Heart Attack: What Is It? Signs, Causes & Emergency Care

Many think that acute ischemia or heart attack is a case when the heart fails abruptly. In truth there are a number of different causes. The heart arteries might be blocked or constricted suddenly. The cardiac muscle could have failed because it severely lacked blood. It could also be irregular heartbeats or congestive heart failure that caused cardiac arrest. Therefore, knowing its symptoms is vital to preventing and lessening mortality risks.

If you or someone else is experiencing heart attack warning signs, call emergency services immediately (dial your local emergency number, such as 1669 in Thailand). Do not drive yourself to the hospital. Time is muscle; seeking urgent medical attention can save a life and minimize permanent heart damage.

What Is Heart Attack (Acute Ischemia)?

Acute Ischemia, commonly known as a myocardial infarction or heart attack, is a medical emergency that falls under the umbrella of acute coronary syndrome. This happens when the heart muscle suddenly does not receive sufficient blood flow due to a severe coronary artery blockage. When the arteries are constricted, the heart muscle stops pumping blood properly to the rest of the body. If blood flow is not restored quickly, the affected heart muscle will begin to die, which can be fatal.

At-Risk Groups

• 50 years old or more
• Suffering from coronary artery disease
• Has a history of the following conditions:
  
  • Diabetes
  • High blood pressure
  • High cholesterol
• Has family history of coronary artery disease
• Smoker
• High stress level
• Overweight

Symptoms and warning signs

• Feeling fatigued with only some exertion 
• Shortness of breath
• Tightness of chest
• Chest congestion
• Feeling weaker than normal (e.g., requiring to rest while walking up the stairs when it never used to be needed before, etc.)
• Light-headed, nausea, vomiting, dizziness
• Sharp pain in one or both arms or shoulders, feeling congested below the wind-pipe
• Sharp pain in the jaw, neck, or around inside both shoulder blades – mostly felt during exercise or when feeling stressed
• Abdominal discomfort – as if being compressed or having indigestion

Symptoms by Group

Heart attack symptoms do not look the same for everyone. Different groups may experience atypical signs that are easily mistaken for other conditions.

• Heart attack in women: Women can experience symptoms that are less typical, including severe abdominal discomfort (often mistaken for indigestion), pain or pressure between the shoulder blades, extreme fatigue, nausea, and jaw pain, although chest pain or discomfort remains the most common symptom.

• Older adults: Seniors may not feel the typical chest discomfort. Instead, they might experience sudden confusion, fainting, shortness of breath, or a generalized feeling of weakness and fatigue. Older adults may also have fewer or less specific symptoms, particularly when they are frail or have multiple medical conditions.

• Diabetics: Because diabetes can cause nerve damage (neuropathy), people with diabetes may experience less typical or “silent” heart attacks, with mild symptoms or sometimes no obvious symptoms.
• High blood pressure: Individuals with chronic hypertension are at a high risk of vascular damage and should be highly vigilant of any sudden tightness in the chest or unexplained breathing difficulties. However, high blood pressure itself does not usually cause specific heart attack symptoms; it is an important risk factor for coronary artery disease and heart attack.

Causes

• Atherosclerosis: The primary cause, which involves the gradual buildup of fatty deposits (plaque) inside the coronary arteries, causing them to harden and narrow over time. 
• Plaque Rupture and Blood Clots: If a cholesterol plaque ruptures or erodes, a blood clot quickly forms around it. This leads to a total or partial coronary artery blockage, starving the heart muscle of necessary oxygen and potentially causing myocardial injury or infarction.
• Coronary Artery Spasm: A less common cause where a severe spasm in the artery temporarily constricts blood flow to the heart muscle.
• Spontaneous Coronary Artery Dissection (SCAD): A rare condition involving a sudden, spontaneous tearing of the coronary artery wall.

Other mechanisms can also cause myocardial infarction, including a mismatch between the heart’s oxygen supply and demand, coronary embolism, and other conditions. The exact cause is determined by the medical team based on the clinical presentation and investigations.

Immediate Action

While waiting for emergency responders to arrive, taking the right immediate actions can improve outcomes:

• Have the person sit down, rest, and try to keep calm.
• Loosen any tight clothing.
• Activate emergency medical services first. If the person is alert and experiencing non-traumatic chest pain, emergency medical personnel or a healthcare professional may advise chewing and swallowing aspirin (typically 162–325 mg), provided there is not known aspirin allergy or other reason to avoid it.
• If the person becomes unconscious and is not breathing normally, begin CPR immediately if you are trained to do so and follow the emergency dispatcher’s instructions.

Heart Attack Diagnosis

In diagnosing a heart attack or acute ischemia, a cardiologist will evaluate the patient’s risks and symptoms while checking their medical history in detail. Proper diagnosis relies on several critical tools:

• ECG (Electrocardiogram): Records the electrical signals in the heart to look for signs of acute myocardial ischemia or infarction and to help determine the urgency of treatment.
• Blood Tests: Used to detect cardiac troponin, a biomarker of heart muscle injury, that can rise when heart muscle cells are injured. Serial measurements may be needed to identify a changing pattern.
• Cardiac Catheterization: A procedure used to locate exact blockages in the coronary arteries by injecting a special dye and taking X-ray images. It may be performed urgently when an acute coronary syndrome requires immediate assessment and possible coronary intervention.

Depending on the clinical situation, doctors may also use echocardiography or other imaging and functional tests to evaluate heart function and identify other possible causes of symptoms.

Heart Attack Treatment

If a person is suffering from a heart attack, they must be treated urgently at a well-equipped hospital. Early treatment is critical because the longer the heart muscle remains without adequate blood flow, the greater the risk of permanent heart damage. Treatments include:

• Administering antiplatelet and anticoagulant medications (“blood thinners”) to prevent blood clots from growing or forming and, in selected cases, clot-busting medications to restore blood flow.
• Performing an angioplasty, also known as percutaneous coronary intervention (PCI), which involves inserting a small balloon to enlarge the narrowed or blocked artery.
• Placing a stent during the angioplasty to keep the artery open and maintain blood flow.
• Conducting coronary artery bypass surgery in severe cases to create a new path for blood to flow around the blockage.
• Providing oxygen when blood oxygen levels are low, and pain relief medications when needed to relieve symptoms and reduce distress.

The choice of treatment depends on the type of heart attack, the location and severity of the coronary blockage, how quickly the patient presents, and the patient’s overall health. For certain STEMI heart attacks, urgent PCI is the preferred method of restoring blood flow when it can be performed promptly; fibrinolytic therapy may be considered when timely PCI is not available.

Recovery

Recovery from a heart attack is a gradual, long-term process aimed at healing the heart muscle and preventing a second event. It typically involves enrolling in a cardiac rehabilitation program, which provides supervised exercise, education on heart-healthy living, risk-factor management, and psychological support. Patients will also need to adhere to their prescribed daily medication regimen (including blood pressure drugs, cholesterol-lowering medications, and antiplatelet or anticoagulant medications when indicated) and make permanent lifestyle modifications.

Cardiac rehabilitation is an important part of recovery and can help improve physical fitness, medication adherence, risk-factor control, and long-term cardiovascular health.

Heart Attack vs. Cardiac Arrest vs. Angina

Heart Attack Prevention

• Maintain regular health and cardiovascular risk assessments, with the frequency depending on your age, risk factors, and medical conditions.
• Consume healthy foods – i.e., limit foods high in saturated and trans fats, excessive salt, and added sugars; eat more vegetables, fruits, whole grains, legumes, nuts, and other high-fiber foods; and choose healthier cooking methods such as baking, steaming, boiling, or grilling instead of deep-frying.
• If you have an existing medical condition, it is important to take your medication regularly – both at home and while travelling.
• Properly manage your stress level through regular physical activity, adequate sleep, relaxation techniques, social support, or professional help when needed. This is because chronic stress can negatively affect cardiovascular health and may make healthy lifestyle habits more difficult to maintain.
• Sleep restfully about 7–9 hours daily. A regular sleep schedule and good sleep quality are also important for cardiovascular health.
• Do not smoke, and avoid exposure to tobacco smoke.
•  Maintain regular physical activity, aiming for at least 150 minutes of moderate-intensity aerobic activity per week when appropriate for your health and fitness level.
•  If you suspect you might have a coronary artery disease, especially if you have symptoms such as chest discomfort or unexplained shortness of breath, do not wait. Consult a doctor promptly.

When to Seek Emergency Care

You should seek emergency care the moment you or someone else exhibits heart attack warning signs. Symptoms can vary widely from person to person, but the most common indicators that require an immediate ambulance include:

• Sudden or persistent chest pain, tightness, pressure, squeezing, or heaviness
• Unexplained shortness of breath, even while resting
• Pain or discomfort that may spread to one or both arms, shoulders, neck, back, or jaw
• Sudden onset of light-headedness, dizziness, cold sweat, nausea, or vomiting
• Sudden unexplained weakness, extreme fatigue, or fainting, particularly when accompanied by other warning signs

Do not wait for symptoms to become severe or try to drive yourself to the hospital. Calling emergency medical services allows treatment to begin sooner and enables medical professionals to provide care during transport.

Maintaining a strong heart is vital. Apart from keeping a healthy lifestyle, regular assessment of cardiovascular risk factors and appropriate medical follow-up can help prevent cardiovascular disease in the long run and reduce the risk of heart attack.

Frequently Asked Questions

1. How can heart attack symptoms differ for women and people with diabetes?

Heart attack symptoms can vary significantly among different groups. Women may experience less typical symptoms such as unusual fatigue, shortness of breath, nausea, vomiting, and pain or discomfort in the back, shoulder, or jaw. However, chest pain or discomfort remains the most common symptom in women. People with diabetes may experience “silent” or less recognizable heart attacks, with mild symptoms or no obvious chest pain. Diabetes-related nerve damage may contribute to reduced awareness of symptoms, but silent heart attacks can occur for other reasons as well.

2. What should I do while waiting for an ambulance if I suspect a heart attack?

First, call emergency medical services immediately. Then have the person sit down, rest, and try to remain calm while loosening any tight clothing. If the person is alert and has non-traumatic chest pain, emergency medical personnel or a healthcare professional may advise chewing and swallowing aspirin (162–325 mg), provided the person has no known aspirin allergy and has not been advised to avoid aspirin. If there is any uncertainty, wait for the emergency medical team rather than giving aspirin. If the person loses consciousness and is not breathing normally, begin CPR immediately if you are trained to do so and follow the emergency dispatcher’s instructions.

3. What is the difference between a heart attack and cardiac arrest?

A heart attack is a circulation problem in which blood flow to the heart muscle is reduced or blocked, causing damage to the heart muscle. It commonly causes chest discomfort, shortness of breath, or discomfort in the arms, back, neck, jaw, or upper abdomen. A cardiac arrest is an electrical or mechanical problem in which the heart suddenly stops pumping blood effectively, causing sudden collapse, loss of responsiveness, and abnormal or absent normal breathing. Both are life-threatening emergencies. A heart attack can cause cardiac arrest, but they are not the same condition.