Heart disease remains the leading cause of death worldwide, with heart attacks playing a major role. In the US, someone experiences a heart attack every 40 seconds, or about 805,000 heart attacks each year, with 605,000 being first-time heart attacks and 200,000 being recurrent events. 

Understanding the risks, recognizing the signs, and making proactive changes can be life-saving. Let’s look at what happens when you have a heart attack, the symptoms, and diagnostic tools. 

What is a Heart Attack?

Also known as a myocardial infarction (MI), a heart attack is when blood flow to the heart muscle becomes partially or completely blocked. This starves the heart of oxygen and nutrients, causing damage or death to the affected heart muscle cells.

This blockage is typically caused by the buildup of fatty deposits called plaque, otherwise known as atherosclerosis. Over time, and if not addressed early, this leads to a blockage and a full-blown heart attack. However, a heart attack might also occur even if someone has a calcium artery score of 0, but there’s a rupture of soft plaque. 

Types of Heart Attacks

There are a few different types of heart attacks, based on the severity or location of the blockage: 

• STEMI heart attack: This stands for ST-segment elevation myocardial infarction. It’s a severe type where one of the major coronary arteries is completely blocked, causing significant damage and requiring emergency treatment.
• NSTEMI heart attack: A non-ST-elevation myocardial infarction is a less severe (but still serious) type with a partial blockage. This causes reduced blood flow to the heart, but not the same distinctive EKG changes seen in a STEMI.
• Mini heart attack: Sometimes called a “mild” heart attack, this occurs when there’s only minor damage to the heart. It’s typically due to reduced blood flow, but not a complete blockage of a coronary artery. 
• MINOCA: A Myocardial Infarction with Non-Obstructive Coronary Arteries is caused by poor blood flow to the heart, despite no evidence of major blockage in the arteries
• Silent heart attack: Around 1 in 5 heart attacks are silent. There are no noticeable silent heart attack symptoms, meaning a person may not realize they’ve had a heart attack until it’s detected later, through diagnostic tests. 

What Is a Widowmaker Heart Attack?

More formally known as an anterior ST-segment elevation myocardial infarction (STEMI), a widowmaker is when there’s a total blockage of the left anterior descending (LAD) artery, one of the heart’s major arteries supplying oxygen-rich blood. 

It gets its name due to its severity. Unfortunately, widowmaker heart attacks are often fatal without immediate medical attention. 

Preventive habits are crucial. Testing for coronary artery calcium (CAC) scores helps clinicians detect LAD plaque buildup earlier. This helps identify individuals at a higher risk of heart attacks in general, but especially widowmakers. 

Learn more in my blog post all about widowmaker heart attacks.

Heart Attack Symptoms

While 1 in 5 heart attacks do not cause any symptoms, there are several common symptoms to look out for. Note that they’re different from symptoms of heartburn, including:

• Chest pain, tightness, or pressure
• Shortness of breath 
• Upper body pain 
• Lightheadedness or dizziness 
• Nausea, vomiting, or indigestion
• Cold sweats
• Fatigue
• Flu-like symptoms

Heart attack symptoms in women can differ significantly from men. While both may experience chest pain, women are more likely to experience nausea, shortness of breath, and back or jaw pain.

Furthermore, in women, cardiovascular disease is typically microvascular, meaning it’s in smaller arteries (for men, it’s macrovascular). This can lead to missed early indications and later diagnoses. 

How Long Does a Heart Attack Last?

Heart attacks might last from a few minutes to several hours, depending on the severity and how quickly it is treated. The symptoms may start suddenly and intensify, or they can come on gradually, feeling like worsening chest discomfort. 

What To Do If You or Someone Is Having a Heart Attack

If you or someone else is experiencing symptoms of a heart attack, call 911 immediately. Emergency medical attention is crucial. Every minute counts, as faster treatment can minimize heart muscle damage and improve outcomes.

Do not attempt to drive yourself to the hospital. Wait for emergency medical services, which can begin life-saving treatment on the way. If you have aspirin nearby, chew one (unless allergic) as it can help thin the blood while waiting for EMS.

How is a Heart Attack Diagnosed?

A few specific tests may be ordered to confirm a heart attack diagnosis or to assess your risk for having one.

Blood Tests

Blood tests are one of the first diagnostic tools to assess whether a heart attack occurred:

• Troponins: Cardiac troponin I (cTnI) and troponin T (cTnT) are proteins found in heart muscle cells released into the blood when the heart is damaged. Troponin tests are common because they’re highly sensitive and specific for detecting heart injury. Either can be used, though cTnI is more common—unless someone is on hemodialysis, in which case cTnT is used/ 
• Creatinine kinase (CK): CK is an enzyme in the heart released into the blood upon heart damage. A specific type of CK called CK-MB is primarily found in the heart muscle, so elevated CK-MB can suggest a heart attack.
• Myoglobin: Myoglobin is a protein found in the heart and skeletal muscle that may be released into the bloodstream during a heart attack. However, myoglobin can also be elevated in other muscle injuries, so this test alone isn’t enough.

Electrocardiogram (EKG) 

This medical test records electrical activity of your heart. Small adhesive electrodes are placed on your chest, arms, and legs and connected to a machine to assess your heart’s activity. It can also determine how much oxygen is flowing into your heart.

This test can diagnose a heart attack by detecting changes in the heart’s electrical patterns, which may indicate damage to the heart muscle. During a heart attack, the blood supply to the heart muscle is blocked. 

This lack of blood supply can cause damage to the affected heart muscle cells, leading to abnormal electrical activity in the heart that is visible during the EKG. An EKG can also detect an enlarged heart or abnormal heart rhythms that may increase the risk of future heart failure.

MRI

An MRI uses a magnetic field to take detailed pictures of your heart and surrounding arteries. It can detect tissue damage, reduced blood flow, swelling, and inflammation around the heart – all likely indicators of a heart attack. 

Chest X-Ray

A chest X-ray may be performed to visualize the size and condition of your heart and lungs. It’s not specific to heart attacks, but may be used to rule out other causes of chest symptoms (like pneumonia or heart failure). This doesn’t show blocked arteries.

A few warning signs that may indicate a heart attack diagnosis include an enlarged heart, pulmonary edema (excess fluid in the lungs), or a pleural effusion (fluid accumulation in the space between the lungs). 

Angiogram or Coronary CT Angiography (CCTA)

This is an X-ray of the blood vessels of your heart. A type of dye that’s visible on an X-ray machine is injected into your heart’s blood vessels, and a series of images is taken.

A CCTA is a noninvasive 3D imaging test that looks for calcified and soft plaques and other blockages or narrowing of the coronary arteries. This provides a comprehensive picture of your heart health and is used to evaluate heart attack risk or investigate symptoms like chest pain.

If a blockage is found, an angioplasty procedure may be done emergently to open up clogged arteries. It may also be used as a preventative measure if you’re considered high risk, have a positive stress test, or have heart disease and are at risk for future cardiovascular events.

CT Scan with Coronary Artery Calcium (CAC) Score

A less expensive option than a CCTA is a simple CT scan without contrast, or a tool called coronary artery calcium (CAC) scoring. This can help determine the extent of calcified plaque buildup present by measuring calcium levels. 

The CAC score can range from 0 to over 400. 400 or above indicates the highest likelihood of a heart attack or risk of a heart attack in the near future. A CT scan can also detect the heart’s structure and function, identifying any areas that may have been damaged or are at risk due to a reduced blood supply.

Heart Attacks: What To Do Now

Heart attacks are a leading cause of death, but they don’t always have to be. If you’ve had a heart attack previously or are concerned about your risk, I can help. 

First, check out my other blog post that goes into detail about heart attack risk factors, treatment, and prevention tips. 

Then, consider joining my 6-week heart optimization group program, Optimize. We’ll cover science-based, practical strategies to help you: 

• Normalize blood sugar and insulin levels⁠
• Lower LDL, apoB, and triglycerides
• Decrease inflammation, including hsCRP and oxidative stress⁠
• Improve blood vessel health and reduce heart strain⁠
• Reduce risk for heart attack, stroke, and heart failure⁠

Want to explore working together 1 on 1? Schedule a complimentary 15-minute discovery call with me here. 

Sources

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