What is a heart attack? [Index]
Coronary attacks (commonly called heart attacks) result from coronary heart disease (C.H.D.) - blood vessel disease in the heart. Coronary artery disease (C.A.D.) and ischemic heart disease are other names for coronary heart disease.
What causes a heart attack? [Index]
The medical term for heart attack is myocardial infarction. A heart attack occurs when the blood supply to part of the heart muscle itself - the myocardium - is severely reduced or stopped. This occurs when one of the coronary arteries that supply blood to the heart muscle is blocked. The blockage is usually from the buildup of plaque (deposits of fat-like substances) due to atherosclerosis. The plaque can eventually tear or rupture, triggering a blood clot to form that blocks the artery and leads to a heart attack. Such an event is sometimes called a coronary thrombosis or coronary occlusion.
If the blood supply is cut off severely or for a long time, muscle cells suffer irreversible injury and die. Disability or death can result, depending on how much heart muscle is damaged.
Sometimes a coronary artery temporarily contracts or goes into spasm. When this happens the artery narrows and blood flow to part of the heart muscle decreases or stops. What causes a spasm is unclear. But spasm can occur in normal-appearing blood vessels as well as vessels partly blocked by atherosclerosis. If a spasm is severe, a heart attack may result.
Most common or "classic" warning signals of a heart attack [Index]
Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back.
Pain that spreads to the shoulders, neck or arms.
Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.
Less common warning signs of heart attack [Index]
Atypical chest pain, stomach or abdominal pain.
Nausea or dizziness (without chest pain).
Shortness of breath and difficulty breathing (without chest pain).
Unexplained anxiety, weakness or fatigue.
Palpitations, cold sweat or paleness.
Not all these signs occur in every attack. Sometimes they go away and return. If some occur, get help fast. IF YOU NOTICE ONE OR MORE OF THESE SIGNS IN ANOTHER PERSON, DON'T WAIT. CALL YOUR EMERGENCY MEDICAL SERVICES SO THE PERSON CAN GET TO A HOSPITAL RIGHT AWAY!
How do I know if a heart attack has occurred? [Index]
A physician who's studied the results of several tests must make the actual diagnosis of a heart attack. The doctor will
Review the patient's complete medical history.
Give a physical examination.
Use an electrocardiogram (E.K.G.) to discover any abnormalities caused by damage to the heart.
Sometimes use a blood test to detect abnormal levels of certain enzymes in the bloodstream.
Blood tests confirm (or refute) suspicions raised in the early stages of evaluation that may occur in an emergency room, intensive care unit or urgent care unit or urgent care setting. These tests are sometimes called heart damage markers or cardiac enzymes.
Risk Factors and Coronary Heart Disease [Index]
Extensive clinical and statistical studies have identified several factors that increase the risk of heart disease and heart attack. Major risk factors are those that medical research has shown significantly increase the risk of heart and blood vessel (cardiovascular) disease. Contributing risk factors are associated with increased risk of cardiovascular disease, but their significance and prevalence haven't yet been precisely determined.
The American Heart Association has identified several risk factors for coronary heart disease. Some of them can be modified, treated or controlled, and some can't. The more risk factors a person has, the greater the chance that he or she will develop heart disease. Also the greater the level of each risk factor, the greater the risk. For example, a person with a total cholesterol of 300 mg/dL has a greater risk than someone with a total cholesterol of 240 mg/dL, even though all people with a total cholesterol greater than 240 are considered high-risk.
What are the major risk factors for coronary heart disease?
Increasing age - About four out of five people who die of coronary heart disease are age 65 or older. At older ages, women who have heart attacks are more likely than men are to die from them within a few weeks.
Male sex (gender) - Men have a greater risk of heart attack than women, and they have attacks earlier in life. Even after menopause, when women's death rate from heart disease increases, it's not as great as men's.
Heredity (including race) - Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe high blood pressure than whites and a higher risk of heart disease. Heart disease risk is also higher among Mexican Americans, American Indians, native Hawaiians and some Asian Americans. This is partly due to higher rates of obesity and diabetes. Most people with a strong family history of heart disease have one or more other risk factors. Just as you can't control your age, sex and race, you can't control your family history. It's even more important to treat and control any other risk factors you have.
You can modify, treat or control most risk factors to lower your risk, by focusing on your lifestyle habits or, if needed, taking medicine.
Tobacco smoke - Smokers' risk of heart attack is more than twice that of nonsmokers. Cigarette smoking is the biggest risk factor for sudden cardiac death; smokers have two to four times the risk of nonsmokers. Smokers who have a heart attack are more likely to die and die suddenly (within an hour) than are nonsmokers. Cigarette smoking also acts with other risk factors to greatly increase the risk for coronary heart disease. People who smoke cigars or pipes seem to have a higher risk of death from coronary heart disease (and possibly stroke), but their risk isn't as great as cigarette smokers'. Constant exposure to other people's smoke - called environmental tobacco smoke, secondhand smoke or passive smoking - increases the risk of heart disease even for nonsmokers.
High blood cholesterol - The risk of coronary heart disease rises as blood cholesterol levels increase. When other risk factors (such as high blood pressure and tobacco smoke) are present, this risk increases even more. A person's cholesterol level is also affected by age, sex, heredity and diet.
High blood pressure - High blood pressure increases the heart's workload, causing the heart to enlarge and weaken over time. It also increases the risk of stroke, heart attack, kidney failure and congestive heart failure. When high blood pressure exists with obesity, smoking, high blood cholesterol levels or diabetes, the risk of heart attack or stroke increases several times.
Physical inactivity - An inactive lifestyle is a risk factor for coronary heart disease. Regular, moderate-to-vigorous exercise is important in preventing heart and blood vessel disease. Even moderate-intensity physical activities are beneficial if done regularly and long term. More vigorous activities are associated with more benefits. Exercise can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people.
Obesity and overweight - People who have excess body fat - especially if a lot of it is in the waist area - are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the strain on the heart, raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels. It can also make diabetes more likely to develop. Many obese and overweight people have difficulty losing weight. By losing 10 to 20 pounds, you can help lower your heart disease risk.
Diabetes mellitus - Diabetes seriously increases the risk of developing cardiovascular disease. Even when glucose levels are under control, diabetes greatly increases the risk of heart disease and stroke. About two-thirds of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's critically important to work with your healthcare provider to manage your diabetes and control any other risk factors you can.
What other factors contribute to heart disease risk?
Individual response to stress may be a contributing factor. Some scientists have noted a relationship between coronary heart disease risk and stress in a person's life, their health behaviors and socioeconomic status. These factors may affect established risk factors. For example, people under stress may overeat, start smoking or smoke more than they otherwise would.
Sex hormones seem to play a role in heart disease. It's well known that men have more heart attacks than women do before the age of menopause. Several population studies show that the loss of natural estrogen as women age may contribute to a higher risk of heart disease after menopause. If menopause is caused by surgery to remove the uterus and ovaries, the risk of heart attack rises sharply. If menopause occurs naturally, the risk rises more slowly. Hormones also affect blood cholesterol. Female hormones tend to raise HDL ("good") cholesterol and lower total blood cholesterol. Male hormones do the opposite. If you've had a natural or surgical menopause, you may be considering estrogen replacement therapy (ERT) or hormone replacement therapy (HRT). ERT and HRT may increase a woman's risk of some diseases and health conditions. Your healthcare provider can give you more information and help you make the best choice.
The early forms of birth control pills, with higher doses of estrogen and progestin, increased a woman's risk of heart disease and stroke, especially in older women who smoked heavily. Newer, lower-dose oral contraceptives carry a much lower risk of cardiovascular disease, except for women who smoke or have high blood pressure. If a woman taking oral contraceptives has other risk factors (and especially if she smokes), her risk of developing blood clots and having a heart attack goes up. It rises even more after age 35. If you take birth control pills, get yearly medical check-ups of your blood pressure, triglyceride and glucose levels.
Drinking too much alcohol can raise blood pressure, cause heart failure and lead to stroke. It can contribute to high triglycerides, cancer and other diseases, and produce irregular heartbeats. It contributes to obesity, alcoholism, suicide and accidents. The risk of heart disease in people who drink moderate amounts of alcohol (an average of one drink for women or two drinks for men per day) is lower than in nondrinkers. One drink is defined as 1½ fluid ounces (fl oz) of 80-proof spirits (such as bourbon, Scotch, vodka, gin, etc.), 1 fl oz of 100-proof spirits, 4 fl oz of wine, or 12 fl oz of beer. It's not recommended that nondrinkers start using alcohol or that drinkers increase their intake.
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Material taken from the American Heart Association.