Diagnosis

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

If you're in an emergency setting for symptoms of a heart attack, you'll be asked about your symptoms and have your blood pressure, pulse and temperature checked. You'll be hooked up to a heart monitor and have tests to see if you're having a heart attack.

Tests include:

  • Electrocardiogram (ECG). This first test done to diagnose a heart attack 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 proteins slowly leak into your blood after heart damage from 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 or are having a heart attack, doctors will take immediate steps to treat your condition. You might also have 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 fluid in your lungs.
  • Echocardiogram. Sound waves directed at your heart from a wandlike device (transducer) held on your chest bounce off your heart and are processed electronically to provide video images of your heart. An echocardiogram can help identify whether an area of your heart has been damaged and isn't pumping normally.
  • Coronary catheterization (angiogram). 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. The dye makes the arteries visible on X-ray, revealing areas of blockage.
  • Exercise stress test. In the days or weeks after your heart attack, you might also have a stress test to measure how your heart and blood vessels respond to exertion. You might walk on a treadmill or pedal a stationary bike while attached to an ECG machine. Or you might receive a drug intravenously that stimulates your heart similar to the way exercise does.

    Another possibility is 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 CT or 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 tubelike 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.

Treatment

Heart attack treatment at a hospital

Each minute after a heart attack, more heart tissue deteriorates or dies. Restoring blood flow quickly helps prevent heart damage.

Medications

Medications given to treat a heart attack might include:

  • Aspirin. The 911 operator might tell you to take aspirin, or emergency medical personnel might give you aspirin immediately. 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'll survive and have less heart damage.
  • Antiplatelet agents. Emergency room doctors may give you other drugs known as platelet aggregation inhibitors to help prevent new clots and keep existing clots from getting larger.
  • 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 clots. Heparin is given intravenously or by an injection under your skin.
  • Pain relievers. You might be given a pain reliever, such as morphine.
  • Nitroglycerin. This medication, used to treat chest pain (angina), can help improve blood flow to the heart by widening (dilating) the blood vessels.
  • 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.
  • Statins. These drugs help control your blood cholesterol.

Surgical and other procedures

In addition to medications, you might have one of these procedures to treat your heart attack:

  • Coronary angioplasty and stenting. In this procedure, also known as percutaneous coronary intervention (PCI), doctors insert a long, thin tube (catheter) that's passed through an artery in your groin or wrist to a blocked artery in your heart. If you've had a heart attack, this procedure is often done immediately after a cardiac catheterization, a procedure used to find blockages.

    This catheter has a special balloon that, once in position, is briefly inflated to open a blocked coronary artery. A metal mesh stent might then be inserted into the artery to keep it open long term, restoring blood flow to the heart. Depending on your condition, you might get a stent coated with a slow-releasing medication to help keep your artery open.

  • Coronary artery bypass surgery. In some cases, doctors perform emergency bypass surgery at the time of a heart attack. If possible, however, you might 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 beyond a blocked or narrowed coronary artery, allowing blood flow to the heart to bypass the narrowed section.

    Once blood flow to your heart is restored and your condition is stable, you're likely to remain in the hospital for several days.

Cardiac rehabilitation

Most hospitals offer programs that might start while you're in the hospital and continue for weeks to a couple of 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.

It's extremely important to participate in this program. People who attend cardiac rehab after a heart attack generally live longer and are less likely to have another heart attack or complications from the heart attack. If cardiac rehab is not recommended during your hospitalization, ask your doctor about it.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

To improve your heart health, take the following steps:

  • Avoid smoke. The most important thing you can do to improve your heart's health is to not smoke. Also, avoid being around secondhand smoke. If you need to quit, ask your doctor for help.
  • Control your blood pressure and cholesterol levels. If one or both of these is high, your doctor can prescribe changes to your diet and medications. Ask your doctor how often you need to have your blood pressure and cholesterol levels monitored.
  • Get regular medical checkups.. Some of the major risk factors for heart attack — high blood cholesterol, high blood pressure and diabetes — cause no symptoms early on. Your doctor can test for these conditions and can help you manage them, if necessary.
  • Exercise. Regular exercise helps improve heart muscle function after a heart attack and helps prevent a heart attack. 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.
  • Eat a heart-healthy diet. Saturated fat, trans fats and cholesterol in your diet can narrow arteries to your heart, and too much salt can raise blood pressure. Eat a heart-healthy diet that includes lean proteins, such as fish and beans, and fruits and vegetables and whole grains.
  • Manage diabetes. 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. 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. That means up to one drink a day for women and men older than age 65, and up to two drinks a day for men age 65 and younger.

Coping and support

Having a heart attack is scary, and you might wonder how it will affect your life and whether you'll have another one.

Fear, anger, guilt and depression are all common after a heart attack. Discussing them with your doctor, a family member or a friend might help. Or consider talking to a mental health provider or joining a support group.

It's important to mention signs or symptoms of depression to your doctor. Cardiac rehabilitation programs can be effective in preventing or treating depression after a heart attack.

Sex after a heart attack

Some people worry about having sex after a heart attack, but most people can safely return to sexual activity after recovery. When you can resume sexual activity will depend on your physical comfort, psychological readiness and previous sexual activity. Ask your doctor when it's safe to have sex.

Some heart medications can affect sexual function. If you're having problems with sexual dysfunction, talk to your doctor.

Preparing for your appointment

A heart attack usually is diagnosed in an emergency setting. However, if you're concerned about your risk of heart attack, see your doctor to check your risk factors and talk about prevention. If your risk is high, you might be referred to a heart specialist (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. You might need to fast before a cholesterol test, for example.

Make a list of:

  • Your symptoms, including any that seem unrelated to coronary artery disease, and when they began
  • Key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and recent major stresses or recent life changes
  • All medications, vitamins and other supplements you take, including doses
  • Questions to ask your doctor

Take a friend or relative along, if possible, to help you remember the information you're given.

Some questions to ask your doctor about heart attack prevention include:

  • What 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?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions, as well.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

  • How severe are your symptoms?
  • Are they constant or do they come and go?
  • What, if anything, seems to improve your symptoms? If you have chest pain, does it improve with rest?
  • What, if anything, worsens your symptoms? If you have chest pain, does strenuous activity make it worse?
  • 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.

May 30, 2018
References
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