Heart attack

Updated: 05-15-2013

Definition

A heart attack usually occurs when a blood clot blocks the flow of blood through a coronary artery — a blood vessel that feeds blood to a part of the heart muscle. The interrupted blood flow that occurs during a heart attack can damage or destroy a part of the heart muscle.

A heart attack, also called a myocardial infarction, can be fatal. Treatment for heart attack has improved dramatically over the years. It is crucial to promptly recognize symptoms and call 911 or emergency medical help if you think you might be having a heart attack.

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Symptoms

Common heart attack symptoms include:

  • Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back)
  • A feeling of fullness, nausea, indigestion, heartburn or abdominal pain
  • Shortness of breath
  • Sweating or a cold sweat
  • Feelings of anxiety or an impending sense of doom
  • Fatigue
  • Trouble sleeping
  • Lightheadedness or dizziness

Heart attack symptoms vary
Not all people who have heart attacks experience the same symptoms or experience them to the same degree. Many heart attacks aren't as dramatic as the ones you've seen on TV. Some people have no symptoms at all, while for others, the first sign may be sudden cardiac arrest. Still, the more signs and symptoms you have, the greater the likelihood that you may be having a heart attack. The severity of heart attack symptoms can vary too. Some people have mild pain, while others experience severe pain.

A heart attack can occur anytime — at work or play, while you're resting, or while you're in motion. Some heart attacks strike suddenly, but many people who experience a heart attack have warning signs and symptoms hours, days or weeks in advance. The earliest warning of a heart attack may be recurrent chest pain (angina) that's triggered by exertion and relieved by rest. Angina is caused by a temporary decrease in blood flow to the heart.

Many people confuse a heart attack with a condition in which your heart suddenly stops (sudden cardiac arrest). Sudden cardiac arrest occurs when an electrical disturbance in your heart disrupts its pumping action and causes blood to stop flowing to the rest of your body. A heart attack can cause cardiac arrest, but it's not the only cause of cardiac arrest.

When to see a doctor
During a heart attack, act immediately. Some people wait too long because they don't recognize the important signs and symptoms. Take these steps:

  • Call for emergency medical help. If you suspect you're having a heart attack, don't hesitate. Immediately call 911 or your local emergency number. If you don't have access to emergency medical services, have someone drive you to the nearest hospital. Drive yourself only as a last resort, if there are absolutely no other options. Driving yourself puts you and others at risk if your condition suddenly worsens.
  • Take nitroglycerin, if prescribed. If your doctor has prescribed nitroglycerin, take it as instructed while awaiting the arrival of emergency medical personnel.
  • Take aspirin, if recommended. If you're concerned about your heart attack risk, ask your doctor if chewing a 162- or 325-milligram (mg) aspirin tablet if you have heart attack symptoms is a good idea. Taking aspirin during a heart attack could reduce the damage to your heart by making your blood less likely to clot. Aspirin can interact with other medications, however, so don't take an aspirin unless your doctor or emergency medical personnel recommend it. Don't delay calling 911 to take an aspirin, though. Call for emergency help first.

What to do if you see someone having a heart attack
If you encounter someone who is unconscious from a presumed heart attack, call for emergency medical help. If you have received training in emergency procedures, begin cardiopulmonary resuscitation (CPR). This helps deliver oxygen to the body and brain.

According to guidelines by the American Heart Association, regardless of whether you've been trained, you should begin CPR with chest compressions. Press down about 2 inches (5 centimeters) on the person's chest for each compression at a rate of about 100 a minute. If you've been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions. If you haven't been trained, continue doing only compressions until help arrives.

Sudden cardiac arrest during a heart attack is commonly caused by a deadly heart rhythm in which the heart quivers uselessly (ventricular fibrillation). Without immediate treatment, ventricular fibrillation leads to death. The timely use of an automated external defibrillator (AED), which shocks the heart back into a normal rhythm, can provide emergency treatment before a person having a heart attack reaches the hospital. But, if you're alone, it's important to continue chest compressions. If there's a second person present, that person can look for a nearby AED.

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Causes

A heart attack occurs when one or more of the arteries supplying your heart with oxygen-rich blood (coronary arteries) become blocked. Over time, a coronary artery can become narrowed from the buildup of various substances, including cholesterol and other substances. This buildup — collectively known as plaques — in arteries throughout the body is called atherosclerosis. When your coronary arteries have narrowed due to atherosclerosis, the condition is known as coronary artery disease. Coronary artery disease is the underlying cause of most heart attacks.

During a heart attack, one of these plaques can rupture and spill out cholesterol and other substances into the bloodstream. A blood clot forms at the site of the rupture, partly because the body is confused and is trying to repair the injured blood vessel. If the clot is large enough, it can completely block the flow of blood through the coronary artery.

Another cause of a heart attack is a spasm of a coronary artery that shuts down blood flow to part of the heart muscle. Drugs, such as cocaine, can cause such a life-threatening spasm. A heart attack can also occur due to a tear in the heart artery (spontaneous coronary artery dissection). Other uncommon causes of heart attack include small blood clots or tumors that have traveled from other parts of the body (coronary embolism). Heart attacks can also occur if blood flow to the heart is severely decreased, in situations such as very low blood pressure (shock).

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Risk factors

Certain factors contribute to the unwanted buildup of fatty deposits (atherosclerosis) that narrows arteries throughout your body, including arteries to your heart. You can improve or eliminate many of these risk factors to reduce your chances of having a first or subsequent heart attack.

Heart attack risk factors include:

  • Age. Men who are 45 or older and women who are 55 or older are more likely to have a heart attack than are younger men and women.
  • Tobacco. Smoking and long-term exposure to secondhand smoke damage the interior walls of arteries — including arteries to your heart — allowing deposits of cholesterol and other substances to collect and slow blood flow. Smoking also increases the risk of deadly blood clots forming and causing a heart attack.
  • High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. High blood pressure that occurs with obesity, smoking, high cholesterol or diabetes increases your risk even more.
  • High blood cholesterol or triglyceride levels. Cholesterol is a major part of the deposits that can narrow arteries throughout your body, including those that supply your heart. A high level of the wrong kind of cholesterol in your blood increases your risk of a heart attack. Low-density lipoprotein (LDL) cholesterol (the "bad" cholesterol) is most likely to narrow arteries. A high level of triglycerides, another type of blood fat related to your diet, also ups your risk of heart attack. However, a high level of high-density lipoprotein (HDL) cholesterol (the "good" cholesterol), which helps the body clean up excess cholesterol, is desirable and lowers your risk of heart attack.
  • Diabetes. Diabetes is the inability of your body to adequately produce insulin or respond to insulin need properly. Insulin, a hormone secreted by your pancreas, allows your body to use glucose, which is a form of sugar from foods. Diabetes, especially uncontrolled diabetes, increases your risk of a heart attack.
  • Family history of heart attack. If your siblings, parents or grandparents have had early heart attacks (by age 55 for male relatives and by age 65 for female relatives), you may be at increased risk.
  • Lack of physical activity. An inactive lifestyle contributes to high blood cholesterol levels and obesity. People who get regular aerobic exercise have better cardiovascular fitness, which decreases their overall risk of heart attack. Exercise is also beneficial in lowering high blood pressure.
  • Obesity. Obesity raises the risk of heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes. Losing just 10 percent of your body weight can lower this risk, however.
  • Stress. You may respond to stress in ways that can increase your risk of a heart attack.
  • Illegal drug use. Using stimulant drugs, such as cocaine or amphetamines, can trigger a spasm of your coronary arteries that can cause a heart attack.
  • A history of preeclampsia. This condition causes high blood pressure during pregnancy, and increases the lifetime risk of heart disease.
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Complications

Heart attack complications are often related to the damage done to your heart during a heart attack. This damage can lead to the following conditions:

  • Abnormal heart rhythms (arrhythmias). If your heart muscle is damaged from a heart attack, electrical "short circuits" can develop, resulting in abnormal heart rhythms, some of which can be serious, even fatal.
  • Heart failure. The amount of damaged tissue in your heart may be so great that the remaining heart muscle can't do an adequate job of pumping blood out of your heart. Heart failure may be a temporary problem that goes away after your heart, which has been stunned by a heart attack, recovers. However, it can also be a chronic condition resulting from extensive and permanent damage to your heart following your heart attack.
  • Heart rupture. Areas of heart muscle weakened by a heart attack can rupture, leaving a hole in part of the heart. This rupture is often fatal.
  • Valve problems. Heart valves damaged during a heart attack may develop severe, life-threatening leakage problems.
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Preparing for your appointment

If you're having a heart attack, it will usually be diagnosed in an emergency setting, rather than at a doctor's appointment. However, if you're concerned about your risk of having a heart attack, make an appointment with your doctor to check your risk factors and talk about preventing a heart attack. Eventually, however, you may be referred to a heart specialist (cardiologist).

Because appointments can be brief, and because there's often a lot of ground to cover, it's a good idea to be prepared for your appointment. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

  • Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. For a cholesterol test, for example, you may need to fast for a period of time beforehand.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to coronary artery disease that could cause a heart attack.
  • Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements that you're taking.
  • Take a family member or friend along, if possible. Sometimes it can be difficult to remember all of the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Be prepared to discuss your diet and exercise habits. If you don't already follow a diet or exercise routine, be ready to talk to your doctor about any challenges you might face in getting started.
  • Write down questions to ask your doctor.

Your time with your doctor may be limited, so preparing a list of questions can help you make the most of your time together. During a visit to your doctor to discuss heart attack prevention, some basic questions to ask your doctor include:

  • What kinds of tests do I need to determine my current heart health?
  • What foods should I eat or avoid?
  • What's an appropriate level of physical activity?
  • How often should I be screened for heart disease? For example, how often do I need a cholesterol test?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there any brochures or other printed material that I can take home with me?
  • What websites do you recommend visiting for more information?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that may come up during your appointment.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

  • When did you first begin experiencing symptoms that might make you think you have heart disease, such as chest pain or shortness of breath?
  • Do you have these symptoms all the time or do they come and go?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms? If you have chest pain, does it improve if you rest?
  • What, if anything, appears to worsen your symptoms? If you have chest pain, does strenuous activity make it worse?
  • Do you have a family history of heart disease or heart attacks?
  • Have you been diagnosed with high blood pressure, diabetes or high cholesterol?

What you can do in the meantime
It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more physically active. These are primary lines of defense against having a heart attack.

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Tests and diagnosis

Ideally, your doctor should screen you during regular physical exams for risk factors that can lead to a heart attack.

If you're having a heart attack or suspect you're having one, your diagnosis will likely happen in an emergency setting. You'll be asked to describe your symptoms and will have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and will almost immediately start to have tests done to see if you are indeed having a heart attack.

The medical staff will listen to your heart and lung sounds with a stethoscope. You'll be asked about your health history and the history of heart disease in your family. Tests will help check if your signs and symptoms, such as chest pain, signal a heart attack or another condition. These tests include:

  • Electrocardiogram (ECG). This is the first test done to diagnose a heart attack. It's often done while you are being asked questions about your symptoms and often by the first responders from emergency medical services. This test records the electrical activity of your heart via electrodes attached to your skin. Impulses are recorded as waves displayed on a monitor or printed on paper. Because injured heart muscle doesn't conduct electrical impulses normally, the ECG may show that a heart attack has occurred or is in progress.
  • Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Emergency room doctors will take samples of your blood to test for the presence of these enzymes.

Additional tests
If you've had a heart attack or one is occurring, doctors will take immediate steps to treat your condition. You may also undergo these additional tests:

  • Chest X-ray. An X-ray image of your chest allows your doctor to check the size of your heart and its blood vessels and to look for any fluid in your lungs.
  • Echocardiogram. This test uses sound waves to produce an image of your heart. During an echocardiogram, sound waves are directed at your heart from a transducer, a wand-like device, held on your chest. The sound waves bounce off your heart and are reflected back through your chest wall and processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged by a heart attack and isn't pumping normally or at peak capacity.
  • Coronary catheterization (angiogram). This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg or groin, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage. Additionally, while the catheter is in position, your doctor may treat the blockage by performing an angioplasty, also known as coronary artery balloon dilation, balloon angioplasty and percutaneous coronary intervention. Angioplasty uses tiny balloons threaded through a blood vessel and into a coronary artery to widen the blocked area. In most cases, a mesh tube (stent) is also placed inside the artery to hold it open more widely and prevent re-narrowing in the future.
  • Exercise stress test. In the days or weeks after your heart attack, you may also undergo a stress test. Stress tests measure how your heart and blood vessels respond to exertion. You may walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you may receive a drug intravenously that stimulates your heart similar to exercise.

    Stress tests help doctors decide the best long-term treatment for you. Your doctor also may order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques to produce detailed images of your heart while you're exercising.

  • Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI). These tests can be used to diagnose heart problems, including the extent of damage from heart attacks. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.

    In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field. The magnetic field aligns atomic particles in some of your cells. When radio waves are broadcast toward these aligned particles, they produce signals that vary according to the type of tissue they are. The signals create images of your heart.

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Treatments and drugs

What to do if you see someone having a heart attack
If you encounter someone who is unconscious from a presumed heart attack, call for emergency medical help. If you have received training in emergency procedures, begin cardiopulmonary resuscitation (CPR). This helps deliver oxygen to the body and brain.

According to guidelines by the American Heart Association, regardless of whether you've been trained, you should begin CPR with chest compressions. Press down about 2 inches (5 centimeters) on the person's chest for each compression at a rate of about 100 a minute. If you've been trained in CPR, check the person's airway and deliver rescue breaths after every 30 compressions. If you haven't been trained, continue doing only compressions until help arrives.

Heart attack treatment at a hospital
If you have a heart attack, your heart attack treatment at a hospital varies depending on the situation. You may be treated with medications, undergo an invasive procedure or both — depending on the severity of your condition and the amount of damage to your heart.

Medications
With each passing minute after a heart attack, more heart tissue loses oxygen and deteriorates or dies. The main way to prevent heart damage is to restore blood flow quickly.

Medications given to treat a heart attack include:

  • Aspirin. You may be instructed to take aspirin by the 911 operator, or you may be given aspirin by emergency medical personnel soon after they arrive. Aspirin reduces blood clotting, thus helping maintain blood flow through a narrowed artery.
  • Thrombolytics. These drugs, also called clotbusters, help dissolve a blood clot that's blocking blood flow to your heart. The earlier you receive a thrombolytic drug after a heart attack, the greater the chance you will survive and lessen the damage to your heart. However, if you are close to a hospital with a cardiac catheterization laboratory, you'll usually be treated with emergency angioplasty and stenting instead of thrombolytics. Clotbuster medications are generally used when it will take too long to get to a cardiac catheterization laboratory, such as in rural communities.
  • Superaspirins. Doctors in the emergency room may give you other drugs that are somewhat similar to aspirin to help prevent new clots from forming. These include medications, such as clopidogrel (Plavix) and others, called platelet aggregation inhibitors.
  • Other blood-thinning medications. You'll likely be given other medications, such as heparin, to make your blood less "sticky" and less likely to form more dangerous clots. Heparin is given intravenously or by an injection under your skin after a heart attack.
  • Pain relievers. If your chest pain or associated pain is great, you may receive a pain reliever, such as morphine, to reduce your discomfort.
  • Nitroglycerin. This medication, used to treat chest pain (angina), temporarily opens arterial blood vessels, improving blood flow to and from your heart.
  • Beta blockers. These medications help relax your heart muscle, slow your heartbeat and decrease blood pressure, making your heart's job easier. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks.
  • ACE inhibitors. These drugs lower blood pressure and reduce stress on the heart.
  • Cholesterol-lowering medications. Drugs called statins help lower levels of unwanted blood cholesterol and may be helpful if given soon after a heart attack to improve survival.

Surgical and other procedures
In addition to medications, you may undergo one of the following procedures to treat your heart attack:

  • Coronary angioplasty and stenting. Emergency angioplasty opens blocked coronary arteries, letting blood flow more freely to your heart. Doctors insert a long, thin tube (catheter) that's passed through an artery, usually in your leg or groin, to a blocked artery in your heart. This catheter is equipped with a special balloon. Once in position, the balloon is briefly inflated to open up a blocked coronary artery. At the same time, a metal mesh stent may be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, your doctor may opt to place a stent coated with a slow-releasing medication to help keep your artery open.

    Coronary angioplasty is done at the same time as a coronary catheterization (angiogram), a procedure that doctors do first to locate narrowed arteries to the heart. When getting an angioplasty for heart attack treatment, the sooner the better to limit the damage to your heart.

  • Coronary artery bypass surgery. In some cases, doctors may perform emergency bypass surgery at the time of a heart attack. If possible, your doctor may suggest that you have bypass surgery after your heart has had time — about three to seven days — to recover from your heart attack.Bypass surgery involves sewing veins or arteries in place at a site beyond a blocked or narrowed coronary artery (bypassing the narrowed section), restoring blood flow to the heart.

Once blood flow to your heart is restored and your condition is stable after your heart attack, you may be hospitalized for observation.

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Lifestyle and home remedies

How you live your life affects the health of your heart. Taking the following steps can help you not only prevent but also recover from a heart attack:

  • Don't smoke. If you smoke, the single most important thing you can do to improve your heart's health is to stop. It's hard to stop smoking by yourself, so ask your doctor to prescribe a treatment plan to help you kick the habit.
  • Avoid secondhand smoke. Being around secondhand smoke can potentially trigger a heart attack, since many of the chemicals in cigarettes that can damage your arteries are also in secondhand smoke.
  • Check your blood pressure and cholesterol levels. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored. If these levels are undesirably high, your doctor can prescribe changes to your diet and medications to help protect your cardiovascular health.
  • Get regular medical checkups. Some of the major risk factors for heart attack — high blood cholesterol, high blood pressure and diabetes — cause no symptoms in their early stages. Your doctor can perform tests to check that you're free of these conditions. If a problem exists, you and your doctor can manage it early to prevent complications that can lead to a heart attack.
  • Exercise regularly. Regular exercise helps improve heart muscle function after a heart attack. Exercise is a major part of a cardiac rehabilitation program. Exercise helps prevent a heart attack by helping you to achieve and maintain a healthy weight and control diabetes, elevated cholesterol and high blood pressure. Exercise doesn't have to be vigorous. For example, walking 30 minutes a day, five days a week can improve your health.
  • Maintain a healthy weight. Excess weight strains your heart and can contribute to high cholesterol, high blood pressure and diabetes. Losing weight can lower your risk of heart disease.
  • Eat a heart-healthy diet. Too much saturated fat and cholesterol in your diet can narrow arteries to your heart. If you've had a heart attack, limit fat and cholesterol — and salt. A diet high in salt can raise your blood pressure. Follow your doctor's and dietitian's advice on eating a heart-healthy diet. Prepare heart-healthy meals together as a family. Fish, lean meats, beans and low-fat dairy are part of a heart-healthy diet. Eat plenty of fruits and vegetables. Fruits and vegetables contain antioxidants — nutrients that help prevent everyday wear and tear on your coronary arteries.
  • Manage diabetes. High blood sugar is damaging to your heart. Regular exercise, eating well and losing weight all help to keep blood sugar levels at more desirable levels. Many people also need medication to manage their diabetes.
  • Control stress. To reduce your risk of a heart attack, reduce stress in your day-to-day activities. Rethink workaholic habits and find healthy ways to minimize or deal with stressful events in your life.
  • If you drink alcohol, do so in moderation. You shouldn't start drinking alcohol if you already opt not to. But, in moderation, alcohol helps raise HDL levels — the "good" cholesterol — and can have a protective effect against heart attack. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger. Excessive drinking can raise your blood pressure and triglyceride levels, increasing your risk of heart attack. Drinking more than one to two alcoholic drinks a day raises blood pressure, so cut back on your drinking if necessary. One drink is equivalent to 12 ounces (355 milliliters, or mL) of beer, 4 ounces (118 mL) of wine or 1.5 ounces (44 mL) of an 80-proof liquor.
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Prevention

It's never too late to take steps to prevent a heart attack — even if you've already had one. Taking medications can reduce your risk of a subsequent heart attack and help your damaged heart function better. Lifestyle factors also play a critical role in heart attack prevention and recovery.

Medications
Doctors typically prescribe drug therapy for people who've had a heart attack or who are at high risk of having one. Medications that help the heart function more effectively or reduce heart attack risk may include:

  • Blood-thinning medications. Aspirin makes your blood platelets less "sticky" and likely to clot. Doctors recommend an aspirin dose between 81 and 325 mg daily for people who've had a heart attack unless they have had an allergic reaction to aspirin or some other serious reason not to take it. If your doctor hasn't recommended that you take a daily aspirin, check with your doctor to find out why.

    Doctors may prescribe aspirin and an anti-clotting drug, such as clopidogrel (Plavix), for people undergoing an angioplasty or stent procedure to open narrowed coronary arteries, both before and after the procedure.

    If you're already taking aspirin due to a previous heart attack or to help prevent a heart attack, be aware that taking these blood thinners and ibuprofen (Advil, Motrin IB, others) at the same time may increase the risk of gastrointestinal problems and may interfere with the heart benefits of aspirin. If you need to take a pain-relieving medication for certain conditions, such as arthritis, discuss with your doctor which pain reliever is best for you.

  • Beta blockers. These drugs lower your heart rate and blood pressure, reducing demand on your heart and helping to prevent further heart attacks. But, these medications can't be given to people with asthma, slow heart rates, low blood pressure or heart failure.
  • Angiotensin-converting enzyme (ACE) inhibitors. Doctors prescribe ACE inhibitors for most people after heart attacks, especially for those who have had a moderate to severe heart attack that has reduced the heart's pumping capacity. These drugs allow blood to flow from your heart more easily.
  • Cholesterol-lowering medications. Medications called statins can help lower your levels of unwanted blood cholesterol. Many people who've had a heart attack take cholesterol-lowering medications to help lower the risk of a subsequent heart attack.

Lifestyle changes
In addition to medications, the same lifestyle changes that can help you recover from a heart attack can also help prevent future heart attacks. These include:

  • Not smoking
  • Controlling certain conditions, such as high blood pressure, high cholesterol and diabetes
  • Staying physically active
  • Eating healthy foods
  • Maintaining a healthy weight
  • Reducing and managing stress
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Coping and support

Having a heart attack is a scary experience. Even if your doctor says you're OK, you may still be afraid. How will this affect your life? Will you be able to get back to work or resume activities you enjoy? Even more frightening — will it happen again?

Fear is just one of the many emotions you and your family must deal with. Other emotions that can be particularly difficult to cope with after a heart attack may include:

  • Anger. You may be angry and wonder: "Why did I have to have a heart attack, and why now?" It's normal to feel some resentment after a heart attack.
  • Guilt. Family members may feel scared at first and then guilty about your heart attack. Some may even feel that they're somehow responsible for doing something that gave you a heart attack.
  • Depression. Depression is common after a heart attack. You may feel that you can no longer do things you used to do — that you're not the same person you were before the heart attack. Cardiac rehabilitation programs can be effective in preventing or treating depression after a heart attack. It's important to mention signs or symptoms of depression to your doctor. You also may need to talk with a mental health professional.

These feelings are common, and openly discussing them with your doctor, a family member or a friend may help you better cope. You need to take care of yourself mentally as well as physically after a heart attack. Exercising and participating in cardiac rehabilitation sessions with other people who are recovering from a heart attack may help you work through these feelings.

Cardiac rehabilitation
The goal of emergency treatment of a heart attack is to restore blood flow and save heart tissue. The purpose of subsequent treatment is to promote healing of your heart and prevent another heart attack.

Many hospitals offer cardiac rehabilitation programs that may start while you're in the hospital and, depending on the severity of your attack, continue for weeks to months after you return home. Cardiac rehabilitation programs generally focus on four main areas — medications, lifestyle changes, emotional issues and a gradual return to your normal activities.

Sex after a heart attack
Some people worry that sex after a heart attack will be too strenuous on their hearts. The demands that sexual intercourse place on your heart parallel any other physical exertion — your heart rate, breathing rate and blood pressure increase. However, most people can safely return to sexual activity after recovering from a heart attack. Each person has a different timeline though, depending on his or her level of physical comfort, psychological readiness and previous sexual activity. Ask your doctor when it's safe to resume sexual activity. With time, you'll likely be able to resume your normal sexual patterns.

Some heart medications may affect sexual function. If you're having problems with sexual dysfunction, talk to your doctor. He or she may be able to help you pinpoint the problem and seek the appropriate treatment.

Ask questions
You and your family may have a lot of questions and concerns after your heart attack. If so, it might be helpful to talk to others who are experiencing some of the same things as you and your family. Many cardiac rehabilitation programs offer counseling services and support groups for heart attack survivors.

Surviving a heart attack doesn't mean that life as you knew it is over. On the contrary, many people can lead full, active lives after a heart attack. But it may mean making some positive changes in your daily habits, being patient as you recover and adopting a can-do attitude.

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