Background image for the top navigation. The Barbara Bush Children's Hospital link. Clinicians page link. Works on Wellness and Employee Benefits page link Family Services page link. Link to Senior Services page.
Email to a friend    Printer Friendly Page
Text Size: decrease font increase font

Search Health Information   Print This Page Print    Email to a Friend Email
Heart Attack and Unstable Angina

Heart Attack and Unstable Angina

Overview

Picture of the heart

What is a heart attack?

A heart attack occurs when blood flow to the heart is blocked. Without blood and the oxygen it carries, part of the heart starts to die. A heart attack doesn't have to be deadly. Quick treatment can restore blood flow to the heart and save your life.

Your doctor might call a heart attack a myocardial infarction, or MI. Your doctor might also use the term acute coronary syndrome for your heart attack or unstable angina.

What is angina, and why is unstable angina a concern?

Angina (say "ANN-juh-nuh" or "ann-JY-nuh") is a type of chest pain or discomfort that occurs when there is not enough blood flow to the heart. Angina can be dangerous. So it is important to pay attention to your symptoms, know what is typical for you, learn how to control it, and know when to call for help.

Symptoms of angina include chest pain or pressure, or a strange feeling in the chest. Some people feel pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.

There are two types of angina:

  • Stable angina has a typical pattern. You can likely predict when it will happen. It happens when your heart is working harder and needs more oxygen, such as during exercise. Your symptoms go away when you rest.
  • Unstable angina is unexpected, and resting or taking nitroglycerin may not help. Your doctor will probably diagnose unstable angina if you are having symptoms for the first time or if your symptoms are getting worse, lasting longer, happening more often, or happening at rest.

Unstable angina is a warning sign that a heart attack may happen soon, so it requires treatment right away. But if you have any symptoms of angina, see your doctor.

What causes a heart attack?

Heart attacks happen when blood flow to the heart is blocked. This usually occurs because fatty deposits called plaque have built up inside the coronary arteries, which supply blood to the heart. If a plaque breaks open, the body tries to fix it by forming a clot around it. The clot can block the artery , preventing the flow of blood and oxygen to the heart.

This process of plaque buildup in the coronary arteries is called coronary artery disease, or CAD. In many people, plaque begins to form in childhood and gradually builds up over a lifetime. Plaque deposits may limit blood flow to the heart and cause angina. But too often, a heart attack is the first sign of CAD.

Things like intense exercise, sudden strong emotion, or illegal drug use (such as a stimulant, like cocaine) can trigger a heart attack. But in many cases, there is no clear reason why heart attacks occur when they do.

What are the symptoms?

Symptoms of a heart attack include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Here are some other ways to describe the pain from heart attack:

  • Many people describe the pain as discomfort, pressure, squeezing, or heaviness in the chest.
  • People often put their fist to their chest when they describe the pain.
  • The pain may spread down the left shoulder and arm and to other areas , such as the back, jaw, neck, or right arm.

Unstable angina has symptoms similar to a heart attack.

What should you do if you think you are having a heart attack?

If you have symptoms of a heart attack, act fast. Quick treatment could save your life.

If your doctor has prescribed nitroglycerin for angina:

  1. Take 1 dose of nitroglycerin and wait 5 minutes.
  2. If your symptoms don't improve or if they get worse, call 911 or other emergency services. Describe your symptoms, and say that you could be having a heart attack.
  3. Stay on the phone. The emergency operator will tell you what to do. The operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Aspirin helps keep blood from clotting, so it may help you survive a heart attack.
  4. Wait for an ambulance. Do not try to drive yourself.

If you do not have nitroglycerin:

  1. Call 911 or other emergency services now. Describe your symptoms, and say that you could be having a heart attack.
  2. Stay on the phone. The emergency operator will tell you what to do. The operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Aspirin helps keep blood from clotting, so it may help you survive a heart attack.
  3. Wait for an ambulance. Do not try to drive yourself.

The best choice is to go to the hospital in an ambulance. The paramedics can begin lifesaving treatments even before you arrive at the hospital. If you cannot reach emergency services, have someone drive you to the hospital right away. Do not drive yourself unless you have absolutely no other choice.

If you think you are having unstable angina but you are not sure, follow the steps listed above. Unstable angina can lead to a heart attack or death, so you need to have it checked right away.

How is a heart attack treated?

If you go to the hospital in an ambulance, treatment will be started right away to restore blood flow and limit damage to the heart. You may be given:

  • Aspirin and other medicines to prevent blood clots.
  • Medicines that break up blood clots (thrombolytics).
  • Medicines to decrease the heart's workload and ease pain.

At the hospital, you will have tests, such as:

  • Electrocardiogram (EKG or ECG) . It can detect signs of poor blood flow, heart muscle damage, abnormal heartbeats, and other heart problems.
  • Blood tests, including tests to see whether cardiac enzymes are high. Having these enzymes in the blood is usually a sign that the heart has been damaged.
  • Cardiac catheterization , if the other tests show that you may be having a heart attack. This test shows which arteries are blocked and how your heart is working.

If cardiac catheterization shows that an artery is blocked, a doctor may do angioplasty right away to help blood flow through the artery. Or a doctor may do emergency bypass surgery to redirect blood around the blocked artery.

After these treatments, you will take medicines to help prevent another heart attack. Take all of your medicines correctly. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine, you might raise your risk of having another heart attack.

After you have had a heart attack, the chance that you will have another one is higher. Taking part in a cardiac rehab program helps lower this risk. A cardiac rehab program is designed for you and supervised by doctors and other specialists. It can help you learn how to eat a balanced diet and exercise safely.

It is common to feel worried and afraid after a heart attack. But if you are feeling very sad or hopeless, ask your doctor about treatment. Getting treatment for depression may help you recover from a heart attack.

Can you prevent a heart attack?

Heart attacks are usually the result of heart disease, so taking steps to delay or reverse coronary artery disease can help prevent a heart attack. Heart disease is the number one killer of both men and women in the United States, so these steps are important for everyone.

To improve your heart health:

  • Don't smoke, and avoid secondhand smoke. Quitting smoking can quickly reduce the risk of another heart attack or death.
  • Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil.
  • Get regular exercise. Your doctor can suggest a safe level of exercise for you.
  • Control your cholesterol and blood pressure.
  • Manage your diabetes.
  • Lower your stress level. Stress can damage your heart.
  • Take a daily aspirin if your doctor advises it.

Cause

A heart attack or unstable angina is caused by sudden narrowing or blockage of a coronary artery. This blockage keeps blood and oxygen from getting to the heart. A heart attack or unstable angina can happen when plaque in the coronary artery breaks open or ruptures. Blood then clots in the artery and blocks blood flow .

With a heart attack, lack of blood flow causes the heart's muscle cells to start to die. With unstable angina, the blood flow is not completely blocked by the blood clot. But a heart attack may soon follow, because the blood clot can quickly grow and block the artery.

Atherosclerosis leads to plaque buildup in the coronary arteries, called coronary artery disease .

A stent in a coronary artery can also become blocked and cause a heart attack. The stent might become narrow again if scar tissue grows after the stent is placed. And a blood clot could get stuck in the stent and block blood flow to the heart.

Heart attack triggers

In most cases, there are no clear reasons why heart attacks occur when they do. But sometimes your body releases adrenaline and other hormones into the bloodstream in response to intense emotions such as anger, fear, and the "fight or flight" impulse. Heavy physical exercise, emotional stress, lack of sleep, and overeating can also trigger this response. Adrenaline increases blood pressure and heart rate and can cause coronary arteries to constrict, which may cause an unstable plaque to rupture.

In rare cases, the coronary artery spasms and contracts, obstructing blood flow and causing chest pain. If severe, the spasm can completely block blood flow and cause a heart attack. Most of the time in these cases, atherosclerosis is also involved, although sometimes the arteries are clear. Cocaine, cold weather, emotional stress, and other things can cause these spasms. But in many other cases, it is not known what triggers the spasm.

Symptoms

Heart attack

Symptoms of a heart attack include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

Call 911 or other emergency services immediately if you think you are having a heart attack.

Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within 5 minutes, call 911. Do not wait to call for help.

Unstable angina

Unstable angina symptoms are similar to a heart attack.

Call 911 or other emergency services immediately if you think you are having a heart attack or unstable angina.

People who have unstable angina often describe their symptoms as:

  • Starting within the past 2 months and becoming more severe.
  • Limiting their physical activity.
  • Suddenly becoming more frequent, severe, or longer-lasting or being brought on by less exertion than before.
  • Occurring at rest with no obvious exertion or stress. Some say these symptoms may wake you up.
  • Not responding to rest or nitroglycerin.

The symptoms of stable angina are different from those of unstable angina. Stable angina occurs at predictable times with a specific amount of exertion or activity and may continue without much change for years. It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than 5 minutes.

Women's symptoms

For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Women are more likely than men to delay seeking help for a possible heart attack. Women delay for many reasons, like not being sure it is a heart attack or not wanting to bother others. But it is better to be safe than sorry. If you have symptoms of a possible heart attack, call for help. When you get to the hospital, don't be afraid to speak up for what you need. To get the tests and care that you need, be sure your doctors know that you think you might be having a heart attack.

For more information, see Women and Coronary Artery Disease.

Other ways to describe chest pain

People who are having a heart attack often describe their chest pain in various ways. The pain:

  • May feel like pressure, heaviness, weight, tightness, squeezing, discomfort, burning, a sharp ache (less common), or a dull ache. People often put their fist to their chest when describing the pain.
  • May radiate from the chest down the left shoulder and arm (the most common site) and also to other areas , including the left shoulder, middle of the back, upper portion of the abdomen, right arm, neck, and jaw.
  • May be diffuse—the exact location of the pain is usually difficult to point out.
  • Is not made worse by taking a deep breath or pressing on the chest.
  • Usually begins at a low level, then gradually increases over several minutes to a peak. The discomfort may come and go. Chest pain that reaches its maximum intensity within seconds may represent another serious problem, such as an aortic aneurysm .

It is possible to have a "silent heart attack" without any symptoms, but this is rare.

What Increases Your Risk

Coronary artery disease (CAD) is the major cause of heart attacks. So the more risk factors you have for CAD, the greater your risk for unstable angina or a heart attack. The main risks for CAD are:

Use the heart attack risk calculator to estimate your risk of having a heart attack over 10 years.

Women and heart disease

Women have unique risk factors for heart disease, including birth control pills and hormone replacement therapy. These things can raise a woman's risk for a heart attack or stroke.

See the topic Women and Coronary Artery Disease for more information on risk, symptoms, and prevention of heart disease.

C-reactive protein (CRP)

A type of protein in your blood may help find your risk of a heart attack. This protein is called a high-sensitivity C-reactive protein (hs-CRP). It is found with a C-reactive protein (CRP) blood test. This test may help find your risk for a heart attack, especially when it is considered along with other risk factors such as cholesterol, age, blood pressure, and smoking. But the connection between high CRP levels and heart disease risk is not understood very well.

NSAIDs

Most nonsteroidal anti-inflammatory drugs (NSAIDs), which are used to relieve pain and fever and reduce swelling and inflammation, may increase the risk of heart attack. This risk is greater if you take NSAIDs at higher doses or for long periods of time. People who are older than 65 or who have existing heart, stomach, or intestinal disease are more likely to have problems.

Aspirin, unlike other NSAIDs, has been shown to reduce the risk of heart attack and stroke. But it also carries the risks of serious stomach and intestinal bleeding as well as skin reactions. Regular use of other NSAIDs, such as ibuprofen, may make aspirin less effective in preventing heart attack and stroke.

For information on how to prevent a heart attack, see the Prevention section of this topic.

When to Call a Doctor

Do not wait if you think you are having a heart attack. Getting help fast can save your life. Even if you're not sure it's a heart attack, have it checked out.

Call 911 or other emergency services immediately if you have symptoms of a heart attack. These may include:

  • Chest pain or pressure, or a strange feeling in the chest.
  • Sweating.
  • Shortness of breath.
  • Nausea or vomiting.
  • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly, or in one or both shoulders or arms.
  • Lightheadedness or sudden weakness.
  • A fast or irregular heartbeat.

After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

Nitroglycerin. If you typically use nitroglycerin to relieve angina and if one dose of nitroglycerin has not relieved your symptoms within 5 minutes, call 911. Do not wait to call for help.

Women's symptoms. For men and women, the most common symptom is chest pain or pressure. But women are somewhat more likely than men to have other symptoms like shortness of breath, nausea, and back or jaw pain.

Why wait for an ambulance?

By calling 911 and taking an ambulance to the hospital, you may be able to start treatment before you arrive at the hospital. If any complications occur along the way, ambulance personnel are trained to evaluate and treat them.

If an ambulance is not readily available, have someone else drive you to the emergency room. Do not drive yourself to the hospital.

CPR

If you witness a person become unconscious, call 911 or other emergency services and start CPR (cardiopulmonary resuscitation). The emergency operator can coach you on how to perform CPR.

To learn more about CPR, see the Cardiopulmonary Resuscitation (CPR) section of the topic Dealing With Emergencies.

Who to see

You will be evaluated and treated by an emergency medicine specialist in the emergency room. For ongoing care, you will likely see a cardiologist and other doctors and nurses who specialize in heart disease. If surgery is needed, you will be referred to a cardiovascular surgeon .

Exams and Tests

Emergency testing for a heart attack

After you call 911 for a heart attack, paramedics will quickly assess your heart rate, blood pressure, and breathing rate. They also will place electrodes on your chest for an electrocardiogram (EKG, ECG) to check your heart's electrical activity.

When you arrive at the hospital, the emergency room doctor will take your history and do a physical exam, and a more complete ECG will be done. A technician will draw blood to test for cardiac enzymes, which are released into the bloodstream when heart cells die.

If your tests show that you are at risk of having or are having a heart attack, your doctor will probably recommend that you have cardiac catheterization. The doctor can then see whether your coronary arteries are blocked and how your heart functions.

If an artery appears blocked, angioplasty—a procedure to open up clogged arteries—may be done during the catheterization. Or you will be referred to a cardiovascular surgeon for coronary artery bypass graft surgery .

If your tests do not clearly show a heart attack or unstable angina and you do not have other risk factors (such as a previous heart attack), you will probably have other tests. These may include a cardiac perfusion scan or SPECT imaging test.

If your tests do not show signs of a heart attack but your doctor thinks you have unstable angina and may be in danger of having a heart attack, you will be admitted to the hospital.

Testing after a heart attack

From 2 to 3 days after a heart attack or after being admitted to the hospital for unstable angina, you may have more tests. (Even though you may have had some of these tests while you were in the emergency room, you may have some of them again.)

Doctors use these tests to see how well your heart is working and to find out whether undamaged areas of the heart are still receiving enough blood flow.

These tests may include:

  • Echocardiogram (echo). An echo is used to find out several things about the heart, including its size, thickness, movement, and blood flow.
  • Stress electrocardiogram (such as treadmill testing). This test compares your ECG while you are at rest to your ECG after your heart has been stressed, either through physical exercise (treadmill or bike) or by using a medicine.
  • Stress echocardiogram. A stress echocardiogram can show whether you may have reduced blood flow to the heart.
  • Cardiac perfusion scan. This test is used to estimate the amount of blood reaching the heart muscle during rest and exercise.
  • Cardiac catheterization. In this test, a dye (contrast material) is injected into the coronary arteries to evaluate your heart and coronary arteries.
  • Cardiac blood pool scan. This test shows how well your heart is pumping blood to the rest of your body.
  • Cholesterol test. This test shows the amounts of cholesterol in your blood.

Treatment Overview

Do not wait if you think you are having a heart attack. Getting help fast can save your life.

Emergency treatment gets blood flowing back to the heart. This treatment is similar for unstable angina and heart attack.

  • For unstable angina, treatment prevents a heart attack.
  • For a heart attack, treatment limits the damage to your heart.

Ambulance and emergency room

Treatment begins in the ambulance and emergency room. The goal of your health care team will be to prevent permanent heart muscle damage by restoring blood flow to your heart as quickly as possible. Treatment includes:

  • Oxygen and pain relief. Oxygen therapy and morphine are typically given.
  • Nitroglycerin. It opens up the arteries of the heart to help blood flow back to the heart.
  • Beta-blockers. These drugs lower the heart rate, blood pressure, and the workload of the heart.

You also will receive medicines to stop blood clots. These are given to prevent blood clots from getting bigger so blood can flow to the heart. Some medicines will break up blood clots to increase blood flow. You might be given:

Angioplasty or surgery

Angioplasty. Doctors try to do angioplasty as soon as possible after a heart attack. Angioplasty might be done for unstable angina, especially if there is a high risk of a heart attack.

Angioplasty gets blood flowing to the heart. It opens a coronary artery that was narrowed or blocked during the heart attack.

But angioplasty is not available in all hospitals. Sometimes an ambulance will take a person to a hospital that provides angioplasty, even if that hospital is farther away. If a person is at a hospital that does not do angioplasty, he or she might be moved to another hospital where angioplasty is available.

If you are treated at a hospital that has proper equipment and staff, you may be taken to the cardiac catheterization lab . You will have cardiac catheterization, also called a coronary angiogram. Your doctor will check your coronary arteries to see if angioplasty is right for you.

Bypass surgery. If angioplasty is not right for you, emergency coronary artery bypass surgery may be done. For example, bypass surgery might be a better option because of the location of the blockage or because of numerous blockages.

Other treatment in the hospital

After a heart attack, you will stay in the hospital for at least a few days. Your doctors and nurses will watch you closely. They will check your heart rate and rhythm, blood pressure, and medicines to make sure you don't have serious complications.

Your doctors will start you on medicines that lower your risk of having another heart attack or having complications and that help you live longer after your heart attack. You may have already been taking some of these medicines. They include:

You will take these medicines for a long time, maybe the rest of your life.

After you go home from the hospital, take all of your medicines correctly. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine, you might raise your risk of having another heart attack.

Cardiac rehabilitation

Cardiac rehabilitation might be started in the hospital or soon after you go home. It's an important part of your recovery after a heart attack. Cardiac rehab teaches you how to be more active and make lifestyle changes that can lead to a stronger heart and better health. Cardiac rehab can help you feel better and reduce your risk of future heart problems.

If you don't do a cardiac rehab program, you will still need to learn about lifestyle changes that can lower your risk of another heart attack. These changes include quitting smoking, eating heart-healthy foods, and being active.

Quitting smoking is part of cardiac rehab. Medicines and counseling can help you quit for good. People who continue to smoke after a heart attack are much more likely than nonsmokers to have another heart attack. When a person quits, the risk of another heart attack decreases a lot in the first year after stopping smoking.

Go to your doctor visits

Your doctor will want to closely watch your health after a heart attack. Be sure to keep all your appointments. Tell your doctor about any changes in your condition, such as changes in chest pain, weight gain or loss, shortness of breath with or without exercise, and feelings of depression.

Prevention

You can help prevent a heart attack by taking steps that slow or prevent coronary artery disease —the main risk factor for a heart attack.

Make lifestyle changes

Control cholesterol and blood pressure

To reduce your risk of a heart attack, you will need to control your cholesterol and manage your blood pressure. Quitting smoking, changing the way you eat, and getting more exercise can help. But if these things don't work, you may also need to take medicines.

Click here to view a Decision Point. High Cholesterol: Should I Take Statins?
Click here to view a Decision Point. High Blood Pressure: Should I Take Medicine?

Take aspirin to prevent a heart attack

Taking daily aspirin might lower your chances of having a heart attack. Talk with your doctor before taking aspirin every day. To see if aspirin is right for you, you and your doctor will balance the benefits and the risks of taking a daily aspirin.

Click here to view a Decision Point. Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

For more information, see the topic Low-Dose Aspirin Therapy.

Manage stress and get help for depression

  • Manage stress. Stress can hurt your heart. Keep stress low by talking about your problems and feelings, rather than keeping your feelings hidden. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or yoga.
  • Get help for depression . Getting treatment for depression can help you stay healthy.

Learn about issues for women

Women have unique risk factors for heart disease, including birth control pills and hormone replacement therapy. These things can raise a woman's risk for a heart attack or stroke.

See the topic Women and Coronary Artery Disease for more information on risk, symptoms, and prevention of heart disease.

Preventing Another Heart Attack

After you've had a heart attack, your biggest concern will probably be that you could have another one. You can help lower your risk of another heart attack by joining a cardiac rehabilitation program and taking your medicines.

Do cardiac rehab

You might have started cardiac rehabilitation (rehab) in the hospital or soon after you got home. It's an important part of your recovery after a heart attack.

In cardiac rehab, you will get education and support that help you make new, healthy habits, such as eating right and getting more exercise.

Make heart-healthy habits

If you don't do a cardiac rehab program, you will still need to learn about lifestyle changes that can lower your risk of another heart attack. These changes include quitting smoking, eating heart-healthy foods, and being active.

For more information on lifestyle changes, see Life After a Heart Attack.

Take your medicines

After having a heart attack, take all of your medicines correctly. Do not stop taking your medicine unless your doctor tells you to. If you stop taking your medicine, you might raise your risk of having another heart attack.

You might take medicines to:

  • Prevent blood clots. These medicines include aspirin and other medicines such as clopidogrel (Plavix).
  • Decrease the workload on your heart (beta-blocker).
  • Lower cholesterol.
  • Treat irregular heartbeats.
  • Lower blood pressure.

For more information, see the Medications section of this topic.

Life After a Heart Attack

Coming home after a heart attack may be unsettling. Your hospital stay may have seemed too short. You may be nervous about being home without doctors and nurses after being so closely watched in the hospital.

But you have had tests that tell your doctor that it is safe for you to return home. Now that you're home, you can take steps to live a healthy lifestyle to reduce the chance of having another heart attack.

Do cardiac rehab

Cardiac rehabilitation (rehab) teaches you how to be more active and make lifestyle changes that can lead to a stronger heart and better health.

If you don't do a cardiac rehab program, you will still need to learn about lifestyle changes that can lower your risk of another heart attack. These changes include quitting smoking, eating heart-healthy foods, and being active. For more information on lifestyle changes, see Prevention.

Learn healthy habits

Making healthy lifestyle changes can reduce your chance of another heart attack. Quitting smoking, eating a low-fat and low-cholesterol diet, getting regular exercise, and staying at a healthy weight are important steps you can take.

Interactive Tool: Are You Ready to Quit Smoking?
Click here to view an Actionset. Heart Disease: Eating a Heart-Healthy Diet
Click here to view an Actionset. Heart Disease: Exercising for a Healthy Heart
Weight Management

For more information on how to make healthy lifestyle changes, see Prevention.

Manage your angina

Tell your doctor about any chest pain or discomfort ( angina ) you have after a heart attack. Many people have stable angina that can be relieved with rest or nitroglycerin.

Manage stress and get help for depression

Depression and heart disease are linked. People who have heart disease are more likely to get depressed. And if you have both depression and heart disease, you may not stay as healthy as possible. This can make depression and heart disease worse.

If you think you may have depression, talk to your doctor.

Stress and anger can also hurt your heart. They might make your symptoms worse. Try different ways to reduce stress, such as exercise, deep breathing, meditation, or yoga.

Have sex when you're ready

You can resume sexual activity after a heart attack when you are healthy and feel ready for it. You could be ready if you can do mild or moderate activity , like brisk walking, without having angina symptoms. Talk with your doctor if you have any concerns. Your doctor can help you know if your heart is healthy enough for sex.

If you take a nitrate, like nitroglycerin, do not take erection-enhancing medicines. Combining these medicines can cause a life-threatening drop in blood pressure.

Get support

Whether you are recovering from a heart attack or are changing your lifestyle so you can avoid another one, emotional support from friends and family is important. Think about joining a heart disease support group. Ask your doctor about the types of support that are available where you live. Meeting other people with the same problems can help you know you're not alone.

Take other steps to live healthier

After a heart attack, it's also important to:

  • Take your medicines exactly as directed. Do not stop taking your medicine unless your doctor tells you to.
  • Keep your blood sugar in your target range if you have diabetes.
  • Get a flu vaccine every year. It can help you stay healthy and prevent another heart attack.
  • Drink alcohol in moderation, if you drink. This means having 1 alcoholic drink a day for women or 2 drinks a day for men.
  • Seek help for sleep problems. Your doctor may want to check for sleep apnea , a common sleep problem in people who have heart disease. For more information, see the topic Sleep Apnea.

Medications

Take all of your medicines correctly. Do not stop taking your medicine unless your doctor tells you to. Taking medicine can lower your risk of having another heart attack or dying from coronary artery disease.

In the ambulance and emergency room

Treatment for a heart attack or unstable angina begins with medicines in the ambulance and emergency room. This treatment is similar for both. The goal is to prevent permanent heart muscle damage or prevent a heart attack by restoring blood flow to your heart as quickly as possible.

You will receive:

You also will receive medicines to stop blood clots so blood can flow to the heart. Some medicines will break up blood clots to increase blood flow. You might be given:

In the hospital and at home

In the hospital, your doctors will start you on medicines that lower your risk of having complications or another heart attack. You may already have taken some of these medicines. They can help you live longer after a heart attack. You will take these medicines for a long time, maybe the rest of your life.

Medicine to lower blood pressure and the heart's workload
Medicine to prevent blood clots from forming and causing another heart attack
Medicine to lower cholesterol
Medicine to manage angina symptoms

What to think about

You may have regular blood tests to monitor how the medicine is working in your body. Your doctor will likely let you know when you need to have the tests.

If your doctor recommends daily aspirin, don't substitute nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, for example) or naproxen (such as Aleve), for the aspirin. NSAIDS relieve pain and inflammation much like aspirin does, but they do not affect blood clotting in the same way that aspirin does. NSAIDs do not lower your risk of another heart attack. In fact, NSAIDs may raise your risk for a heart attack or stroke.

If you need to take an NSAID for a long time, such as for pain, talk with your doctor to see if it is safe for you. For more information about daily aspirin and NSAIDs, see Low-Dose Aspirin Therapy.

Surgery

An angioplasty procedure or bypass surgery might be done to open blocked arteries and improve blood flow to the heart.

Angioplasty

Angioplasty. This procedure gets blood flowing back to the heart. It opens a coronary artery that was narrowed or blocked during a heart attack. Doctors try to do angioplasty as soon as possible after a heart attack. Angioplasty might be done for unstable angina, especially if there is a high risk of a heart attack.

Angioplasty is not surgery. It is done using a thin, soft tube called a catheter that's inserted in your artery. It doesn't use large cuts (incisions) or require anesthesia to make you sleep.

Most of the time, stents are placed during angioplasty. . They keep the artery open.

But angioplasty is not done at all hospitals. Sometimes an ambulance will take a person to a hospital that provides angioplasty, even if that hospital is farther away. If a person is at a hospital that does not do angioplasty, he or she might be moved to another hospital where it is available.

If you are at a hospital that has proper equipment and staff to do this procedure, you may have cardiac catheterization, also called coronary angiogram. Your doctor will check your coronary arteries to see if angioplasty is right for you.

Bypass surgery

Bypass surgery. If angioplasty is not right for you, emergency coronary artery bypass surgery may be done. For example, bypass surgery might be a better choice because of the location of the blockage or because you have many blockages.

Cardiac rehabilitation after surgery

After you have had angioplasty or bypass surgery, you may be encouraged to take part in a cardiac rehabilitation program to help lower your risk of death from heart disease. For more information, see the topic Cardiac Rehabilitation.

Treatment for Complications

Heart attacks that damage critical or large areas of the heart tend to cause more problems (complications) later. If only a small amount of heart muscle dies, the heart may still function normally after a heart attack.

The chance that these complications will occur depends on the amount of heart tissue affected by a heart attack and whether medicines are given during and after a heart attack to help prevent these complications. Your age, general health, and other things also affect your risk of complications and death.

About half of all people who have a heart attack will have a serious complication. The kinds of complications you may have depend upon the location and extent of the heart muscle damage. The most common complications are:

Treatment for heart rhythm problems

If the heart attack caused an arrhythmia, you may take medicines or you may need a cardiac device such as a pacemaker.

If your heart rate is too slow ( bradycardia ), your doctor may recommend a pacemaker.

Click here to view a Decision Point. Heart Rate Problems: Should I Get a Pacemaker?

If you have abnormal heart rhythms or if you are at risk for abnormal heart rhythms that can be deadly, your doctor may recommend an implantable cardioverter-defibrillator (ICD).

Click here to view a Decision Point. Heart Rhythm Problems: Should I Get an ICD?

For information on different types of arrhythmias, see:

End-of-Life Decisions

Palliative care

If your condition gets worse, you may want to think about palliative care . This is care for people who have illnesses that do not go away and often get worse over time. It is different than care to cure your illness. Palliative care focuses on improving your quality of life—not just in your body, but also in your mind and spirit. Some people combine palliative care with curative care.

For more information, see the topic Palliative Care.

End-of-life decisions

Treatment for a heart attack is increasingly successful at prolonging life and reducing complications and hospitalization. But a heart attack can lead to problems that get worse over time, such as heart failure and abnormal heart rhythms ( arrhythmias ).

It can be hard to have talks with your doctor and family about the end of your life. But making these decisions now may bring you and your family peace of mind. Your family won't have to wonder what you want. And you can spend your time focusing on your relationships.

You will need to decide if you want life-support measures if your health gets very bad. An advance directive is a legal document that tells doctors how to care for you at the end of your life. You also can say where you want to have care. And you can name someone who can make sure your wishes are followed.

For more information, see:

Your doctor may talk to you about your desire to be revived (resuscitated) if your heart stops pumping and you are unable to breathe on your own.

Click here to view a Decision Point. End-of-Life Care: Should I Receive CPR and Life Support?

Other Places To Get Help

Organizations

Society for Interventional Radiology
3975 Fair Ridge Drive
Suite 400 North
Fairfax, VA 22033
Phone: 1-800-488-7284
Web Address: www.sirweb.org
 

The Society of Interventional Radiology is a national organization of physicians, scientists, and health professionals dedicated to improving public health through disease management and minimally invasive, image-guided therapies. Intervention radiology includes using X-rays, MRI, and other imaging to move a thin tube in the body, usually in an artery, to treat a disease. An example is angioplasty for heart disease. The Web site includes a section on patient information. This section gives information on therapies for various diseases and conditions. The Web site can also help you find a doctor.


American Heart Association (AHA)
7272 Greenville Avenue
Dallas, TX  75231
Phone: 1-800-AHA-USA1 (1-800-242-8721)
Web Address: www.heart.org
 

Visit the American Heart Association (AHA) website for information on physical activity, diet, and various heart-related conditions. You can search for information on heart disease and stroke, share information with friends and family, and use tools to help you make heart-healthy goals and plans. Contact the AHA to find your nearest local or state AHA group. The AHA provides brochures and information about support groups and community programs, including Mended Hearts, a nationwide organization whose members visit people with heart problems and provide information and support.


HeartHub for Patients
Web Address: www.hearthub.org
 

HeartHub for Patients is a website from the American Heart Association. It provides patient-focused information, tools, and resources about heart diseases and stroke. The site helps you understand and manage your health. It includes online tools that explain your risks and treatment options. The site includes articles, the latest news in health and research, videos, interactive tools, forums and community groups, and e-newsletters.

The website includes health centers that cover heart rhythm problems, cardiac rehabilitation, caregivers, cholesterol, diabetes, heart attack, heart failure, high blood pressure, peripheral artery disease, and stroke.

HeartHub for Patients also links to Heart360.org, another American Heart Association website. Heart360 is a tool that helps you send and receive medical information with your doctor. It also helps you monitor your health at home. It gives you access to tools to manage and monitor high blood pressure, diabetes, high cholesterol, physical activity, and nutrition.


National Heart, Lung, and Blood Institute (NHLBI)
P.O. Box 30105
Bethesda, MD  20824-0105
Phone: (301) 592-8573
Fax: (240) 629-3246
TDD: (240) 629-3255
Email: nhlbiinfo@nhlbi.nih.gov
Web Address: www.nhlbi.nih.gov
 

The U.S. National Heart, Lung, and Blood Institute (NHLBI) information center offers information and publications about preventing and treating:

  • Diseases affecting the heart and circulation, such as heart attacks, high cholesterol, high blood pressure, peripheral artery disease, and heart problems present at birth (congenital heart diseases).
  • Diseases that affect the lungs, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema, sleep apnea, and pneumonia.
  • Diseases that affect the blood, such as anemia, hemochromatosis, hemophilia, thalassemia, and von Willebrand disease.

Women's Heart Foundation
Phone: (609) 771-9600
Email: bonnie@womensheart.org
Web Address: www.womensheart.org
 

The Women's Heart Foundation provides education for women about preventing and treating heart disease. Information covers caregiving, exercise, nutrition, and medical and surgical treatments. The information focuses on the unique needs of women who have heart disease.


References

Other Works Consulted

  • Abraham NS, et al. (2010). ACCF/ACG/AHA 2010 Expert consensus statement on the concomitant use of proton pump inhibitors and thienopyridines: A focused update of the ACCF/ACG/AHA 2008 Expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use.
  • Antman EM, et al. (2004). ACC/AHA guidelines for management of patients with ST-elevation myocardial infarction. Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation, 110(5): 588–636.
  • Antman EM, et al. (2007). 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 117(2): 296–329. Originally published online December 10, 2007 (doi:10.1161/circulationaha.107.188209).
  • Bhatt DL, et al. (2008). ACCF/ACG/AHA 2008 Expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents. Circulation, 118(18): 1894–1909.
  • Buckley DI, et al. (2009). C-reactive protein as a risk factor for coronary heart disease: A systematic review and meta-analysis for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 151(7): 483–495.
  • De Lemos JA, et al. (2011). Unstable angina and non-ST-segment elevation myocardial infarction. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1328–1353. New York: McGraw-Hill.
  • Epstein AE, et al. (2008). ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 117(21): e350–e408. [Correction in Circulation, 120(5): e34–e35.]
  • Guyatt GH, et al. (2012). Executive summary: Antithrombotic therapy and prevention of thrombosis, 9th ed.—American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 141(2, Suppl): 7S–47S.
  • Hass EE, et al. (2011). ST-segmented elevation myocardial infarction. In V Fuster et al., eds., Hurst's the Heart, 13th ed., vol. 2, pp. 1354–1385. New York: McGraw-Hill.
  • Hendel RC et al. (2009). ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 appropriate use criteria for cardiac radionuclide imaging. Circulation, 119(22): e561–e587.
  • Holmes DR, et al. (2010). ACCF/AHA Clopidogrel clinical alert: Approaches to the FDA "Boxed Warning": A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the American Heart Association.
  • Jneid H, et al. (2012). 2012 ACCF/AHA Focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction. Circulation, 126(7): 875–910.
  • King SB III, et al. (2007). 2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 117(2): 261–295. Originally published online December 13, 2007 (doi:10.1161/circulationaha.107.188208).
  • Krumholz HM, et al. (2008). ACC/AHA 2008 Performance measures for adults with ST-elevation and Non ST-elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non ST-Elevation Myocardial Infarction). Circulation, 118(24): 2596–2648
  • Levine GN, et al. (2011). 2011 ACC/AHA/SCAI guideline for percutaneous coronary intervention: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation, 124(23): e574–e651.
  • Levine GN, et al. (2012). Sexual activity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 125(8): 1058–1072.
  • Lichtman JH, et al. (2008). Depression and coronary heart disease: Recommendations for screening, referral, and treatment: A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endor
  • Malenka DJ, et al. (2008). Outcomes following coronary stenting in the era of bare-metal vs the era of drug-eluting stents. JAMA, 299(24): 2868–2876.
  • O'Connor RE, et al. (2010). Acute coronary syndromes: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 122(18): S787–S817.
  • O'Gara PT, et al. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: Executive summary. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 127(4): e362–e425.
  • Roger VL, et al. (2011). Heart disease and stroke statistics 2011 update: A report from the American Heart Association. Circulation, 123(4): e18–e209.
  • Sarkees ML, Bavry AA (2010). Non ST-elevation acute coronary syndrome, search date December 2009. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
  • Skinner JS, Cooper A (2011). Secondary prevention of ischaemic cardiac events, search date May 2010. BMJ Clinical Evidence. Available online: http://www.clinicalevidence.com.
  • Smith SC, et al. (2011). AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation. Circulation, 124(22): 2458–2473. Also available online: http://circ.ahajournals.org/content/124/22/2458.full.
  • Somers VK, et al. (2008). Sleep apnea and cardiovascular disease: An American Heart Association/American College of Cardiology Foundation Scientific Statement from the American Heart Association Council for High Blood Pressure Research Professional Education Committee, Council on Clinical Cardiology, Stroke Council, and Council on Cardiovascular Nursing in collaboration with the National
  • U.S. Preventive Services Task Force (2009). Aspirin for the prevention of cardiovascular disease. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsasmi.htm.
  • U.S. Preventive Services Task Force (2009). Using nontraditional risk factors in coronary heart disease risk assessment. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspscoronaryhd.htm.
  • Wakai A (2011). Myocardial infarction (ST-elevation), search date October 2009. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.

Credits

By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer John M. Miller, MD, FACC - Cardiology, Electrophysiology
Last Revised April 4, 2011

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2013 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

Maine Medical Center | 22 Bramhall Street | Portland, Maine 04102-3175 | (207) 662-0111