HEART ATTACK

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Definition

A heart attack is when blood vessels that supply blood to the heart are blocked, preventing enough oxygen from getting to the heart. The heart muscle dies or becomes permanently damaged. Your doctor calls this a myocardial infarction.

Alternative Names

Myocardial infarction; MI; Acute MI; ST-elevation myocardial infarction; non-ST-elevation myocardial infarction

Causes, incidence, and risk factors

Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart starves for oxygen and heart cells die.

In atherosclerosis, plaque builds up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack can occur as a result of the following:

• The slow buildup of plaque may almost block one of your coronary arteries. A heart attack may occur if not enough oxygen-containing blood can flow through this blockage. This is more likely to happen when you are exercising.
• The plaque itself develops cracks (fissures) or tears. Blood platelets stick to these tears and form a blood clot (thrombus). A heart attack can occur if this blood clot completely blocks the passage of oxygen-rich blood to the heart.

Occasionally, sudden overwhelming stress can trigger a heart attack.

Risk factors for heart attack and coronary artery disease include:

• Increasing age (over age 65)
• Male gender
• Diabetes
• Family history of coronary artery disease (genetic or hereditary factors)
• High blood pressure
• Smoking
• Too much fat in your diet
• Unhealthy cholesterol levels, especially high LDL ("bad") cholesterol and low HDL ("good") cholesterol
• Chronic kidney disease

Symptoms

Chest pain is a major symptom of heart attack. You may feel the pain in only one part of your body, or it may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back.

The pain can be severe or mild. It can feel like:

• A tight band around the chest
• Bad indigestion
• Something heavy sitting on your chest
• Squeezing or heavy pressure

The pain usually lasts longer than 20 minutes. Rest and a medicine called nitroglycerin do not completely relieve the pain of a heart attack. Symptoms may also go away and come back.

Other symptoms of a heart attack include:

• Anxiety
• Cough
• Fainting
• Light-headedness, dizziness
• Nausea or vomiting
• Palpitations (feeling like your heart is beating too fast)
• Shortness of breath
• Sweating, which may be extreme

Some people (the elderly, people with diabetes, and women) may have little or no chest pain. Or, they may experience unusual symptoms (shortness of breath, fatigue, weakness). A "silent heart attack" is a heart attack with no symptoms.

Reviewer Info: Alan Berger, MD, Assistant Professor, Divisions of Cardiology and Epidemiology, University of Minnesota, Minneapolis, MN. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., 04/23/2009