Heart Attack

Causes

Coronary artery disease (CAD), or atherosclerosis, is the condition that most often causes heart attacks. As you age, fatty deposits called plaque form and may build up inside your coronary arteries, which supply blood to your heart. If plaque buildup is severe enough, you may experience angina (chest pain), or you may not have any symptoms at all.

If you experience added stress or injury, such as high blood pressure, severe infection, or severe emotional distress, the area of the artery that has the plaque buildup could break open and form a clot in response to the injury. This clot can cause a sudden total blockage of the artery and be the immediate cause of a heart attack.

The risks for coronary artery disease are increased if you:

  • Are male.
  • Are female over the age of 55 and/or in menopause.
  • Have a family history of premature heart disease.
  • Have high cholesterol.
  • Have high blood pressure.
  • Have an inactive lifestyle.
  • Use tobacco.
  • Have diabetes.
  • Are overweight.

Symptoms

Symptoms of a heart attack include:

Chest discomfort or pain that lasts longer than 5 minutes AND is not relieved by rest or nitroglycerin AND feels like:

  • Pressure
  • Tightness
  • Squeezing
  • Crushing
  • Intense burning
  • Aching

You might also have (especially if you are a woman):

  • Pain that moves to your back, shoulder, neck, jaw, teeth, arm, or wrist.
  • Shortness of breath.
  • Sweating.
  • Dizziness.
  • Fainting.
  • Nausea (sick to your stomach).
  • Vomiting (throwing up).
  • Unusual weakness.
  • Fast or irregular heartbeat.
  • Sense of impending (coming) doom.

If you think that you might be having a heart attack, act quickly. Getting medical attention right away – within 1 hour – can save your life and lessen the amount of heart muscle that gets damaged.

  • Call 911 emergency services before you call anyone else if your symptoms are not relieved in 3 to 5 minutes by nitroglycerin and rest.
  • Stop what you are doing.
  • Sit or lie down.
  • Take nitroglycerin. If you have not taken Viagra, Levitra, or Cialis in the past 72 hours, and you have a prescription for nitroglycerin, place 1 nitroglycerin tablet (0.4 mg) under your tongue. Let it dissolve. Do not chew or swallow the pill.
  • Continue to put 1 nitroglycerin tablet under your tongue every 5 minutes until your symptoms are relieved.
  • Do not drive yourself to the Emergency Department.
  • Chew one adult-strength (325 mg) uncoated aspirin tablet or 4 "baby" aspirins (81 mg each) if you have them, are not allergic to aspirin, and are not already taking daily aspirin.

Diagnosis

Once you arrive at the Emergency Department, several tests will be done to confirm or rule out the diagnosis of a heart attack:

  • An electrocardiogram (EKG / ECG), which tests the electrical activity of your heart.
  • A brief physical examination of the heart, lungs, and abdomen.
  • Blood tests to look for heart muscle damage.
  • Chest X-rays.

Treatment

The treatment you receive in the Emergency Department will depend upon:

  • How long ago your chest pain started.
  • Results of your blood test.
  • If you have ongoing symptoms. 
  • The size of your heart attack.
  • The area of your heart that is affected.
  • The pattern of your electrocardiogram (EKG/ECG).

In the Emergency Department you will probably have:

  • A catheter placed into a vein (IV).
  • Oxygen.
  • Medication to dissolve the blood clot, relieve your pain, and lower your heart rate and blood pressure.

You may receive additional nitroglycerin from the paramedic or Emergency Department staff. It is important that you notify all of these caregivers immediately if you have taken Viagra, Levitra, or Cialis within the prior 72 hours, since these medicines can have a fatal interaction with nitroglycerin.

If you did not have a heart attack, we may still be concerned about your chest pain. You may need to stay in the Emergencey Department longer so that we can run more blood tests or do a stress test before you are released to go home. Other tests and procedures may include:

You may be admitted to the hospital or transferred to another hospital. If the electrocardiogram and blood tests determine that the best treatment would be to open or repair the artery responsible for the blockage right away, you may need a cardiac catheterization or bypass surgery.

A cardiac catheterization allows us to see what blockages exist. During this procedure, a catheter is placed in a large artery of your leg or arm and guided into the arteries of your heart. The arteries can often be opened with a small balloon (angioplasty) and held open with a small expandable wire tube, called a stent.

Coronary artery bypass graft (CABG) surgery is sometimes needed. If the angioplasty is unable to reach or open a blockage, this surgical procedure takes veins from another part of your body and uses them to go around the blocked artery in your heart.

Recovery and Medications

Recovery

To help you recover from a heart attack, we may recommend that you stay in the hospital, and we will provide you with discharge instructions before you go home.

Expect to stay in the hospital for a few days to a week. This will depend upon the type of heart attack you had and the treatment you received, as well as your general health before your heart attack.

Make the most of your recovery while you are in the hospital. You may receive physical therapy, occupational therapy, and respiratory therapy while you are in the hospital. We may also give you a stress test to help us evaluate your recovery and make physical activity recommendations.

We will help you prevent another heart attack and avoid future problems. When you are discharged from the hospital, you will receive instructions about medications to take and suggestions for a healthy lifestyle that will support your recovery.

Medications

Medications may include:

  • Aspirin.
  • Beta blockers.
  • Statins.
  • Angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB).
  • Antiplatelets (if you have a stent).

Certain types of medications to cut down on stomach acid should not be taken with antiplatelet medication. Please discuss this with us if you are taking any type of antacids.

Lifestyle Changes and Management

It’s never too late to make lifestyle changes that can improve the health of your heart. A heart-healthy lifestyle consists of maintaining a healthy weight, managing your diabetes, staying active, managing stress, and avoiding tobacco.

Healthy lifestyle recommendations:

  • If you use tobacco, we strongly advise you to stop. Your risk of having a heart attack goes down within the first 24 hours after your last cigarette.
  • Eat a diet that is low in saturated fat and trans fat, but one that is high in fiber with lots of fruits and vegetables.
  • Make physical activity part of your daily routine.
  • Maintain a healthy weight.
  • Recognize and manage stress and depression.

We will work with you to:

  • Control your blood pressure.
  • Lower your cholesterol.
  • Manage your blood sugar levels if you have diabetes.

We will provide you specific guidelines about the type of activities you can do and when it will be safe to do them. We may have you take an exercise stress test to determine what type of activity to recommend.

If you are not having chest discomfort or other complications, you will probably be able to return to your usual activities, including driving, within a few weeks. Ask your doctor when you will be able to resume sexual activity.

Depending on your occupation and the severity of your heart attack, you may be able to return to work in 2 to 6 weeks. Start slowly. Allow yourself plenty of time to regain your strength and energy.

Cardiac rehabilitation program participation

We strongly recommend that you participate in a cardiac rehabilitation program such as MULTIFIT to help you recover and to support you in achieving a healthy lifestyle. You will learn about the process of heart disease, proper physical activity, heart-healthy eating, and medications that protect your heart. In MULTIFIT, your personal care manager, together with your physician, will support and guide you while you learn how to live better and healthier with your condition.


If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following:
(1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.