Heart Attack: Your GoodRx Guide

Definition

A heart attack — or myocardial infarction — is a serious medical condition that always requires emergency medical care. It happens when the heart muscle is deprived of nutrient-rich blood for long enough to damage the pumping walls of the heart. 

The cause is usually a blockage — or clot — in the coronary arteries. These are the small arteries that supply the heart muscle with the blood it needs to keep beating. Depending on which coronary arteries are affected, how many are affected, and how much time goes by before a person receives treatment, the impact can range from mild to deadly. 

Heart attacks are common. Over 800,000 people in the U.S. have a heart attack every year. Heart attacks are the leading cause of death in the U.S. as well.

Causes

Heart attacks are caused atherosclerosis (quite literally, hardening of the arteries), which happens when a sludgy plaque develops on the walls of the arteries. This plaque is made up of fat, cholesterol, and blood cells, and it builds up over time, narrowing the blood vessels and limiting how much blood can flow through them. When atherosclerosis happens in the coronary arteries — the blood vessels that bring blood to your heart — and they narrow so much that no more blood can get through, that causes a heart attack. The symptoms of a heart attack are caused by the heart muscle not getting enough oxygen and nutrient-rich blood to keep pumping. 

What puts someone at risk of heart attacks?

Why is it that some people get heart attacks, and others don’t? This boils down to risk. There are some risks, such as age and family history, that you can’t do much about beyond being aware of them. But other risks can be treated and even reversed — although this isn’t always easy. 

Heart disease is common, so knowing whether you are at risk is a good idea. A healthcare provider can help you figure out what your level of risk is and what to do about it. 

Here are some of the strongest risk factors for heart attacks:

• Age

• Family history of heart attacks

• Smoking

• High blood pressure

• High cholesterol

• Diabetes

• Obesity

You may not even know you have some of these — like high blood pressure, high cholesterol, or diabetes. Regular check-ups are a good way to screen for these conditions. In most cases, all it takes is a blood pressure check and some simple labs. 

Stress and life trauma also affect a person’s risk of heart disease — and these factors affect communities of color disproportionately. Stress-management techniques, like yoga, meditation, and exercise, may help some people with stress, but, for many people, the causes of life stress run deep and can be hard to change. In this case, taking care of yourself and keeping up to date with regular health check-ups is even more important.

Symptoms

There are some common symptoms of a heart attack, although not everyone always has the same symptoms. 

Chest pain is the main symptom of a heart attack. Here are some features of chest pain that might mean you’re having a heart attack:

• Feels like pressure

• Located in the middle of the chest

• Made worse by exerting yourself

• Travels to the arms, neck, or jaw

Some other symptoms that people commonly experience during a heart attack are:

• Shortness of breath

• Sweating

• Nausea

• Abdominal pain

• Indigestion

If you have chest pain and one or more of these symptoms, you should seek emergency medical care. It’s impossible to know whether you are having a heart attack without getting seen and tested by a trained medical professional. So, if it feels like it could be a heart attack, don’t waste any time getting help. 

Heart attack warning signs in women

It might seem strange, but women have different heart attack symptoms than men do. Over the years, women have unfortunately been under-represented in research about heart disease. This has led to an incomplete picture of what we think a heart attack feels like. As a result, the ‘classic’ heart attack symptoms you hear about apply more to men than they do to women. Often, women don’t have chest pain associated with their heart attacks. 

The most common symptoms of a heart attack in women are:

• Shortness of breath

• Unexplained weakness

• Fatigue

Medications

When you have a heart attack, you’ll need immediate treatment — in the form of medications and, often, procedures — to stabilize your condition and save your heart. 

Medications used to treat heart attacks in the hospital include:

• Oxygen, if your blood oxygen is low

• Pain relievers, such as nitroglycerin or morphine, to help with pain 

• Blood thinners to stop blood clots from forming, such as antiplatelet drugs or anticoagulants

• Heart medications, called beta-blockers or calcium channel blockers, to reduce how hard your heart has to work

• Cholesterol-lowering medications, such as statins, to prevent plaque build-up

• ACE inhibitors or ACE receptor blockers, which treat blood pressure

After the emergency has passed, you’ll probably need long-term medications to keep you from having another heart attack. Apart from aspirin, these will all require a prescription:

• Antiplatelet agents

• Blood-pressure medications

• Beta-blockers

• Cholesterol medications 

The good news is that many of the medications you need after a heart attack are relatively inexpensive, including: 

• Metoprolol 

• Lisinopril 

• Atorvastatin

Treatments

Most likely, you’ll need a procedure to treat a heart attack. Not everyone needs all of these procedures. It depends on which hospital you are at and how severe your heart attack is. 

Cardiac catheterization and angioplasty

This is a procedure in which cardiologists thread a wire from your wrist or groin into the blood vessels around your heart. Once the wire is placed, they look for a blockage in the coronary arteries using X-rays and dye injected into the blood vessels. If they find a blockage, they open it up by deploying a stent — a tiny, umbrella-like device — that holds the artery open so blood can keep flowing through it. Most people are awake during this procedure. 

Heart bypass

Coronary artery bypass grafting (CABG) is a big surgery during which a surgeon uses blood vessels taken from your chest or your leg to replace, or “bypass,” the blocked arteries supplying the heart muscle. If a heart attack is severe, or if the cardiologist can’t open the blockage with an angioplasty, you may need CABG.

Fibrinolysis

Fibrinolytics are medications you get through an IV that break up blood clots. If you are having a STEMI, and you can’t have an angioplasty, this treatment may be offered.

Recovery

If you just had a heart attack, you’ve been through a lot. You may be overwhelmed or scared. 

If you have a primary care provider, you’ll want to set up an appointment as soon as possible. Because you’ve just been through a pretty stressful hospital stay, you might have a lot of questions — and you might not be sure what to expect. Seeing your primary care provider is a great way to get on track with what’s coming next and to make sure you have all of the medications you need.

Fortunately, there is a lot you can do to help with your recovery.

Cardiac rehabilitation and exercise

Many people will start cardiac rehabilitation, which is a supervised program with a team of providers that focuses on exercise, diet, and stress. It’s a safe and effective way to get healthy again after a heart attack.

Returning to physical activity after a heart attack is important. Work with your healthcare providers to see exactly what activity is right for you, but here are some general guidelines:

• You can start light activities, like walking, almost right away.

• Slowly increase your aerobic exercise, starting in 1 to 2 weeks.

• Start gentle resistance exercise 2 to 4 weeks out.

Diet changes

Eating a heart-healthy diet after a heart attack is helpful for your recovery. The Mediterranean diet and the DASH diet are both great options to help lower blood pressure and cholesterol levels. 

A heart-healthy diet is one that includes: 

• Fruits and vegetables

• Whole grains

• Low-fat dairy

• Lean meats, like chicken or turkey

• Beans

• Nuts

Here are some foods to avoid:

• Sweets

• Sugary beverages

• Red meat

Prevention

Most people want to avoid having a heart attack in the first place. And, if you’ve had a heart attack already, you’ll want to make sure that it doesn’t happen again. Either way, being on top of your heart health and heart risks is important to keeping you healthy.   

Although it’s not possible to prevent all heart attacks, you can lower the risk of getting a heart attack:  

• Make time every year to get screened for conditions that increase the risk of a heart attack by getting a diabetes test and checking your blood pressure, cholesterol level, weight, BMI, and waist measurement.

• Know or find out your family history. Heart disease runs in families, so if family members have had heart attacks, there’s a good chance you’re at risk. If you don’t know your birth family, this may be tricky, but not impossible — and it could save your life. A good place to start could be public records, obituaries, and family photos.

What can I do to lower my risk of another heart attack?

If you have already had a heart attack — and survived — you’re in a better situation than most are to prevent another heart attack in the future. You know your risk, and you (hopefully) know what to do to reduce that risk.  

• See your healthcare provider regularly.  

• Take your prescribed medications for heart disease, high blood pressure, diabetes, and high cholesterol. 

• Stay on track with check-ups to keep your blood pressure, weight, cholesterol levels, and blood glucose within healthy limits. 

• If you’re having trouble getting or staying on your medications, talk to your healthcare provider.

• Do you smoke? If so, think seriously about quitting. 

• Whether you are on medication or not, eat a heart-healthy diet and get enough exercise. Try setting some exercise goals, like briskly walking, cycling or jogging four to five times per week. Having a friend or relative join you can help keep you motivated.