Typical symptoms of a heart attack are feelings of pressure, tightness or pain in the chest area of the body. Often these radiate into the left arm. Less commonly, the right arm or both arms are affected. There may also be discomfort in the neck, jaw or upper abdomen. Other symptoms include anxiety, sweating, nausea, vomiting, shortness of breath, pain in the abdomen or back, or cardiac arrhythmias. In some patients, however, all these symptoms are absent because they suffer a so-called “silent heart attack”. This occurs more frequently in women, diabetics, patients over 75 years of age or with kidney disease, and dementia patients. [1]

The heart is supplied with all the substances it needs to function via the so-called coronary vessels. In the event of a heart attack, one or more of these vessels suddenly closes completely. As a result, the heart muscle is suddenly no longer supplied with oxygen and part of the tissue dies. The longer the blood vessel remains closed, the greater the damage. Often the heart can then no longer pump. A heart attack always means a threat to life. [2] There are several reasons for this occlusion. In medicine, a distinction is made between 2 variants [1] of myocardial infarction:

Myocardial infarction type 1: Certain components of the blood are deposited on the blood vessels of the heart and so-called plaques are formed, which enlarge and lead to the final occlusion of the same nature. The affected part of the heart can no longer be supplied with oxygen and other nutrients. It will die if the vessel is not reopened as quickly as possible.

Myocardial infarction type 2: Even without plaque formation, parts of the heart can die. This is usually caused by diseases such as arrhythmias, high or low blood pressure, infections or major surgery.

Many people survive a heart attack today. It is particularly important that those affected are admitted to a hospital quickly. Every minute counts, because a heart attack always means danger to life! [3]

Experts attribute ¾ of all deaths to the fact that those affected downplayed their chest pain and did not call 911 in time. [2] Therefore, do not hesitate to consult a doctor, even in the case of supposedly minor complaints. Only the affected patient can assess whether or not it is an emergency.

If an occlusion of a vessel is detected in the clinic, it must be reopened as soon as possible. This should be done within the first 1 ½ hours. Then the muscle tissue can largely recover. With each elapsed minute, the risk increases that the affected person will retain permanent damage or, in the worst case, die. [2]

After doctors have examined the patient, they use a lot of clinical data to calculate an initial prognosis based on so-called risk scores, for example the GRACE score. [1] This includes the results of blood tests or measurement of heart rate. [4]

As a result, the question of whether one can survive a heart attack can only be answered on an individual basis. People with a good prognosis have a better chance of surviving a heart attack than those with a poor prognosis.

There are only individual answers to this question. It also depends on the severity of the heart attack. Basically, if you have pain in your chest or upper body, you should never wait and see a doctor or clinic as soon as possible. [5]

It is best not to delay your visit for the following or similar reasons: [5]

The following table provides information about typical and atypical signs of a heart attack: [5]

The treatment of a heart attack is always individual and can be very complex. It is therefore important that you always consult closely with your doctor. The following information can help you get an overview of the most common therapies. This makes it easier to talk to doctors or other health professionals and exchange ideas.

The type of heart attack (also called myocardial infarction or MI) determines the treatments a medical team will recommend.

A complete blockage of a coronary artery means it is a “STEMI” heart attack or an ST-elevation myocardial infarction. A partial occlusion is called an “NSTEMI” heart attack or a non-ST elevation myocardial infarction. The types of treatment are similar in some ways, but can also be very different. The aim of the therapy is to allow the congested blood to flow freely again.

Here is a list of many common surgical heart attack treatments:

• Angioplasty: A special medical tube with a deflated balloon attached to it is pushed up to the narrowing in the coronary arteries. By inflating the balloon, the constriction is removed and the plaques are pressed against the vessel wall.
• Atherectomy: A procedure similar to angioplasty, except that the catheter has a rotating shaver at its tip that cuts plaque from the artery.
• Bypass surgery: Blocked vessels are supplied with blood again by inserting a new vein to bypass the blocked area. Vessels are often taken from other parts of the body, for example from the arms or legs.
• Heart transplant: A diseased heart is replaced with a donated, healthy human heart.
• Cardiomyoplasty: An experimental procedure in which skeletal muscles are removed from a patient’s back or abdomen to help the heart function.
• Artificial heart valve surgery: Replaces a damaged or diseased heart valve with a functioning one.
• Laser angioplasty: Similar to angioplasty, except the catheter has a laser tip that opens the blocked artery.
• Minimally invasive heart surgery: Specialized centers can carry out operations for a bypass or new heart valves very gently and through the smallest possible openings in the body. On the one hand, the method aims to avoid completely opening the chest. On the other hand, a heart-lung machine should be avoided if possible.
• Radiofrequency ablation (RFA): A catheter with an electrode at the tip is passed through the veins to the heart muscle to destroy carefully selected heart muscle cells in a very small area.
• Stent Procedure: A stent is a small tube made of wire mesh that is used to open an artery during angioplasty.
• Transmyocardial revascularization (TMR): A laser is used to place holes in specific parts of the heart to allow blood to flow again.

Treatment for a heart attack involves a variety of medications. The following list provides a quick overview of the common preparations. Your doctor will recommend the best combination of heart attack medications for your situation.

• Angiotensin-converting enzymes (ACE): dilate blood vessels and reduce resistance by reducing angiotensin II levels. Allow blood to flow more easily and make the heart’s work easier and more efficient.
• Angiotensin II receptor blockers: lower blood pressure and protect the vessels
• Angiotensin receptor-neprilysin inhibitor: A combination of active ingredients that expands the blood vessels, thus preventing an increase in blood pressure and relieving the strain on the heart. It is often used when ACE inhibitors and beta blockers do not have the desired effect.
• Anticoagulants: inhibit blood clotting.
• Beta blockers: Beta receptor blockers also lower resting heart rate and blood pressure.
• Cholesterol-lowering medications: Cholesterol is a fat and occurs naturally in our body. If cholesterol levels are poor, it is deposited in the blood vessels. It may therefore be necessary to lower cholesterol levels using different types of therapy.
• Digitalis preparation: It is intended to help increase the heart’s beating power and reduce the heart’s frequency in order to relieve the strain on the heart as a whole.
• Diuretics: Promote the excretion of urine (diuresis) and are intended to help remove excess water from the body to relieve pressure on the heart.
• Dual antiplatelet therapy (DAPT): Some patients are treated with two types of antiplatelet drugs at the same time to reduce blood clotting. This is called dual antiplatelet therapy. For example, when stents have been inserted into the coronary arteries or coronary artery bypass surgery has been performed.
• Calcium channel blockers: They also lower blood pressure by blocking the penetration of calcium into muscle cells.
• Combined alpha and beta blockers: These also serve to lower blood pressure and are usually used when other medications have not sufficiently relieved the pressure on the vessels.
• Antiplatelet agents: Prevent the formation of blood clots by preventing blood platelets from sticking together. A platelet aggregation inhibitor is ASA. Almost all patients with coronary artery disease, including those who have had a heart attack, are treated with aspirin for the rest of their lives. A second type of platelet aggregation inhibitor, a so-called P2Y12 inhibitor, is usually prescribed for months or years in addition to aspirin therapy.
• Vasodilators: have a vasodilating effect

You will be prescribed the medication that is best for you based on your risk of blood clots and bleeding. The choice of type of medication and the duration of treatment will be determined in discussions with your doctor.

Heart attack patients are often asked to undergo a series of diagnostic tests and procedures. These tests are important and help your doctor determine whether you have had a heart attack, how much damage your heart has suffered, and whether and what degree of coronary artery disease (CHD) you have. CHD is often the trigger for a heart attack. The tests help the doctor determine what treatment and lifestyle changes can keep your heart healthy and prevent serious future medical events.

There are “non-invasive” and “invasive” diagnostic tests. Invasive procedures may involve inserting a tube, device, or endoscope. Non-invasive diagnostic tests provide imaging without the need to insert devices into the body. [7]

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Electrocardiogram (ECG): This is usually the first test done to diagnose a heart attack. The ECG records electrical signals from the heart. Adhesive patches (electrodes) are stuck to the patient’s chest and limbs. The signals are recorded as waves that are displayed on a monitor or printed on paper. Because an injured heart muscle does not conduct electrical impulses normally, the EKG may show that a heart attack has occurred or is in progress.

Blood tests: Certain substances slowly leak into your blood after damage to the heart from a heart attack. Doctors in the emergency room will take samples of your blood to look for these proteins or enzymes.

Optional

Chest X-ray: An X-ray of your chest allows your doctor to check the size of your heart and its blood vessels and check for fluid in your lungs.

Echocardiogram: Sound waves (ultrasound) produce images of the heart moving. This test allows your doctor to see how your heart’s chambers and valves pump blood through your heart. An echocardiogram can help detect whether an area of your heart is damaged.

Coronary catheterization (angiogram). A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter). The catheter is advanced through an artery, usually in your leg or groin, to the arteries in your heart. The dye makes the arteries visible on the X-ray and reveals areas of blockages.

Computed tomography (CT) or magnetic resonance therapy (MRI) of the heart: These tests create images of your heart and chest. CT scans of the heart use X-rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. In both tests, you lie on a table that slides into a long tube-shaped device. Both can be used to diagnose heart problems, including the extent of damage from heart attacks. [8th]

Will I recover from my heart attack?

The answer is most likely yes. The heart muscle begins to heal soon after a heart attack. It usually takes about eight weeks to heal. However, scar tissue may remain in the damaged area that cannot contract and pump as well as healthy muscle tissue. How much pumping function is impaired depends on the size and location of the scar tissue. Most heart attack survivors have coronary artery disease (CAD). They should make lifestyle changes and possibly take medications to prevent a future heart attack. [7]

Why is there often no advance warning?

Patients with incipient or progressive atherosclerosis (hardening of the blood vessels) often have few or no symptoms. When a coronary artery narrows and restricts blood flow, other nearby blood vessels that supply the heart sometimes dilate to compensate. This may explain why there are no warning signs. Such a network of dilated nearby blood vessels is called a collateral circulation and helps the body further delay a heart attack. However, collateral circulation can also develop after a heart attack to help the heart muscle recover.

Is my heart permanently damaged?

The extent of damage to the heart muscle depends on the size of the area served by the blocked artery and the time between blockage and treatment. Heart muscle damaged by a heart attack heals by forming scar tissue. This can take several weeks. This time also depends on how large the affected area is and how well the body can heal itself. Basically, the heart is a very robust organ. Even if part of it is seriously injured, the rest of the heart continues to work. But because of the damage, your heart may be weakened and unable to pump as much blood as before. With proper treatment and lifestyle changes after a heart attack, further damage can be limited or prevented. [7]

What treatments will I need?

Treatments for heart attack patients include medication, lifestyle changes, and in some cases, surgery. Your doctor may also perform some diagnostic tests to determine how much damage has been done to your heart and, if applicable, what degree of coronary artery disease you have.

How long should I rest after my heart attack?

Rest is important after a heart attack. But it’s just as important to participate in recreational activities and social events and to start making physical activity a part of daily life. In many cases, doctors recommend that those affected do more physical activity than before the heart attack. Good sleep is particularly important for heart attack patients. And if you feel tired during the day, take a nap or a short break. Heart patients should rest before they become too tired.

When can I go back to work?

Most heart attack patients can return to work within two weeks to three months, depending on the severity of the attack. Your doctor will decide when you can return to work and whether your current job is suitable for a person who has had a heart attack.

Is it normal to feel so depressed?

Heart attack patients report a wide range of emotions, typically for about two to six months after the event. Depression is completely normal, as is anxiety and anger. For example, every time they feel a small pain, many are afraid that it will happen again. Fear that you will die. This is normal and will pass with time. Some are angry that this happened and feel irritable and have a “short fuse.” Resentment is normal after a heart attack. Try to understand that your family and friends are just as worried as you are. Although depression after a heart attack is normal, you should talk to your doctor and those close to you about your feelings. Especially if sleep or self-esteem is affected or if you have suicidal thoughts. Don’t be afraid to ask for help. With a trusted support team of medical professionals, family and friends, recovery is much quicker.

How will my family feel?

Your heart attack has likely had a major emotional impact on your family. Your loved ones may feel scared, angry, resentful, or even guilty. Teenagers are particularly sensitive and may think that something they did caused your heart attack. It is better for everyone to express their feelings openly. Don’t let the feelings fester – this can be destructive. If you think counseling would help your family better cope with your heart attack, ask your doctor for help. He can refer you to the appropriate authorities.

Is chest pain normal after a heart attack?

If you have had a heart attack once, your risk of having another one is increased. A relatively typical pain in coronary artery disease (CHD), which is often the cause of a heart attack, is a slight pain or pressure in the chest that quickly disappears. It typically occurs during or immediately after physical exertion, intense emotions, or a heavy meal. Any other type of chest pain should be discussed with your doctor. There are exercises and medications that can help reduce or prevent the pain. If you don’t know whether your chest pain is a symptom of CHD or a heart attack, call emergency medical attention.

Why is cardiac rehabilitation important?

One of the best things you can do for yourself is to participate in a cardiac rehabilitation program. Here you will learn everything you need to get and stay healthy. Rehabilitation programs are medically supervised to help you improve your health, such as: B. through exercise training, training and advice on reducing stress. These programs often take place in a hospital with a rehabilitation team or with the help of your doctor, nurse, nutritionist, or other medical professional.

Why are lifestyle changes important?

Lifestyle changes are one of the most important things patients can do to prevent another heart attack, heart disease or stroke. Stop smoking, exercise appropriately and eat well.

What about sex after a heart attack?

Most people can resume normal sexual behavior within a few weeks of recovering from a heart attack. Talk to your doctor to decide what is safe for you. [9]

In 2019, more women died from ischemic heart disease than from breast cancer (52,550 vs. 18,519), and 18,361 more succumbed to acute or recurrent myocardial infarction. [10]
Symptoms that occurred 1 month before myocardial infarction in women, according to one study: 1. fatigue, 2. sleep disturbances, 3. shortness of breath. Only about 30% reported upper body discomfort. [11]
Typical complaints in the early stages of heart disease in women are [12]:

• Shortness of breath
• Fatigue
• Physical weakness
• Sleep disturbances
• Complaints in the upper abdomen

In contrast to men, women often only report other symptoms when asked, such as a feeling of pressure or tightness in the chest after physical exertion, in stressful situations, in cold weather or after sumptuous meals. In addition, these symptoms occur only in about 40-60% of women before an infarction. [12]

These 9 key factors can help you lower your risk for heart attack and stroke if you’ve never had one. And they can help you work with your health care team (doctors, nurses, pharmacists, dietitians, and other professionals) to create an effective prevention plan.

1. Determine your risk
If you are between 40 and 75 years old and have never had a heart attack or stroke, you can use tests to estimate your risk for a cardiovascular event in the next 10 years. These are offered free on the Internet at various sites. Certain factors can increase your risk, such as smoking, kidney disease or a family history of heart disease. Knowing your risk factors can help you and your medical team choose the best treatment plan for you. Many risk factors can be improved with lifestyle changes.

2. Eat a healthy diet
Focus your diet on vegetables, fruits, whole grains, legumes, nuts, plant proteins, lean animal proteins and fish. Avoid highly processed products, sweetened beverages, too much sodium or saturated fat or so-called trans fats. Pay attention to nutritional information on packaged foods.

3. Be physically active
Move more! This is one of the best ways to stay healthy and fit, as well as prevent disease. Adults should exercise at least 150 minutes a week at moderate intensity or 75 minutes at vigorous intensity. If you are already active, you can increase your intensity to get even more benefits. If you are not active now, simply start by sitting less and moving more.

4. Watch your weight
Stay at a weight that is healthy for you. You can check this by looking at your body mass index (BMI). There are many calculators for this on the Internet. Try to reduce your weight if you are overweight. Start by eating fewer calories and exercising more. If you need help, talk to your medical team about a weight loss plan.

5. Live a smoke-free life
If you don’t smoke, vaporize or use tobacco products, never start. There is no such thing as a safe tobacco product. If you find it challenging to quit smoking or using tobacco, ask your team for help to kick the habit using proven methods. Don’t just swap one source of tobacco for another. And try to avoid secondhand smoke, too.

6. Treat your diseases
If you have conditions that put you at increased risk, it is very important that you work with your healthcare team to make lifestyle changes. These diseases include high blood pressure (hypertension), high cholesterol, high blood sugar or diabetes. Many diseases can be prevented or managed by eating better, exercising more, losing weight and quitting tobacco.

7. Take your medicine
If you have a medical condition, your doctor may prescribe statins or other medicines to help control cholesterol, blood sugar and blood pressure. Take all medicines as prescribed. However, do not take ASA as a preventive unless your doctor advises you to do so. If you have never had a heart attack or stroke, a daily ASA may not help you at all and could cause problems, including the risk of bleeding. If you have already had a heart attack or stroke, your doctor may want you to take a low dose of ASA to reduce your risk for another one.

8. Be a team player

Your health care team can help you lower your risk for heart disease or stroke so you can live a longer, healthier life. Work together on your prevention plan. Ask questions and talk openly about any challenges you may face as you try to make healthy changes. Stress, sleep, mental health, family situations, tobacco use, food access, social support and other issues can affect your health and well-being.

9. Live well today for a healthier tomorrow
A healthy lifestyle is the best way to delay or prevent many heart and brain diseases. This means being active and fit, eating a healthy diet, avoiding tobacco, and treating conditions that can increase your risk. Take charge of your health. Get tips, tools and inspiration to make changes and create healthy habits that you can maintain throughout your life.

This is a difficult question that many people – and their doctors – ask themselves every year. After all, chest pain can be caused by other conditions besides a heart attack. For example, chest pain also occurs with problems with the pancreas, the lungs, or even with panic attacks. [5]

Panic attacks occur when stress hormones trigger the body’s “fight-or-flight” response, often leading to palpitations, chest pain, and shortness of breath. In most heart attacks, the occlusion of a coronary artery results in the same symptoms.

One of the main differences between the two is that a heart attack often occurs during physical exertion, while a panic attack often manifests during periods of rest. When the workload on the heart increases, such as when shoveling snow or walking up stairs especially in people who do not routinely exert themselves physically, a heart attack is more likely to occur.

Another difference is duration: panic attacks usually subside gradually and many are over after 20 minutes. A heart attack, on the other hand, often lasts much longer and can worsen over time.

If in doubt, always seek medical attention immediately. It is important not to minimize symptoms, as the situation can escalate quickly. Never hesitate to call 911.

If it is determined that the symptoms are a panic attack, a number of treatment options are available. These include integrated therapies that focus on stress management and relaxation techniques, such as meditation, acupuncture, yoga and tai chi.

Cardisiography can also have a calming effect because it helps to take cardiac precautions. We describe this method in detail here.

This table compares the different symptoms of heart attacks and panic attacks: [14]

Information about typical and atypical signs of a heart attack can be found in the following table: [5].