Heart Attack - 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.
- 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 can occur in childhood, but it appears more often in middle age and among overweight people. Diabetes greatly increases your risk of a heart attack.
- High blood pressure. Over time, high blood pressure can damage arteries that feed your heart by accelerating atherosclerosis. The risk of high blood pressure increases as you age, but the main culprits for most people are eating a diet too high in salt and being overweight. High blood pressure can also be an inherited problem.
- 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 LDL level is undesirable and is often a result of a diet high in saturated fats and cholesterol. A high level of triglycerides, a type of blood fat related to your diet, also is undesirable. 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.
- Family history of heart attack. If your siblings, parents or grandparents have had heart attacks, you may be at increased risk. Your family may have a genetic condition that raises unwanted blood cholesterol levels. High blood pressure also can run in families.
- 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. Obese people have a high proportion of body fat (a body mass index of 30 or higher). Obesity raises the risk of heart disease because it's associated with high blood cholesterol levels, high blood pressure and diabetes.
- Stress. You may respond to stress in ways that can increase your risk of a heart attack. If you're under stress, you may overeat or smoke from nervous tension. Too much stress, as well as anger, can also raise your blood pressure.
- 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.
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. This decreases blood flow to tissues and organs throughout your body and may produce shortness of breath, fatigue, and swelling in your ankles and feet. Heart failure may be a temporary problem that goes away after your heart, which has been stunned by a heart attack, recovers over a few days to weeks. 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.
Perparing 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, as well as any vitamins or supplements, that you're taking.
- Take a family member or friend along, if possible. Sometimes it can be difficult to soak up all 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 is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. During a visit to your doctor to discuss heart attack prevention, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- What are other possible causes for my symptoms or condition?
- What kinds of tests will I need?
- What's the best treatment?
- 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?
- What are the alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.
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?
- Have your symptoms been continuous or occasional?
- 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.
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.
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 following 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. If your doctor also wants to see images of your heart while you're exercising, he or she may order a nuclear stress test, which is similar to an exercise stress test, but uses an injected dye and special imaging techniques.
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.
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.
Regardless of whether you've been trained, you should begin CPR with chest compressions. Press down about two inches (about five 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 compressions only.
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.
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 given aspirin by emergency medical personnel soon after they arrive or as soon as you get to the hospital. 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 following a heart attack, the greater the chance you will survive and lessen the damage to your heart.
- 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 and is usually used during the first few days 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.
- Cholesterol-lowering medications. Examples include statins, niacin, fibrates and bile acid sequestrants. These drugs 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. Usually, your doctor may suggest that you have bypass surgery after your heart has had time 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 following your heart attack, you may be hospitalized for observation.
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 cholesterol. Have your blood cholesterol levels checked regularly, through a blood test at your doctor's office. If "bad" cholesterol levels are undesirably high, your doctor can prescribe changes to your diet and medications to help lower the numbers and protect your cardiovascular health. How frequently you'll need your cholesterol checked depends on how high your cholesterol is. People who have high cholesterol may need more-frequent tests.
- 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.
- Control your blood pressure. Have your blood pressure checked every two years. Your doctor may recommend more frequent measurement if you have high blood pressure or a history of coronary artery disease.
- Exercise regularly. Regular exercise helps improve heart muscle function following 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 is part of a heart-healthy diet. It contains omega-3 fatty acids, which help improve blood cholesterol levels and prevent blood clots. Eat plenty of fruits and vegetables. Fruits and vegetables contain antioxidants — nutrients that help prevent everyday wear and tear on your coronary arteries.
- Manage 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. Men should have no more than two drinks a day, and women should have no more than one. 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.
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.
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 less "sticky" and likely to clot. Doctors recommend a daily aspirin 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, 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. Many people will need to take beta blockers for the rest of their lives following a heart attack.
- 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, prevent some of the complications of heart attacks and make a subsequent heart attack less likely.
- Cholesterol-lowering medications. A variety of medications, including statins, niacin, fibrates and bile acid sequestrants, can help lower your levels of unwanted blood cholesterol. The majority of people who've had a heart attack take cholesterol-lowering medications — drugs that help lower the risk of a subsequent heart attack. These medications can help prevent future heart attacks even if your cholesterol was not very high at the time of the heart attack.
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
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.
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.
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 three main areas — medications, lifestyle changes and emotional issues.
Sex after a heart attack
Many people worry that sex after a heart attack will be too strenuous on their hearts. However, most people can safely return to sexual activity after recovering from a heart attack. Each person has a different timeline, depending on his or her level of physical comfort, psychological readiness and previous sexual activity.
The demands that sexual intercourse place on your heart approximate those of taking a brisk walk, scrubbing a floor, or climbing one or two flights of stairs. In a way, sexual activity parallels any other physical exertion — your heart rate, breathing rate and blood pressure increase. 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, such as beta blockers, may affect sexual function. However, sexual dysfunction following a heart attack is more often due to depression or anxiety than to medications. 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.
You and your family may have a lot of questions and concerns following 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.
By Mayo Clinic Staff
Original article: http://www.huffingtonpost.com/2012/11/07/national-stress-awareness-day_n_2082186.html