presentation of heart attack

Heart Attack Symptoms, Risk, and Recovery

What is a heart attack.

Heart attack signs and symptoms in men and women: Chest pain or discomfort; Shortness of breath; Pain or discomfort in the jaw, neck, back, arm, or shoulder; Feeling nauseous, light-headed, or unusually tired.

A heart attack, also called a myocardial infarction, happens when a part of the heart muscle doesn’t get enough blood.

The more time that passes without treatment to restore blood flow, the greater the damage to the heart muscle.

Coronary artery disease (CAD)  is the main cause of heart attack. A less common cause is a severe spasm, or sudden contraction, of a coronary artery that can stop blood flow to the heart muscle.

What are the symptoms of heart attack?

The major symptoms of a heart attack are

• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Feeling weak, light-headed, or faint. You may also break out into a cold sweat.
• Pain or discomfort in the jaw, neck, or back.
• Pain or discomfort in one or both arms or shoulders.
• Shortness of breath. This often comes along with chest discomfort, but shortness of breath also can happen before chest discomfort.

Other symptoms of a heart attack could include unusual or unexplained tiredness and nausea or vomiting. Women are more likely to have these other symptoms.  Learn more about women and heart disease .

Every 40 seconds, someone in the United States has a heart attack. 1 Learn more facts about heart attack and heart disease.

Call 9-1-1 if you notice symptoms of a heart attack.

If you notice the symptoms of a heart attack in yourself or someone else,  call 9-1-1 immediately . The sooner you get to an emergency room, the sooner you can get treatment to reduce the amount of damage to the heart muscle. At the hospital, health care professionals can run tests to find out if a heart attack is happening and decide the best treatment.

In some cases, a heart attack requires cardiopulmonary resuscitation (CPR) or an electrical shock (defibrillation) to the heart to get the heart pumping again. Bystanders trained to use CPR or a defibrillator may be able to help until emergency medical personnel arrive.

Remember, the chances of surviving a heart attack are better the sooner emergency treatment begins.

What are the risk factors for heart attack?

Several health conditions, your lifestyle, and your age and family history can increase your risk for heart disease and heart attack. These are called risk factors. About  half of all Americans have at least one of the three key risk factors for heart disease: high blood pressure, high blood cholesterol, and smoking. 2

Some risk factors cannot be controlled, such as your age or family history. But you can take steps to lower your risk by changing the factors you  can control.

Learn more about risk factors for heart disease and heart attack.

What can I do to recover after a heart attack?

If you’ve had a heart attack, your heart may be damaged. This could affect your heart’s rhythm and its ability to pump blood to the rest of the body. You may also be at risk for another heart attack or conditions such as  stroke , kidney disorders, and peripheral arterial disease (PAD).

You can lower your chances of having future health problems following a heart attack with these steps:

• Physical activity —Talk with your health care team about the things you do each day in your life and work. Your doctor may want you to limit work, travel, or sexual activity for some time after a heart attack.
• Lifestyle changes —Eating a healthier diet, increasing physical activity, quitting smoking, and managing stress—in addition to taking prescribed medicines—can help improve your heart health and quality of life. Ask your health care team about attending a program called cardiac rehabilitation to help you make these lifestyle changes.
• Physical activity
• Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit smoking
• Counseling to find ways to relieve stress and improve mental health

A team of people may help you through cardiac rehab, including your health care team, exercise and nutrition specialists, physical therapists, and counselors or mental health professionals.

More Information

• American Heart Association: Heart Attack
• National Heart, Lung, and Blood Institute: Heart Attack
• Tsao CW, Aday AW, Almarzooq ZI, Beaton AZ, Bittencourt MS, Boehme AK, et al. Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association . 2023;147:e93–e621.
• Fryar CD, Chen T-C, Li X. Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010 [PDF-494K] . NCHS data brief, no. 103. Hyattsville, MD: National Center for Health Statistics; 2012. Accessed May 9, 2019.

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StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

StatPearls [Internet].

Myocardial infarction.

Niranjan Ojha ; Amit S. Dhamoon .

Affiliations

Last Update: August 8, 2023 .

• Continuing Education Activity

Myocardial infarction (MI), colloquially known as "heart attack," is caused by decreased or complete cessation of blood flow to a portion of the myocardium. Myocardial infarction may be"silent," and go undetected, or it could be a catastrophic event leading to hemodynamic deterioration and sudden death. Most myocardial infarctions are due to underlying coronary artery disease, the leading cause of death in the United States. With coronary artery occlusion, the myocardium is deprived of oxygen. Prolonged deprivation of oxygen supply to the myocardium can lead to myocardial cell death and necrosis. Patients can present with chest discomfort or pressure that can radiate to the neck, jaw, shoulder, or arm. In addition to the history and physical exam, myocardial ischemia may be associated with ECG changes and elevated biochemical markers such as cardiac troponins. This activity describes the pathophysiology, evaluation, and management of myocardial infarction and highlights the role of the interprofessional team in improving care for affected patients.

• Review the basic pathophysiology of myocardial infarction.
• Explain the management protocol when presented with acute myocardial infarction, including all necessary laboratory and other diagnostic testing.
• Summarize the long-term management and rehabilitation for a patient post-MI.
• Explain interprofessional team strategies for improving care coordination and communication to advance the prevention and management of myocardial infarction leading to improved outcomes.
• Introduction

Myocardial infarction (MI), colloquially known as “heart attack,” is caused by decreased or complete cessation of blood flow to a portion of the myocardium. Myocardial infarction may be “silent” and go undetected, or it could be a catastrophic event leading to hemodynamic deterioration and sudden death. [1] Most myocardial infarctions are due to underlying coronary artery disease, the leading cause of death in the United States. With coronary artery occlusion, the myocardium is deprived of oxygen. Prolonged deprivation of oxygen supply to the myocardium can lead to myocardial cell death and necrosis. [2]  Patients can present with chest discomfort or pressure that can radiate to the neck, jaw, shoulder, or arm. In addition to the history and physical exam, myocardial ischemia may be associated with ECG changes and elevated biochemical markers such as cardiac troponins. [3] [4]

As stated above, myocardial infarction is closely associated with coronary artery disease. INTERHEART is an international multi-center case-control study which delineated the following modifiable risk factors for coronary artery disease: [5] [6]

• Abnormal lipid profile/blood apolipoprotein (raised ApoB/ApoA1)
• Hypertension
• Diabetes mellitus
• Abdominal obesity (waist/hip ratio) (greater than 0.90 for males and greater than 0.85 for females)
• Psychosocial factors such as depression, loss of the locus of control, global stress, financial stress, and life events including marital separation, job loss, and family conflicts
• Lack of daily consumption of fruits or vegetables
• Lack of physical activity
• Alcohol consumption (weaker association, protective)

The INTERHEART study showed that all the above risk factors were significantly associated with acute myocardial infarction except for alcohol consumption, which showed a weaker association. Smoking and abnormal apolipoprotein ratio showed the strongest association with acute myocardial infarction. The increased risk associated with diabetes and hypertension were found to be higher in women, and the protective effect of exercise and alcohol was also found to be higher in women. [5]

Other risk factors include a moderately high level of plasma homocysteine, which is an independent risk factor of MI. Elevated plasma homocysteine is potentially modifiable and can be treated with folic acid, vitamin B6, and vitamin B12. [7]

Some non-modifiable risk factors for myocardial infarction include advanced age, male gender (males tend to have myocardial infarction earlier in life), genetics (there is an increased risk of MI if a first-degree relative has a history of cardiovascular events before the age of 50). [6] [8]  The role of genetic loci that increase the risk for MI is under active investigation. [9] [10]

• Epidemiology

The most common cause of death and disability in the western world and worldwide is coronary artery disease. [11]  Based on 2015 mortality data from the National Health Interview Survey (NHIS-CDC), MI mortality was 114,023, and MI any-mention mortality (i.e., MI is mentioned as a contributing factor in the death certificate) was 151,863.

As per the National Health and Nutrition Examination Survey (NHANES)-CDC data from 2011 to 2014, an estimated 16.5 million Americans older than 20 years of age have coronary artery disease, and the prevalence was higher in males than females for all ages. As per the NHANES 2011 through 2014, the overall prevalence of MI is 3.0% in US adults older than 20 years of age.

Prevalence of MI in the US Sub-populations

Non-Hispanic Whites

• 4.0% (Male)
• 2.4% (Female)

Non-Hispanic Blacks

• 3.3% (Male)
• 2.2% (Female)
• 2.9% (Male)
• 2.1% (Female)

Non-Hispanic Asians

• 2.6% (Male)
• 0.7% (Female)

Based on the Atherosclerosis Risk in Communities Study (ARIC) performed by National Heart, Lung, and Blood Institute (NHLBI) collected between 2005 and 2014, the estimated annual incidence is 605,000 new MIs and 200,000 recurrent MIs. [12]

The ARIC study also found that the average age at first MI is 65.6 years for males and 72.0 years for females. In the past decades, several studies have shown a declining incidence of MI in the United States. [12]

• Pathophysiology

The acute occlusion of one or multiple large epicardial coronary arteries for more than 20 to 40 minutes can lead to acute myocardial infarction. The occlusion is usually thrombotic and due to the rupture of a plaque formed in the coronary arteries. The occlusion leads to a lack of oxygen in the myocardium, which results in sarcolemmal disruption and myofibril relaxation. [2]  These changes are one of the first ultrastructural changes in the process of MI, which are followed by mitochondrial alterations. The prolonged ischemia ultimately results in liquefactive necrosis of myocardial tissue. The necrosis spreads from sub-endocardium to sub-epicardium. The subepicardium is believed to have increased collateral circulation, which delays its death. [2]  Depending on the territory affected by the infarction, the cardiac function is compromised. Due to the negligible regeneration capacity of the myocardium, the infarcted area heals by scar formation, and often, the heart is remodeled characterized by dilation, segmental hypertrophy of remaining viable tissue, and cardiac dysfunction. [13]

• History and Physical

The imbalance between oxygen supply and the demand leads to myocardial ischemia and can sometimes lead to myocardial infarction. The patient’s history, electrocardiographic findings, and elevated serum biomarkers help identify ischemic symptoms. Myocardial ischemia can present as chest pain, upper extremity pain, mandibular, or epigastric discomfort that occurs during exertion or at rest. Myocardial ischemia can also present as dyspnea or fatigue, which are known to be ischemic equivalents. [14]  The chest pain is usually retrosternal and is sometimes described as the sensation of pressure or heaviness. The pain often radiates to the left shoulder, neck, or arms with no obvious precipitating factors, and it may be intermittent or persistent. The pain usually lasts for more than 20 minutes. [15]  It is usually not affected by positional changes or active movement of the region. Additional symptoms, such as sweating, nausea, abdominal pain, dyspnea, and syncope, may also be present. [14] [16] [17]  The MI can also present atypically with subtle findings such as palpitations, or more dramatic manifestations, such as cardiac arrest. The MI can sometimes present with no symptoms. [18]

The three components in the evaluation of the MI are clinical features, ECG findings, and cardiac biomarkers.

The resting 12 lead ECG is the first-line diagnostic tool for the diagnosis of acute coronary syndrome (ACS). It should be obtained within 10 minutes of the patient’s arrival in the emergency department. [17]  Acute MI is often associated with dynamic changes in the ECG waveform. Serial ECG monitoring can provide important clues to the diagnosis if the initial EKG is non-diagnostic at initial presentation. [14]  Serial or continuous ECG recordings may help determine reperfusion or re-occlusion status. A large and prompt reduction in ST-segment elevation is usually seen in reperfusion. [14]

ECG findings suggestive of ongoing coronary artery occlusion (in the absence of left ventricular hypertrophy and bundle branch block): [19]

ST-segment elevation in two contiguous lead (measured at J-point) of

• Greater than 5 mm in men younger than 40 years, greater than 2 mm in men older than 40 years, or greater than 1.5 mm in women in leads V2-V3 and/or
• Greater than 1 mm in all other leads

ST-segment depression and T-wave changes

• New horizontal or down-sloping ST-segment depression greater than 5 mm in 2 contiguous leads and/or T inversion greater than 1 mm in two contiguous leads with prominent R waves or R/S ratio of greater than 1

The hyperacute T-wave amplitude, with prominent symmetrical T waves in two contiguous leads, maybe an early sign of acute MI that may precede the ST-segment elevation. Other ECG findings associated with myocardial ischemia include cardiac arrhythmias, intraventricular blocks, atrioventricular conduction delays, and loss of precordial R-wave amplitude (less specific finding). [14]

ECG findings alone are not sufficient to diagnose acute myocardial ischemia or acute MI as other conditions such as acute pericarditis, left ventricular hypertrophy (LVH), left bundle branch block (LBBB), Brugada syndrome, Takatsubo syndrome (TTS), and early repolarization patterns also present with ST deviation.

ECG changes associated with prior MI (in the absence of left ventricular hypertrophy and left bundle branch block):

• Any Q wave in lead V2-V3 greater than 0.02 s or QS complex in leads V2-V3
• Q wave > 03 s and greater than 1 mm deep or QS complex in leads I, II, aVL, aVF or V4-V6 in any two leads of contiguous lead grouping (I, aVL; V1-V6; II, III, aVF)
• R wave > 0.04 s in V1-V2 and R/S greater than 1 with a concordant positive T wave in the absence of conduction defect.

Biomarker Detection of MI

Cardiac troponins (I and T) are components of the contractile apparatus of myocardial cells and expressed almost exclusively in the heart. Elevated serum levels of cardiac troponin are not specific to the underlying mode of injury (ischemic vs. tension) [14]   [20] . The rising and/or falling pattern of cardiac troponins (cTn) values with at least one value above the 99 percentile of upper reference limit (URL) associated with symptoms of myocardial ischemia would indicate an acute MI. Serial testing of cTn values at 0 hours, 3 hours, and 6 hours would give a better perspective on the severity and time course of the myocardial injury. Depending on the baseline cTn value, the rising/falling pattern is interpreted. If the cTn baseline value is markedly elevated, a minimum change of greater than 20% in follow up testing is significant for myocardial ischemia. Creatine kinase MB isoform can also be used in the diagnosis of MI, but it is less sensitive and specific than cTn level. [4] [21]

Different imaging techniques are used to assess myocardial perfusion, myocardial viability, myocardial thickness, thickening and motion, and the effect of myocyte loss on the kinetics of para-magnetic or radio-opaque contrast agents indicating myocardial fibrosis or scars. [14]  Some imaging modalities that can be used are echocardiography, radionuclide imaging, and cardiac magnetic resonance imaging (cardiac MRI). Regional wall motion abnormalities induced by ischemia can be detected by echocardiography almost immediately after the onset of ischemia when greater than 20% transmural myocardial thickness is affected. Cardiac MRI provides an accurate assessment of myocardial structure and function. [14]

• Treatment / Management

Acute Management

Reperfusion therapy is indicated in all patients with symptoms of ischemia of less than 12-hours duration and persistent ST-segment elevation. Primary percutaneous coronary intervention (PCI) is preferred to fibrinolysis if the procedure can be performed <120 minutes of ECG diagnosis. If there is no immediate option of PCI (>120 minutes), fibrinolysis should be started within 10 minutes of STEMI after ruling out contraindications. If transfer to a PCI center is possible in 60 to 90 minutes after a bolus of the fibrinolytic agent and patient meets reperfusion criteria, a routine PCI can be done, or a rescue PCI can be planned. [19] [17]  If fibrinolysis is planned, it should be carried out with fibrin-specific agents such as tenecteplase, alteplase, or reteplase (class I). [19]

Relief of pain, breathlessness, and anxiety: The chest pain due to myocardial infarction is associated with sympathetic arousal, which causes vasoconstriction and increased workload for the ischemic heart. Intravenous opioids (e.g., morphine) are the analgesics most commonly used for pain relief (Class IIa). [19]  The results from CRUSADE quality improvement initiative have shown that the use of morphine may be associated with a higher risk of death and adverse clinical outcomes. [22]  The study was done from the CIRCUS (Does Cyclosporine Improve outcome in STEMI patients) database, which showed no significant adverse events associated with morphine use in a case of anterior ST-segment elevation MI. [23] A mild anxiolytic (usually a benzodiazepine) may be considered in very anxious patients (class IIa). Supplemental oxygen is indicated in patients with hypoxemia (SaO2 <90% or PaO2 <60mm Hg) (Class I). [19]

Nitrates: Intravenous nitrates are more effective than sublingual nitrates with regard to symptom relief and regression of ST depression (NSTEMI). The dose is titrated upward until symptoms are relieved, blood pressure is normalized in hypertensive patients, or side effects such as a headache and hypotension are noted. [17]

Beta-blockers: This group of drugs reduces myocardial oxygen consumption by lowering heart rate, blood pressure, and myocardial contractility. They block beta receptors in the body, including the heart, and reduce the effects of circulating catecholamines. Beta-blockers should not be used in suspected coronary vasospasm.

Platelet inhibition: Aspirin is recommended in both STEMI and NSTEMI in an oral loading dose of 150 to 300 mg (non-enteric coated formulation) and a maintenance dose of 75 to 100 mg per day long-term regardless of treatment strategy (class I). [17] Aspirin inhibits thromboxane A2 production throughout the lifespan of the platelet. [24]

Most P2Y12 inhibitors are inactive prodrugs (except for ticagrelor, which is an orally active drug that does not require activation) that require oxidation by hepatic cytochrome P450 system to generate an active metabolite which selectively inhibits P2Y12 receptors irreversibly. Inhibition of P2Y12 receptors leads to inhibition of ATP induced platelet aggregation. The commonly used P2Y12 inhibitors are clopidogrel, prasugrel, and ticagrelor.

The loading dose for clopidogrel is 300 to 600 mg loading dose followed by 75 mg per day.

Prasugrel, 60 mg loading dose, and 10 mg per day of a maintenance dose have a faster onset when compared to clopidogrel. [19]

Patients undergoing PCI should be treated with dual antiplatelet therapy (DAPT) with aspirin + P2Y12 inhibitor and a parenteral anticoagulant. In PCI, the use of prasugrel or ticagrelor is found to be superior to clopidogrel. Aspirin and clopidogrel are also found to decrease the number of ischemic events in NSTEMI and UA. [17]

The anticoagulants used during PCI are unfractionated heparin, enoxaparin, and bivalirudin. The bivalirudin is recommended during primary PCI if the patient has heparin-induced thrombocytopenia. [19]

Long-Term Management

Lipid-lowering treatment: It is recommended to start high-intensity statins that reduce low-density lipoproteins (LDLs) and stabilize atherosclerotic plaques. High-density lipoproteins are found to be protective. [19]

Antithrombotic therapy: Aspirin is recommended lifelong, and the addition of another agent depends on the therapeutic procedure done, such as PCI with stent placement.

ACE inhibitors are recommended in patients with systolic left ventricular dysfunction, or heart failure, hypertension, or diabetes.

Beta-blockers are recommended in patients with LVEF less than 40% if no other contraindications are present.

Antihypertensive therapy can maintain a blood pressure goal of less than 140/90 mm Hg.

Mineralocorticoid receptor antagonist therapy is recommended in a patient with left ventricular dysfunction (LVEF less than 40%).

Glucose lowering therapy in people with diabetes to achieve current blood sugar goals.  [19]

Lifestyle Modifications

Smoking cessation is the most cost-effective secondary measure to prevent MI. Smoking has a pro-thrombotic effect, which has a strong association with atherosclerosis and myocardial infarction. [6]

Diet, alcohol, and weight control: A diet low in saturated fat with a focus on whole grain products, vegetables, fruits, and the fish is considered cardioprotective. The target level for bodyweight is body mass index of 20 to 25 kg/m2  and waist circumference of <94 cm for the men and <80 cm for the female. [25]

• Differential Diagnosis
• Angina pectoris
• Non-ST segment elevation myocardial infarction (NSTEMI)
• ST-segment elevation myocardial infarction (STEMI)
• Pulmonary embolism
• Pneumothorax

Despite many advances in treatment, acute MI still carries a mortality rate of 5-30%; the majority of deaths occur prior to arrival to the hospital. In addition, within the first year after an MI, there is an additional mortality rate of 5% to 12%. The overall prognosis depends on the extent of heart muscle damage and ejection fraction. Patients with preserved left ventricular function tend to have good outcomes. Factors that worsen prognosis include:

• Advanced age
• Delayed reperfusion
• Low ejection fraction
• Presence of congestive heart failure
• Elevations in C-reactive protein and B-type natriuretic peptide ( BNP ) levels
• Complications

Type and Manifestation

I: Ischemic

• Reinfarction
• Extension of infarction

II: Arrhythmias

• Supraventricular or ventricular arrhythmia
• Sinus bradycardia and atrioventricular block

III: Mechanical

• Myocardial dysfunction
• Cardiac failure
• Cardiogenic shock
• Cardiac rupture (Free wall rupture, ventricular septal rupture, papillary muscle rupture)

IV: Embolic

• Left ventricular mural thrombus,
• Peripheral embolus

V: Inflammatory

• Pericarditis (infarct associated pericarditis, late pericarditis, or post-cardiac injury pericarditis)
• Pericardial effusion
• Enhancing Healthcare Team Outcomes

The diagnosis and management of patients with ischemic heart disease are best done with an interprofessional team. In most hospitals, there are cardiology teams that are dedicated to the management of these patients.

For patients who present with chest pain, the key to the management of MI is time to treatment. Thus, healthcare professionals, including nurses who work in the emergency department, must be familiar with the symptoms of MI and the importance of rapid triage. A cardiology consult should be made immediately to ensure that the patient gets treated within the time frame recommendations. Because MI can be associated with several serious complications, these patients are best managed in an ICU setting.

There is no cure for ischemic heart disease, and all treatments are symptom-oriented. The key to improving outcomes is to prevent coronary artery disease. The primary care provider and nurse practitioner should educate the patient on the benefits of a healthy diet, the importance of controlling blood pressure and diabetes, exercising regularly, discontinuing smoking, maintaining healthy body weight, and remaining compliant with medications. The pharmacist should educate the patient on types of medication used to treat ischemic heart disease, their benefits, and potential adverse effects.

Only through such a team approach can the morbidity and mortality of myocardial infarction be lowered. [Level 5]

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Myocardial Infarction (Heart Attack) Warning Signs in Women. U.S. Department of Health and Human Services Office on Women's Health

ECG With Pardee Waves Indicating AMI. Pardee waves indicate acute myocardial infarction in the inferior leads II, III, and aVF with reciprocal changes in the anterolateral leads. Wikimedia Commons, Glenlarson

Transesophageal echocardiography, Thrombo embolism, Pulmonary artery, Pulmonary Embolism, Thromboembolic , Right Pulmonary artery, TE, RPA, Acute ECG segment elevation mimicking myocardial infarction in a patient with pulmonary embolism Contribute by (more...)

Ischemic ventricular tachycardia in a patient with an old inferior myocardial infarction Contributed by Alina Negru, MD

Disclosure: Niranjan Ojha declares no relevant financial relationships with ineligible companies.

Disclosure: Amit Dhamoon declares no relevant financial relationships with ineligible companies.

This book is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ), which permits others to distribute the work, provided that the article is not altered or used commercially. You are not required to obtain permission to distribute this article, provided that you credit the author and journal.

• Cite this Page Ojha N, Dhamoon AS. Myocardial Infarction. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-.

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Heart attack

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Call triple zero (000) for an ambulance immediately if you or someone else may be having a heart attack.

• A heart attack occurs when the blood supply to your heart is blocked and your heart muscle can’t get enough oxygen.
• Common symptoms of a heart attack are chest pain, feeling breathless and sweating.
• Heart attacks are mostly caused by coronary heart disease.
• You can reduce your risk of having a heart attack by adopting a healthy lifestyle.

What is a heart attack?

To work properly, your heart needs a continuous supply of blood. It normally receives this from blood vessels called coronary arteries.

When a coronary artery suddenly becomes blocked, oxygen can’t get to your heart muscle. This causes a heart attack (or ‘myocardial infarction’).

A heart attack is a medical emergency: without oxygen, your heart muscle begins to die and your heart can become permanently damaged.

Heart attacks can be fatal — every day, 17 Australians die from a heart attack. One patient is admitted to hospital due to heart attack every 13 minutes.

What are the symptoms of a heart attack?

If you have any of the symptoms below, you could be having a heart attack. If symptoms are severe, get worse, or last longer than 10 minutes, call triple zero (000) immediately and ask for an ambulance. If calling triple zero (000) does not work on your mobile, try calling 112.

The most common symptoms of a heart attack are:

• chest pain — pressure or tightness in your chest that may spread to your jaw, neck or left arm
• suddenly feeling dizzy , faint , light-headed or anxious
• nausea or vomiting
• a feeling of indigestion
• sweating, or a cold sweat
• looking pale
• shortness of breath or difficulty breathing
• palpitations (being aware of your heart beating)

Chest pain may come and go.

Heart attack symptoms in females

Females may experience different symptoms, such as:

• breathlessness and generally feeling unwell
• tightness or discomfort in your arms
• chest pain that feels more like burning, throbbing, tightness or like trapped wind
• a feeling of indigestion or upper tummy pain
• upper back pain or pressure

Heart attack symptoms differ from person to person. Some people experience no warning signs before a heart attack. It’s possible to not feel any chest pain at all.

CHECK YOUR SYMPTOMS — Use the Symptom Checker and find out if you need to seek medical help.

What causes heart attacks?

The most common cause of a heart attack is coronary artery disease . This is where fatty deposits, cholesterol and other substances build up in the walls of your coronary arteries that supply oxygen to your heart.

Over time, this build-up hardens into cholesterol plaques. The plaque can rupture (burst) and cause a blood clot which blocks your artery.

In some cases, heart attacks have another cause.

• Coronary artery spasm (variant angina) is an unusual narrowing of blood vessels that can stop blood flow to your heart.
• Spontaneous coronary artery dissection is a sudden tear in the wall of your coronary artery.

Certain lifestyle factors are shown to increase your chances of having a heart attack. These include:

• an unhealthy diet high in saturated fat , salt and added sugar
• not getting enough physical activity
• having high blood pressure
• having high cholesterol
• having diabetes
• being overweight or obese

When should I see my doctor?

Call triple zero (000) immediately and ask for an ambulance, if you or someone near you experiences symptoms of a heart attack that are:

• getting worse, or
• lasting longer than 10 minutes

If calling triple zero (000) does not work on your mobile, try calling 112. Early treatment could save a life.

See your doctor regularly to manage your health. Your doctor can test for heart disease risk factors and help you take steps to prevent a heart attack.

FIND A HEALTH SERVICE — The Service Finder can help you find doctors, pharmacies, hospitals and other health services.

How are heart attacks diagnosed?

If you think you might be having a heart attack, you need immediate assessment in hospital. There, a doctor will assess your symptoms and check your vital signs, including your blood pressure , pulse and temperature.

There are several tests that help show if you’ve had a heart attack, and whether any damage was caused. These include:

• electrocardiogram (ECG) — electrical leads are placed on your chest, arms and legs to record the electrical signals travelling through your heart muscle
• troponin blood tests
• chest x-ray
• angiography (or, cardiac catheterisation ) — a small tube (catheter) is inserted into an artery in your groin or your wrist, which can then be guided to your heart where a special dye is injected into the coronary arteries to show if there is a narrowing or blockage
• echocardiogram — an ultrasound scan of your heart
• CT scan or MRI scan of the heart

How are heart attacks treated?

When treating a heart attack it is important to restore blood flow to your heart quickly. Heart muscle cells depend on oxygen and the longer your heart is without oxygen, the more permanent and widespread the damage.

Treating the blocked artery

Treatments that can restore blood flow to your heart include the following.

• Coronary angioplasty is a procedure where the blocked coronary artery is opened up from the inside using a special balloon inserted during cardiac catheterisation. Your artery may then be kept open with a special metal tube (stent).
• Thrombolytic therapy uses a medicine to dissolve the blood clot in your blocked coronary artery.
• Bypass surgery ( coronary artery bypass graft surgery , or CABG) is open heart surgery that involves redirecting blood to bypass (go around) the blockage in your coronary artery.

Medications

Medicines are given to treat a heart attack and prevent the risk of another heart attack. These include:

• pain relievers
• medicines that reduce the blood’s clotting action, such as aspirin , or other blood-thinning medicines
• nitrate medicines to improve blood flow through the coronary arteries
• heart and blood pressure medicines ( ACE inhibitors, angiotensin II receptor blockers , beta blockers )
• cholesterol-lowering medicines

Cardiac rehabilitation

If you are recovering from a heart attack you may be referred for cardiac rehabilitation. This service provides support during your recovery and helps reduce your risk of heart disease.

ASK YOUR DOCTOR — Preparing for an appointment? Use the Question Builder for general tips on what to ask your GP or specialist.

How can I prevent a heart attack?

Making positive lifestyle changes is the best way to lower your risk of a heart attack.

There are a number of ways you can improve your heart health:

• quitting smoking
• eating a healthy diet
• seeing your doctor to help manage your cholesterol and blood pressure
• staying physically active and exercising regularly
• maintaining a healthy weight
• drinking alcohol in moderation
• reducing stress and looking after your mental wellbeing

There are also other risk factors that you can’t control, like your: age, sex, ethnicity and family history .

Speak with your doctor if you’re concerned about your risk factors. They can give you tips on how you can reduce your risk of a heart attack.

ARE YOU AT RISK? — Are you at risk of type 2 diabetes, heart disease or kidney disease? Use the Risk Checker to find out.

NEED TO LOSE WEIGHT? — Use the BMI Calculator to find out if your weight and waist size are in a healthy range.

Complications of a heart attack

Complications following a heart attack can be serious. Some complications include the following:

• Arrhythmias — your heart may develop an abnormal heartbeat following a heart attack due to your damaged heart muscle disrupting electrical signals.
• Heart failure — your heart may have difficulty pumping enough blood, due to the muscles being too weak or too stiff.
• Cardiogenic shock — a life-threatening condition where your heart suddenly can’t pump enough blood to your body.
• Heart rupture — this is a rare but serious complication in which your heart’s muscles, walls or valves split apart.

Is a cardiac arrest the same thing as a heart attack?

A cardiac arrest and a heart attack are both medical emergencies. However, they are not the same thing.

During a cardiac arrest, the electrical system that controls your heart rate and rhythm stops working properly, and your heart stops beating.

Someone having a cardiac arrest will collapse and have no pulse. They may not breathe properly, or not at all, and they will lose consciousness.

If someone has a cardiac arrest, they need help immediately. Call 000 (triple zero) for an ambulance.

While waiting for the ambulance to arrive, begin chest compressions (cardiopulmonary resuscitation or CPR). Use a device called a defibrillator , if available.

Sometimes a heart attack can progress into a cardiac arrest.

Does COVID-19 cause heart attacks?

A heart attack is a possible complication of COVID-19 . COVID-19 can also worsen existing heart conditions.

When people with cardiovascular disease catch COVID-19, they have a higher risk of severe complications.

Get vaccinated against COVID-19 and the flu to help protect yourself and others.

The Heart Foundation has more information about COVID-19 and heart disease .

Life after a heart attack

Recovering from a heart attack can be both emotionally and physically challenging. Hearing stories from others who have experienced a heart attack can help.

The Heart Foundation have shared several people’s "heart stories" on their website.

Resources and support

Support and information on heart attack and heart health are also available from the Heart Foundation .

The Heart Foundation has a warning signs of heart attack action plan . There are instructions on what to do if you have chest pain or other possible signs of a heart attack.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with 24 hours a day, 7 days a week.

Other languages

Do you prefer to read languages other than English? The Heart Foundation has fact sheets on heart health translated into more than 25 languages .

Learn more here about the development and quality assurance of healthdirect content .

Last reviewed: November 2022

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• Strategies to prevent heart disease

You can help prevent heart disease by following a heart-healthy lifestyle. Here are strategies to help you protect your heart.

Heart disease is a leading cause of death. You can't change some risk factors for it, such as family history, sex at birth or age. But you can take plenty of other steps to lower your risk of heart disease.

Get started with these eight tips to boost your heart health:

1. Don't smoke or use tobacco

One of the best things you can do for your heart is to stop smoking or using smokeless tobacco. Even if you're not a smoker, be sure to stay away from secondhand smoke.

Chemicals in tobacco can damage the heart and blood vessels. Cigarette smoke lowers the oxygen in the blood, which raises blood pressure and heart rate. That's because the heart has to work harder to supply enough oxygen to the body and brain.

There's good news though. The risk of heart disease starts to drop in as little as a day after quitting. After a year without cigarettes, the risk of heart disease drops to about half that of a smoker. No matter how long or how much you smoked, you'll start reaping rewards as soon as you quit.

2. Get moving: Aim for at least 30 to 60 minutes of activity daily

Regular, daily physical activity can lower the risk of heart disease. Physical activity helps control your weight. It also lowers the chances of getting other conditions that may put a strain on the heart. These include high blood pressure, high cholesterol and type 2 diabetes.

If you haven't been active for a while, you may need to slowly work your way up to these goals. But in general, you should aim for at least:

• 150 minutes a week of moderate aerobic exercise, such as walking at a brisk pace.
• 75 minutes a week of vigorous aerobic activity, such as running.
• Two or more strength training sessions a week.

Even shorter bouts of activity offer heart benefits. So if you can't meet those guidelines, don't give up. Just five minutes of moving can help. Activities such as gardening, housekeeping, taking the stairs and walking the dog all count toward your total. You don't have to exercise hard to benefit. But you can see bigger benefits if you boost the intensity, length and frequency of your workouts.

3. Eat a heart-healthy diet

A healthy diet can help protect the heart, improve blood pressure and cholesterol, and lower the risk of type 2 diabetes. A heart-healthy eating plan includes:

• Vegetables and fruits.
• Beans or other legumes.
• Lean meats and fish.
• Low-fat or fat-free dairy foods.
• Whole grains.
• Healthy fats such as olive oil and avocado.

Two examples of heart-healthy food plans include the Dietary Approaches to Stop Hypertension (DASH) eating plan and the Mediterranean diet.

Take in less of the following:

• Salt or high-sodium meals.
• Sugar or sweetened beverages.
• Highly refined carbohydrates.
• Highly processed food, such as processed meats.
• Saturated fat, which is found in red meat, full-fat dairy products, palm oil and coconut oil.
• Trans fat, which is found in some fried fast food, chips and baked goods.

4. Maintain a healthy weight

Being overweight — especially around the middle of the body — raises the risk of heart disease. Extra weight can lead to conditions that raise the chances of getting heart disease. These conditions include high blood pressure, high cholesterol and type 2 diabetes.

The body mass index (BMI) uses height and weight to find out whether a person is overweight or obese. A BMI of 25 or higher is considered overweight. In general, it's linked with higher cholesterol, higher blood pressure, and an increased risk of heart disease and stroke.

Waist circumference also can be a useful tool to measure how much belly fat you have. The risk of heart disease is higher if the waist measurement is greater than:

• 40 inches (101.6 centimeters, or cm) for men.
• 35 inches (88.9 cm) for women.

Even a small weight loss can be good for you. Reducing weight by just 3% to 5% can help lower certain fats in the blood called triglycerides. It can lower blood sugar, also called glucose. And it can cut the risk of type 2 diabetes. Losing even more helps lower blood pressure and blood cholesterol levels.

5. Get quality sleep

People who don't get enough sleep have a higher risk of obesity, high blood pressure, heart attack, diabetes and depression.

Most adults need at least seven hours of sleep each night. Children usually need more. So make sure you get enough rest. Set a sleep schedule and stick to it. To do that, go to bed and wake up at the same times each day. Keep your bedroom dark and quiet too, so it's easier to sleep.

Talk to a member of your health care team if you feel like you get enough sleep but you're still tired throughout the day. Ask if you need to be evaluated for obstructive sleep apnea. It's a condition that can raise your risk of heart disease. Symptoms of obstructive sleep apnea include loud snoring, stopping breathing for short times during sleep and waking up gasping for air. Treatment for obstructive sleep apnea may involve losing weight if you're overweight. It also might involve using a device that keeps your airway open while you sleep. This is called a continuous positive airway pressure (CPAP) device.

6. Manage stress

Ongoing stress can play a role in higher blood pressure and other risk factors for heart disease. Some people also cope with stress in unhealthy ways. For example, they may overeat, drink or smoke. You can boost your health by finding other ways to manage stress. Healthy tactics include physical activity, relaxation exercises, mindfulness, yoga and meditation.

If stress becomes overwhelming, get a health care checkup. Ongoing stress may be linked with mental health conditions such as anxiety and depression. These conditions also are tied to heart disease risk factors, including higher blood pressure and less blow flow to the heart. If you think you might have depression or anxiety, it's important to get treatment.

7. Get regular health screening tests

High blood pressure and high cholesterol can damage the heart and blood vessels. But if you don't get checked for these conditions, you likely won't know whether you have them. Regular screening tests can tell you what your numbers are and whether you need to take action.

Blood pressure. Regular blood pressure screenings usually start in childhood. Starting at age 18, blood pressure should be measured at least once every two years. This checks for high blood pressure as a risk factor for heart disease and stroke.

If you're between 18 and 39 and have risk factors for high blood pressure, you'll likely be screened once a year. People age 40 and older also are given a blood pressure test yearly.

• Cholesterol levels. The National Heart, Lung, and Blood Institute (NHLBI) recommends that cholesterol screenings start between the ages of 9 and 11. Earlier testing may be recommended if you have other risk factors, such as a family history of early-onset heart disease. After the first cholesterol test, screenings should be repeated every five years. Then the timing changes with age. The NHLBI recommends that women ages 55 to 65 and men ages 45 to 65 get screened every 1 to 2 years. People over 65 should get their cholesterol tested once a year.
• Type 2 diabetes screening. Diabetes involves ongoing high blood sugar levels. It raises the chances of getting heart disease. Risk factors for diabetes include being overweight and having a family history of diabetes. If you have any of the risk factors, your health care team may recommend early screening. If not, screening is recommended starting at age 45. Then you get your blood sugar levels tested again every three years.

If you have a condition such as high cholesterol, high blood pressure or diabetes, talk with your health care team. Your doctor may prescribe medicines and recommend lifestyle changes. Make sure to take your medicines exactly as prescribed, and follow a healthy-lifestyle plan.

8. Take steps to prevent infections

Certain infections may lead to heart problems. For instance, gum disease may be a risk factor for heart and blood vessel diseases. So brush and floss daily. Get regular dental checkups too.

Other illnesses caused by infections can make existing heart problems worse. Vaccines help protect against infectious diseases. So stay up to date on the following shots:

• Yearly flu vaccine.
• COVID-19 vaccine, which lowers the chances of getting very sick.
• Pneumococcal vaccine, which reduces the risk of certain illnesses caused by bacteria.
• Tdap vaccine, which protects against tetanus, diphtheria and pertussis.

Ask your health care professional if you need any other vaccines too.

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• Know your risk for heart disease. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/risk_factors.htm. Accessed May 15, 2023.
• Heart disease facts. Centers for Disease Control and Prevention. https://www.cdc.gov/heartdisease/facts.htm. Accessed May 15, 2023.
• Hennekens CH. Overview of primary prevention of coronary heart disease and stroke. https://www.uptodate.com/contents/search. Accessed May 15, 2023.
• How to prevent heart disease at any age. American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/how-to-help-prevent-heart-disease-at-any-age. Accessed May 15, 2023.
• Heart-healthy lifestyle changes. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/heart-healthy-lifestyle-changes. Accessed May 15, 2023.
• Smokeless tobacco: Health effects. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/smokeless/health_effects/index.htm. Accessed May 15, 2023.
• How smoking affects heart health. U.S. Food and Drug Administration. https://www.fda.gov/tobacco-products/health-information/how-smoking-affects-heart-health. Accessed May 15, 2023.
• Benefits of quitting. American Lung Association. https://www.lung.org/stop-smoking/i-want-to-quit/benefits-of-quitting.html. Accessed May 15, 2023.
• Physical Activity Guidelines for Americans. 2nd ed. U.S. Department of Health and Human Services. https://health.gov/our-work/physical-activity/current-guidelines. Accessed May 15, 2023.
• How does sleep affect your heart health? Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/sleep.htm. Accessed May 15, 2023.
• Sleep apnea. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/sleep-apnea. Accessed May 15, 2023.
• AskMayoExpert. Screening, immunization, and prevention (child). Mayo Clinic; 2022.
• AskMayoExpert. Screening, immunization, and prevention (adult). Mayo Clinic; 2022.
• Sleep and chronic disease. https://www.cdc.gov/sleep/about_sleep/chronic_disease.html. Accessed May 15, 2023.
• AskMayoExpert. Hypertension (adult). Mayo Clinic; 2023.
• Lopez-Jimenez F (expert opinion). June 19, 2023.
• Stress and heart health. American Heart Association. https://www.heart.org/en/healthy-living/healthy-lifestyle/stress-management/stress-and-heart-health. Accessed June 20, 2023.
• Blood cholesterol: Diagnosis. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health/blood-cholesterol/diagnosis. June 20, 2023.
• Wilder RS, et al. Overview of gingivitis and periodontitis in adults. https://www.uptodate.com/contents/search. Accessed June 20, 2023.
• What vaccines are recommended for you? Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/adults/rec-vac/index.html. Accessed June 20, 2023.

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News releases.

News Release

Monday, December 10, 2007

Heart Attack Symptoms in Women — Are they Different?

Chest pain is still the most common sign of a heart attack for most women, although studies have shown that women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart attack or other form of acute coronary syndrome (ACS), according to an article "Symptom Presentation of Women With Acute Coronary Syndromes — Myth vs. Reality" published online Dec. 10 in the Archives of Internal Medicine . The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

Researchers examined 35 years of research that yielded 69 studies 69 studies and found that, depending on the size of the study (which ranged from large trials to single centers and interviews), between 30 percent and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 percent to 27 percent of men did not experience chest discomfort. Overall, the majority of women — and men — in the reviewed studies had chest discomfort with heart attack (two-thirds to three-quarters, depending on study size).

Study authors also found that older people are more likely to have heart attack without chest discomfort. However, because women are on average nearly a decade older than men at the time of their initial heart attack, the researchers call for more studies to determine the degree to which gender independently influences heart attack symptoms.

They conclude that current research does not indicate a need to differentiate heart attack symptoms in women from those in men, and public health messages should continue to emphasize chest pain or discomfort, shortness of breath, and other common signs of heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.

The authors also report that women are more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with ACS. For example, women are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.

Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays. Noting that many studies exclude patients who do not report chest pain, the researchers call for additional research from well-designed studies to further investigate gender differences in heart attack symptoms. This includes expanding symptom definitions and greater standardization in data collection and reporting of women's symptoms.

Study co-author George Sopko, M.D., Medical Officer with NHLBI's Division of Cardiovascular Diseases, is available for comment. To schedule interviews, contact the NHLBI Communications Office at 301-496-4236 or at [email protected].

NHLBI is part of the National Institutes of Health (NIH), the Federal Government’s primary agency for biomedical and behavioral research. NHLBI press releases and fact sheets, including information on the Women’s Health Initiative and on overweight and obesity can be found online at www.nhlbi.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

NIH…Turning Discovery Into Health ®

• Act In Time To Heart Attack Signs is an NHLBI education campaign that that urges physicians to educate their patients about heart attack risk, warning signs, and survival. For information on heart attack warning signs for both the public and health care professionals, http://www.nhlbi.nih.gov/actintime/haws/haws.htm .
• The Heart Truth, NHLBI's national awareness campaign for women about heart disease, aims to spread the word that heart disease is largely preventable. For midlife women, the most common risk factors for heart disease in order of greatest prevalence include overweight/obesity, high blood cholesterol, diabetes, and high blood pressure. For more on The Heart Truth, http://www.hearttruth.gov .
• For current recommendations for heart health, see Your Guide to a Healthy Heart, http://www.nhlbi.nih.gov/health/public/heart/other/your_guide/healthyheart.htm .

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Heart Attack

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Heart Attack. The Disease. What is a heart Attack?. when blood flow is blocked from reaching part of the heart prevents sufficient oxygen from reaching heart causes heart muscle to become damaged or die. also known as myocardial infarction. What are the Causes?.

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Heart Attack The Disease

What is a heart Attack? • when blood flow is blocked from reaching part of the heart • prevents sufficient oxygen from reaching heart • causes heart muscle to become damaged or die • also known as myocardial infarction

What are the Causes? Heart attacks are caused by: • blood clots blocking the coronary arteries • this stops blood flow and heart cells die • clot forms because coronary arteries becomes narrowed by plaque (atherosclerosis) • plaque cracks and triggers clot • less commonly from blood vessel problems and severe coronary artery spasm • spasm could be related to drugs, stress, smoking

Diabetes Family history of Coronary Artery Disease (CAD) High fat diet Race: higher risk in African Americans, Mexican Americans, Native Americans, and Native Hawaiians High blood pressure Increasing age Smoking Unhealthy cholesterol levels Lack of exercise Stress Sex: men over 45, women over 55 Am I at Risk? Risk Factors

Shortness of breath Loss of consciousness Perspiration Severe crushing pain Tightness or squeezing in chest (Angina) Pain possibly spreading to left arm, shoulder, neck or jaw Light-headedness Many attacks begin slowly with mild pain May feel like heartburn/indigestion Nausea and vomiting How do I know if I am having a Heart Attack? Symptoms DO NOT IGNORE SYMPTOMS!

Diagnosing a Heart Attack • Physician uses stethoscope to find abnormal heart rhythms/sounds • Check pulse and blood pressure • Electrocardiograms (ECG) detect irregular heart beat (arrhythmia) or blocked coronary artery • Blood tests • High level of cardiac enzymes indicate damaged heart muscle • CK (creatine kinase), MB (myoglobin) and troponin released from damaged heart muscle (proteins)

Treating a Heart Attack Victim • While heart attack is occurring: • Take aspirin at home to help dissolve clot • Ambulance/Doctors will administer clot busters such as streptokinase and nitrates • Surgery may be needed to clear/open arteries • Put on oxygen • CPR may be needed or defibulation to restore heart beat • Morphine administered • Relieves pain, sedates, and reduces oxygen demand

After person is stabilized: • Thrombolytic Therapy • Medicine given to dissolve blood clots • Beta- Blockers • Decrease workload for heart, relieve pains, and correct arrhythmia • ACE (angiotensin-converting enzymes) inhibitors • Lower blood pressure, reduce strain for heart • Anticoagulents • Thin blood and prevent clots from forming • Antiplatelet Medicine • Stop platelets from clumping together

More Advanced Treatments • Angioplasty • Open coronary arteries • Catheter with balloon is threaded through blood vessel to blocked artery • Balloon then inflates pushing plaque aside • Doctors sometimes place a stent in the artery • Coronary Artery Bypass Grafting • Arteries or veins are taken from other parts of the body to bypass arteries • These arteries/veins are then sewn in place • Open-heart surgery could be required if heart ruptures

Rehabilitation • Discharged from hospital after a week at earliest • Activites slowly increase over 8 weeks • Resume full schedule after 2 months out of the hospital • Long term treatment with beta-blockers and aspirin • Drugs to lower cholesterol are given • Badly damaged heart requires warfarin (anticoagulent) for 3 months

Facts • 40% of heart attacks are fatal • Half of these deaths occur in first hour • Over 1.1 million heart attacks in United States each year • One of the leading killers in America • Males have higher risks for heart attacks

Don’t smoke Healthy diet Control blood sugar Exercise Lose weight if obese Control BP Low fat diet Lower salt intake Lower cholesterol Control diabetes Reducing Your Risk Prevention

References Internet sources • Berger, A. (2009). Heart Attack- Overview. Retrieved April 23, 2009, from http://www.umm.edu/ency/article/000195.htm • Heart Attack: Warning Signs and Tips on Prevention. (2009). FamilyDoctor.org. Retrieved May 14, 2009, from http://familydoctor.org/online/famdocen/home/common/heartdisease/basics/291.html • Heart Attack. (2008, March). National Heart Lung and Blood Institute (all articles on side used). Retrieved May 14, 2009, from http://www.nhlbi.nih.gov/health/dci/Diseases/HeartAttack/HeartAttack_whatis.html

Book Sources • Bunch, Bryan. (2003). Heart Attack. “Diseases” (Vol. 4 pp. 70-72) Danbury: Scientific Publishing, Inc. • Margolis, S. (2005). Heart Attack. In medical guide to Health After 50 (pp. 376-380). New York, NY: Black Dog & Leventhal, Inc. Pictures • http://www.daviddarling.info/encyclopedia/C/coronary_artery.html • http://myhealth.ucsd.edu/library/healthguide/en-us/support/topic.asp?hwid=zm2431 • http://farm4.static.flickr.com/3205/2723962050_284c85ccf9.jpg • http://www.crestock.com/image/763286-heart-monitor-screen.aspx • http://www.firstaidmonster.com/images/products/FAM_ASPIRIN_1000-1520.jpg • http://www.nhlbi.nih.gov/health/dci/Diseases/Angioplasty/Angioplasty_All.html • http://www.usageorge.com/Jokes/Jokes/No-smoking-sign.gif

Video • http://www.healthcentral.com/cholesterol/understanding-cholesterol-13-115.html

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