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Heart Attack

  • Cynthia M. Johnson, MA by
Publication Type:


Heart Attack

(Acute Myocardial Infarction [AMI]; Myocardial Infarction [MI]; ST-Segment-Elevation MI [STEMI]; Transmural Myocardial infarction)


A heart attack is when an area of the heart does not get enough blood flow. The area becomes damaged or dies within a short time after blood flow is stopped. If a large or vital area is affected the heart may stop. A heart attack may be:

  • STEMI—A major artery is fully blocked. This is a more serious type of heart attack
  • NSTEMI—Partial block of an artery. The block may also allow periods of some blood flow.

There are two main coronary arteries. They split off into smaller branches that spread out over the heart. A blockage on larger artery will affect more of the heart. It can cause a severe heart attack. Blockages in the smaller arteries will have a smaller effect.

Blockages may only last a short time and then allow some blood flow. Others may last longer and cause more harm.

Heart Attack.

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The coronary arteries bring blood and oxygen to the heart muscle. A heart attack happens when one or more of these arteries is blocked due to:

  • Narrowing of the coronary arteries due to one or more of following:
    • Thickening of the artery walls (common aging process)
    • A buildup of fatty plaques inside the arteries
    • A spasm of the coronary arteries
    • A blood clot that develops in the arteries
  • An embolism—a blood clot that travels to the heart from other areas of the body

Risk Factors

The risk of heart attack is greater in males and older adults. The risk is also higher in those with blood vessel disease or damage. Things that may increase risk of blood vessel disease and heart attacks are:

  • Certain health problems, such as:
  • Lifestyle habits, such as:
    • Smoking and vaping
    • Not getting enough daily activity
    • Cocaine use
    • Poor sleep
  • The use of nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
  • Stress
  • Family members with heart disease
  • Using testosterone therapy


Symptoms can differ from person to person. Common ones are:

  • Squeezing, heavy chest pain behind breastbone—usually comes on quickly especially with:
    • Exercise or exertion
    • Emotional stress
    • Cold weather
    • A large meal
  • Pain in the left shoulder, left arm, or jaw
  • Shortness of breath
  • Sweating, clammy skin
  • Nausea
  • Weakness
  • Loss of consciousness
  • Anxiety or a sense of doom or panic without a reason

Unusual symptoms of heart attack (more common in women):

  • Stomach pain
  • Back and shoulder pain
  • Confusion
  • Fainting


A heart attack is an emergency. Tests to confirm a heart attack and look for changes in the heart include:

  • ECG—shows the electrical activity of the heart. It can show if a heart attack has happened or may be happening. ECG can show if the heart attack is STEMI or NSTEMI.
  • Blood tests—can show markers in the blood. These markers appear when a heart attack occurs. They can also show how much damage was done to the heart muscle.
  • Echocardiogram—shows the size, shape, and motion of the heart.
  • Coronary angiography—Can help find blockages or damage to the arteries.

Other tests will be based on a person's specific needs. They may include:

  • Stress test—records the heart's electrical activity under physical stress. This may be done days or weeks after the heart attack.
  • Electron-beam computed tomography (EBCT)—takes pictures of the heart, coronary arteries, and surrounding area.


The first goal of treatment is to improve blood flow and get oxygen to the heart as fast as possible. Treatment includes:

  • Aspirin and other antiplatelet agents—to break up clots in the blood and improve blood flow. It works best when given within the first 6 hours after symptoms appear.
  • Oxygen therapy—to increase oxygen to the heart
  • Nitrate medicines—to quickly open blood vessels and improve blood flow to heart muscle
  • Medicine to ease pain
  • Beta-blockers and angiotensin-converting enzyme (ACE) inhibitors—to decrease the workload on the heart
  • Anti anxiety medicine


Healthy heart habits can lower the risk of a heart attack. These are:

Small daily doses of aspirin may help some people lower their risk. This should only be done with a doctor’s approval. Aspirin can have side effects like bleeding in the stomach. Aspirin may also cause problems with other medicine.


Surgery may be needed for clots that do not respond to medicine. Some blockages may also be caused by a buildup of plaque in blood vessels. Surgery can help to improve blood flow. Options are:

  • Balloon angioplasty—A wire is passed through blood vessels to the heart. A balloon is inflated to open the blocked artery. A mesh device called a stent may also be placed. It will help prop the area open.
  • Coronary artery bypass grafting (CABG)—Part of a blood vessel from another area of the body will be taken. It will be attached above and below the blocked area. This will help create blood flow around the blockage.


Cardiac rehabilitation can help after a heart attack. It will teach healthy habits to decrease the risk of another heart attack. The program will also monitor the heart as physical activity is increased. Severe heart attacks can also make the heart weaker. Rehabilitation can help to adjust to changes.

A heart attack can be a major life event. It is common for people to have depression after a heart attack. Therapy and medicine can help to manage these challenges.





  • Davidson KW, Barry MJ, et al. Aspirin use to prevent cardiovascular disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577-1584.
  • How does sleep affect your heart health? Centers for Disease Control and Prevention website. Available at: https://www.cdc.gov/bloodpressure/sleep.htm.
  • Life's essential 8. American Heart Association website. Available at:https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8.
  • ST-elevation myocardial infarction (STEMI). EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/st-elevation-myocardial-infarction-stemi.
  • What is a heart attack? American Heart Association website. Available at: https://www.heart.org/en/health-topics/heart-attack/about-heart-attacks.
  • What is a heart attack? National Heart Lung and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/heart-attack.
  • 7/17/2017 DynaMed Systematic Literature Surveillance https://www.dynamed.com/condition/acute-coronary-syndromes: Bally M, Dendukuri N, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909.


  • Mark S. Itzkowitz, MD, JD
Last Updated:

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.