A heart attack can be frightening for the person having it. But most are treatable once you know the signs, and many are preventable with simple lifestyle changes. Here’s how to know when to seek help and what to expect in the hospital and later during your recovery. Plus, are you on the road to a heart attack? Find out with our quiz...
It’s the leading cause of death in women, and yet few of us expect to have a heart attack, and wouldn’t recognize the signs if we did.
“Heart attack symptoms in women can be different from those in men,” says Lisa Reis, M.D., a cardiologist and assistant professor at St. Louis University Hospital in Missouri. “We often feel fatigue and shortness of breath, while men experience crushing chest pain.”
Nausea, light-headedness and unusual jaw pain are also heart attack symptoms in women, she says.
Heart attacks occur when arteries get clogged and prevent blood and oxygen from getting to the organ.
“Smoking is the biggest [heart attack] risk factor because it increases inflammation in the arteries, which destabilizes plaque and can cause plaque rupture,” says Tracy Stevens, M.D., medical director of St. Luke’s Muriel I. Kauffman Women’s Heart Center and professor at the University of Missouri-Kansas City School of Medicine.
Other risk factors include obesity, high cholesterol, high blood pressure, a high-fat diet and lack of exercise, she says.
Yet women at risk may not even know when they have a heart attack.
“Thirty percent of women feel no symptoms when they have a heart attack,” says Binoy Singh, M.D., an internist and cardiologist with Columbia Doctors of Somers, N.Y. “Fewer than 50% have chest pains.”
That can be dangerous because early treatment is vital.
“Every second you delay getting to the hospital is another second we could have saved heart tissue,” says Rim Al-Bezim, M.D., a cardiologist with Capital Health Center for Women’s Health in Baltimore.
If you suspect you’re having a heart attack, “call 911 immediately,” says Ajanta De, M.D., an interventional cardiologist with Loyola University Health Systems near Chicago. “Don’t even think about driving yourself to the hospital.”
While waiting for help to arrive, chew a regular-dose aspirin with a glass of water to help prevent blood clotting. Chewed aspirin works more than twice as fast as swallowed at preventing blood clotting (five minutes compared to 12 minutes for a swallowed tablet), according to a study conducted at University of Texas Southwestern Medical School in Dallas.
If you’ve been prescribed nitroglycerin tablets or spray for angina, take one to three pills or sprays to relieve symptoms. Then lie down, take deep breaths and try to stay calm, according to Johns Hopkins University’s Heart Attack Action Plan.
Most heart attacks can be treated without surgery, provided you get to the hospital within 90 minutes, says Singh.
The minute you arrive at the emergency room, you’ll get an electrocardiogram (EKG), which records electrical activity of your heart via electrodes. You may also get a computerized axial tomography (CT) scan or magnetic resonance imaging (MRI) and/or blood tests to determine whether you have heart tissue damage, Singh says.
Once physicians verify that you did have a heart attack, you’ll undergo cardiac catheterization. During this procedure, a long, narrow tube is inserted into a blood vessel in your arm or leg and guided to the coronary arteries via a special X-ray machine to locate the blockage, he says.
After the blocked artery is found, you’ll get coronary (balloon) angioplasty, a procedure in which a catheter with a small balloon top is placed at the narrowing in the artery and then inflated to open the artery and increase blood flow to the heart, Singh says.
You may also get a stent – a small metal mesh tube that expands your artery to keep it open, says Peter Alagona, M.D., program director of general cardiology at Penn State Hershey Heart and Vascular Institute and an associate professor of medicine and radiology.
“For most women, these are the only treatments needed to treat a heart attack,” Singh says.
You may also undergo thrombolysis, a procedure in which a clot-dissolving agent is injected into your artery to restore blood flow, says Singh.
According to the American Heart Association (AHA), women are more likely to survive if they get thrombolysis within 12 hours after the heart attack (ideally, within 90 minutes), but in a 2004 study conducted at St Luke's-Roosevelt Hospital Center in New York and other medical centers and universities, only 6% of the women received thrombolysis compared to 21% of the men.
Medications
Your cardiologist may prescribe one or more medications to reduce the risk of another heart attack, says Al-Bezim. A few more common drugs include:
Anticoagulants (Dalteparin, Lovenox, Coumadin): Prevent clots from forming in blood vessels
Antiplatelets (aspirin, Ticlopidine, Clopidogrel/Plavix): Keep blood clots from forming
ACE Inhibitors (Lotensin, Vasotec, Altace): Expand blood vessels so blood flows more freely and the heart doesn’t have to work as hard
Beta blockers (Sectral, Zebeta, Cartrol): Lower blood pressure and prevent future heart attacks
Calcium channel blockers ( Lotrel, Vascor, Sular, Calan): Treat high blood pressure by relaxing blood vessels and the heart
Diuretics (Lasix, Lozol, Bumex): Increase the loss of excess fluids through urination to lessen the heart’s workload
Vasodilators (Isordil, Natrecor, Nitrates): Relax blood vessels and increase oxygen supply to heart
Niacin and/or Statins (Gemfibrozil, Clofibrate): Lower bad (LDL) cholesterol and raise good (HDL) cholesterol, which flushes bad cholesterol from arteries and prevents plaque buildup, which can cause a heart attack.
Surgical Treatments
If you have a heart attack, the most common and effective surgery is coronary artery bypass surgery (open heart surgery), says David Meyerson, M.D., head of cardiology at Johns Hopkins University School of Medicine.
In this procedure, surgeons take a healthy blood vessel from your leg, arm or chest (depending on the size of the blockage) and use it to make a new artery, bypassing the blocked artery and restoring blood flow to the heart, he says.
Bypass surgery improves blood flow, decreases chest pain, reduces the risk of another heart attack and improves your ability to exercise, Meyerson says.
You can have a single, double, triple, quadruple or even a quintuple bypass, depending on the number of coronary arteries bypassed in the procedure, Singh says.
There are three types of bypass surgery:
Traditional bypass surgery is a 4-5-hour open-heart surgery. You’re connected to a heart-lung bypass machine, and the surgery is performed while your heart is stopped.
Off-pump bypass surgery, which is performed while your heart is beating, using advanced equipment that stabilizes your heart. This procedure may reduce the risk of intraoperative bleeding (and the need for blood transfusion), renal complications and neurological problems after surgery. Both traditional bypass and off-pump surgeries yield excellent results, and the length of hospital stay, mortality rate and long-term neurological function and cardiac outcome are similar, according to the AHA.
Minimally invasive bypass surgery is done through a 3-inch incision in your chest wall. This type of surgery can be done without stopping the heart and putting the patient on a heart-lung machine, according to University of Maryland Medical Center (UMMC). It minimizes scarring and infection, shortens your hospital stay, and is less expensive than other bypass surgeries, according to the AHA. But this type of surgery can be used only when one or two arteries need a bypass and they’re in the front of the heart.
Cardiac Rehab
About a week or so after your procedure, you’ll begin a 12-week cardiac rehab program to reduce your risk of a second heart attack. You’ll learn to eat healthily, exercise, reduce stress and stop smoking, says Kim Haukland, R.N., head of cardiac rehab at Loyola University Health Systems outside Chicago.
“Cardiac rehab is a huge confidence booster,” she says. “People who have a heart attack often feel alone and scared to go out of the house. In cardiac rehab, they meet people in the same boat and get support and encouragement.”
Steps you can take
Besides not smoking, these lifestyle changes can reduce your risk of another heart attack:
Lose weight
Being overweight strains your heart and may also contribute to high cholesterol and hypertension, says De. Losing just 10 pounds makes a big difference.
Exercise regularly
Working out helps you maintain a healthy weight and lowers cholesterol and blood pressure. For best results, exercise for an hour as many days as possible, dividing your workout between a half hour of aerobic exercise like walking, cycling, swimming or running on the treadmill, and a half hour of strength training, Singh says.
“Find out if your local health club offers a structured program for cardiac patients,” says Jay Gillespie, Ph.D., associate professor of health sciences and director of the exercise science program at Northeastern University in Boston.
Eat a heart-healthy diet
“The Mediterranean diet is perfect if you’ve had a heart attack, [because] it revolves around fresh fruits and vegetables, whole grains and foods high in fiber, lean meats, poultry and fish once or twice a week,” says Darlene Zimmerman, MS, R.D., Heart Smart dietitian at Henry Ford Hospital Heart and Vascular Institute in Detroit.
Fish has omega-3 fatty acids, which help improve blood cholesterol levels and prevent blood clots, while plenty of fruits and vegetables contain fiber and antioxidants. Fiber flushes bad fats from arteries while antioxidants help protect and repair them, reducing the chance you’ll have a heart attack.
Cut fat
Your diet should contain no more than 25%-30% calories from fat, says Julie Bolick, R.D., a clinical nutritionist and lipid specialist for the University of Utah’s Cardiovascular Genetics Research Center.
“Keep saturated fat intake to 7% of your total calories by switching to lean meats, margarine instead of butter and eating low- and fat-free dairy products instead of full-fat versions,” she says.
Especially avoid trans fats, which are found in processed foods and fast foods. They raise LDL cholesterol.
Lower dietary cholesterol
When cholesterol accumulates in the walls of your arteries, it causes arteries to narrow, slowing down or blocking blood flow to the heart.
That’s why experts advise eating no more than 200 milligrams (mg) of cholesterol daily, Bolick says.
Steer clear of high-cholesterol foods like eggs, organ meats and full-fat dairy products; instead, eat egg substitutes or egg whites, lean meat and low- or nonfat dairy products.
Drink in moderation
“One drink a day can help increase good cholesterol,” Zimmerman says.
However, excessive drinking can raise blood pressure and triglyceride levels, and increase heart attack risk.
Lower sodium
A high-sodium diet contributes to high blood pressure, a major heart attack risk factor, according to the AHA.
To reduce your heart attack risk, consume no more than 2,300 mg of sodium daily, advises Zimmerman. Avoid high-salt foods, such as preserved meats, or packaged soups and stews and fast foods. Also, consider adopting the DASH diet (Dietary Approaches to Stop Hypertension).
Manage depression
Depression causes physical changes in two hormonal systems that influence heart health, according to a 2009 University of Chicago study.
The mental disorder doubles the risk of sudden cardiac death and increases the chance someone will have a heart attack by 60% or more, the study found.
If you’ve had a heart attack and are suffering from depression, you may need to see a psychotherapist or psychiatrist, says Barry Jacobs, Psy.D., a psychologist with Crozer-Keystone Family Medicine Residency Program near Philadelphia.
Reduce stress
Chronic stress triggers hormones that increase heart rate, elevate blood pressure, cholesterol and triglyceride levels, and increase your heart attack risk, according to the AHA.
To reduce stress, get enough sleep, exercise regularly, spend time with friends and loved ones, and do enjoyable activities every day. Also try stress-busters such as yoga, tai chi and deep breathing, the AHA recommends.
For more expert advice and information, visit our Heart Attack Health Center.
Are You on the Road to a Heart Attack?
Every 20 seconds, a heart attack occurs somewhere in the United States. Coronary heart disease, the leading cause of death in this country, contributes to the 1.5 million heart attacks that occur each year. Will you become a part of this statistic?
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