedure, called angioplasty, may be used to restore blood flow through the artery. Sometimes during angioplasty, the doctor will place a small mesh tube, called a stent, in the artery to help keep it open.

How Is a Heart Attack Treated?

Treating a heart attack early can prevent or limit damage to the heart muscle. Medical personnel can begin diagnosis and treatment even before you get to the hospital.

Certain treatments are usually started right away if a heart attack is suspected. These treatments include:

• Oxygen,
• Aspirin, to prevent further blood clotting,
• Nitroglycerin, to reduce the workload on the heart and improve blood flow through the coronary arteries, and
• Treatment for chest pain.

Once the diagnosis of heart attack is confirmed or strongly suspected, treatments to try to restore blood flow to the heart are started as soon as possible.

A number of different kinds of medicines may be used to treat heart attack, including thrombolytics, beta blockers, ACE inhibitors, anticoagulants, and antiplatelet medicines.

Thrombolytics are used to dissolve blood clots that are blocking the coronary arteries. To be most effective, these medicines must be given within 1 hour after the start of heart attack symptoms.

Beta blockers decrease the workload on your heart. They're also used to relieve chest pain or discomfort, to help prevent additional heart attacks, and to correct arrhythmias.

ACE inhibitors lower blood pressure and reduce the strain on your heart. They also help slow down further weakening of the heart muscle.

Anticoagulants thin the blood and prevent clots from forming in your arteries.

Antiplatelet medicines, such as aspirin and clopidogrel, also prevent clots by stopping a type of blood cell, called platelets, from clumping together.

Other medicines may also be given to relieve pain and anxiety and to treat arrhythmias.

If medicines can't stop a heart attack, medical procedures—surgical or nonsurgical—may be used. These procedures include angioplasty and coronary artery bypass grafting.

Angioplasty is a nonsurgical procedure that's used to open blocked coronary arteries. A thin, flexible tube, called a catheter, with a balloon on the end is threaded through a blood vessel to the blocked coronary artery. Then, the balloon is inflated to push the plaque against the wall of the artery. This widens the inside of the artery and restores blood flow.

During angioplasty, a small mesh tube called a stent may be put in the artery to help keep it open. Some stents are coated with medicines that help prevent the artery from becoming blocked again.

Coronary artery bypass grafting is a type of surgery. Arteries or veins are taken from other areas of your body and sewn in place to bypass blocked coronary arteries. This provides a new route for blood flow to the heart muscle.

Most people spend several days in the hospital after a heart attack. When you leave the hospital, treatment doesn't stop. Your doctor may recommend lifestyle changes to lower your chances of having another heart attack. These may include quitting smoking, losing weight, changing your diet, and increasing your physical activity.

At home, your treatment may also include daily medicines and cardiac rehabilitation—called rehab for short.

Cardiac rehab can help you recover from a heart attack, and it may help prevent another one. Almost everyone who has had a heart attack can benefit from rehab. The heart is a muscle, and the right exercise will strengthen it.

Rehab also includes education, counseling, and learning about reducing your risk factors. Your cardiac rehab team may include doctors, such as your family doctor, a cardiologist, or a surgeon; nurses; exercise specialists; physical and occupational therapists; dietitians; and psychologists or other behavioral therapists.

How Can a Heart Attack Be Prevented?

Lowering your risk factors for coronary artery disease can help prevent a heart attack. Even if you already have coronary artery disease, you may still take steps to lower your risk of heart attack.

Risk factors include smoking, high blood pressure, high blood cholesterol, overweight and obesity, physical inactivity, diabetes, age, and family history of early heart disease.

Reducing your risk for heart disease usually means making healthy lifestyle choices, including:

• Following a low-fat diet rich in fruits and vegetables. Pay careful attention to the amounts and types of fat in your diet, and lower your salt intake. These changes can help lower high blood pressure and high blood cholesterol.
• Losing weight if you're overweight or obese,
• Quitting smoking, and
• Doing physical activity to improve heart fitness. Ask your doctor how much and what kinds of physical activity are safe for you.

In addition to making lifestyle changes, you can lower you chances of heart attack by treating conditions that make a heart attack more likely, such as high blood cholesterol, high blood pressure, and diabetes.

You may need medicine if diet and exercise aren't enough to keep your cholesterol and blood pressure under control. You also may need to take medicine to control your blood sugar levels if you're diabetic.

Make sure that you have an emergency action plan in case you or someone else in your family has a heart attack. This is especially important if you're at high risk or have already had a heart attack.

Talk with your doctor about the signs and symptoms of heart attack, when you should call 9–1–1, and steps you can take while waiting for medical help to arrive.

Life After a Heart Attack

Many people survive heart attacks and live active and full lives. If you get help quickly, treatment can limit the damage to your heart muscle. Less heart damage improves your chances for a better quality of life.

After a heart attack, you will need treatment for coronary artery disease to prevent another heart attack. Your doctor may recommend:

• Lifestyle changes, such as quitting smoking, following a healthy diet, increasing your physical activity, and losing weight, if needed,
• Medicines to control chest pain or discomfort, blood pressure, blood cholesterol, and your heart's workload, and
• Participation in a cardiac rehabilitation program.

After a heart attack, most people without chest pain or discomfort or other complications can safely return to most of their normal activities within a few weeks. Most can begin walking immediately. Sexual activity also can begin within a few weeks for most patients. Talk to your doctor about a safe schedule for returning to your normal activities.

If allowed by State law, driving can usually begin within a week for most patients who don't have chest pain or discomfort or other complications. People with complications shouldn't drive until their symptoms have been stable for a few weeks.

After a heart attack, many people worry about having another heart attack. Sometimes they feel depressed or have trouble adjusting to the new lifestyle that's needed to limit further heart trouble. Your doctor may recommend medicine or professional counseling if you have depression or anxiety. Physical activity can improve mental well-being, but you should consult with your doctor before starting any fitness activities.

Once you've had a heart attack, you're at higher risk for another one. It's important to know the difference between angina and a heart attack. The pain of angina usually occurs after exertion and goes away in a few minutes when you rest or take medicine as directed. During a heart attack, the pain is usually more severe than angina, and it doesn't go away when you rest or take medicine. If you don't know whether your chest pain is angina or a heart attack, call 9–1–1.

Remember, the symptoms of a second heart attack may not be the same as those of a first heart attack. Don't take a chance if you're in doubt. Always call 9–1–1 within 5 minutes if you or someone you're with has symptoms of a heart attack.

Links to Other Information About Heart Attack

For more information about heart attack and other heart diseases and conditions, including "Your Guide to Living Well with Heart Disease" and Act in Time to Heart Attack Signs materials, go to the NHLBI Web site at www.nhlbi.nih.gov.

You can download or order copies of NHLBI publications from the Web site. To speak with a health information specialist or order print copies of publications, call the NHLBI Health Information Center at 301–592–8573.