Patient information from BMJ

Heart attack: what is it?

Last published:Sep 20, 2021

If you've had a heart attack it probably came as a big shock to you. But there are good treatments available for people who have had a heart attack. This leaflet gives you information about heart attacks and about recovering and staying healthy afterwards.

We've brought together the best and most up-to-date research about heart attacks to see what treatments work. You can use our information to talk to your doctor and decide which treatments are best for you.

What happens when you have a heart attack?

Your heart pumps blood around your body. It carries oxygen and energy to your muscles. Your heart is made of muscle and it needs a good blood supply to keep pumping.

When you have a heart attack, one of the blood vessels that carries blood to your heart gets blocked by a blood clot. When this happens the heart doesn't get enough oxygen. This often causes severe chest pain and makes you feel breathless. If the blood supply is cut off for too long part of the heart will die.

If you've been taken to hospital after having a heart attack you will have had emergency treatment in hospital to open up the blood vessel and get the blood flowing again. This is done with medicines, and often also by an operation called an angioplasty. These treatments can limit the damage to your heart.

Doctors will then keep a close watch over you to see if you develop any other problems. These problems can include having an irregular heart beat, or problems with how well your heart pumps. If a large amount of your heart muscle has been damaged by the heart attack, your heart may not pump so well as before. This is called heart failure.

The most risky time is the few hours after the heart attack. Once you are beyond that you'll probably spend several days resting in hospital. During this time doctors will do more tests to try to find out which part of your heart has been damaged, and how much.

If all goes well you'll probably go home about a week after your heart attack.

Why did I have a heart attack?

Having a heart attack is a big shock, especially if you were in good health before it happened. You may wonder why it happened to you. Heart attacks are caused by blood clots that form in your arteries. Doctors don't know exactly why they cause problems for some people and not others.

But you're more likely to have problems if your arteries are narrow because of clumps of fat on the artery wall. Doctors call this atherosclerosis. Atherosclerosis is more common in older people. If you have atherosclerosis in the arteries leading to your heart, this is called heart disease. You might have heart disease for many years without knowing it. A heart attack might be the first sign of trouble.

Other things that increase your chance of having a heart attack include:

• being a man. Men are more likely than women to have a heart attack. But this only applies to younger men and women. After the menopause women are no less likely than men to have a heart attack.

• having high blood pressure.

• having diabetes. People with diabetes usually need to take medicines to help them avoid heart problems.

• having high cholesterol in your blood.

• being overweight.

• smoking.

• not taking regular exercise.

• having a close family member who has had a heart attack while still fairly young (under about 60 years old).

These things (doctors call them risk factors) make heart attacks more likely. But even if several of these risk factors apply to you, it doesn't mean you'll definitely have a heart attack. Some people with many risk factors will never have a heart attack, while some people will have a heart attack even though they have none of these risk factors.

What happens when you go home?

When you go home from hospital you can start gradually getting your life back to normal. If you live alone, it may help to have someone stay with you for a few weeks, to help you adjust.

You may feel anxious about what you can and can't do. The key is to take things slowly. You will gradually be able to do more without getting tired and breathless.

It's normal to feel tired, anxious, angry, or low after a stressful event like a heart attack. But if your low mood continues, talk to your doctor. Some people become depressed after a heart attack. But there are treatments that can help you.

Most people who live through a straightforward heart attack can return to their normal level of activity within six weeks, although getting back to work might take several months.

Cardiac rehabilitation programmes are available in many areas. These are programmes where you get support from specialist nurses and other specialists to help you recover. Before you leave hospital, you and your doctors should discuss how you can join a programme. If your doctors don't mention it, ask.

What will happen to me in the longer term?

How you get along after a heart attack depends on how much of your heart has been damaged. Your recovery also depends on how well you stick to your drug treatment and your plans to have a more healthy life.

Some people who have had a heart attack get chest pain (angina) and feel short of breath from time to time.

Angina happens when your heart doesn't get enough blood: for example, when you exercise or go out in the cold. It goes away with rest. Your doctor can give you medicine to help with the pain caused by angina.

Shortness of breath may mean your heart is not pumping as well as before the heart attack.

To predict how well you'll do after a heart attack doctors look at several things:

• Is your heart pumping properly?

• Where has your heart been damaged? Attacks that damage the front of your heart are more dangerous than those that affect the back or base of your heart.

• What was your blood pressure and how fast was your heart beating when you were admitted to hospital? If you had low blood pressure and your heart was beating quickly, you probably had a serious heart attack.

• How old are you? The older you are, the more likely it is that your heart attack was dangerous.

Remember that you are over the first hurdle: you survived your heart attack. Sticking to your treatments and making some healthy changes to your lifestyle gives you the best chance of a longer, healthier life.

Where to get more help

There are many charities, support groups, and other organisations that offer advice and support to people who have had a heart attack. Your doctor should be able to help you find one in your area or to help you find help online. For example, in the UK, the British Heart Foundation (http://www.bhf.org.uk) is a registered charity that provides advice and support to people with heart conditions, including people who've had a heart attack.