Your heart pumps blood, which carries oxygen to all parts of your body. Your heart, just like every other part of your body, needs oxygen to survive. Special blood vessels on the surface of your heart (coronary arteries) deliver blood to your heart muscle. When the blood supply to your heart muscle slows down or gets blocked, a portion of heart muscle dies. This is called a heart attack.
Because a heart attack damages only a small part of your heart muscle, the rest of your heart continues to work normally. If you have another heart attack, however, more heart tissue may be damaged.
Years ago people often died from heart attacks. If enough heart muscle is damaged, people can sometimes still die from a heart attack. But heart attacks don’t happen in a moment. Rather, they happen over a period of hours, if not longer. Today with advanced treatments- and immediate medical help-most people survive. Yet after a heart attack, the heart muscle is no longer as healthy as it once was. So heart attacks can lead to other heart problems such as heart failure or arrhythmias.
Other names for heart attack: coronary, coronary thrombosis, myocardial infarction (Ml).
A heart attack is usually caused by plaque buildup in your coronary arteries. Plaque is made of fatty substances, like cholesterol, in your blood. The plaque builds up slowly over time. Eventually plaque can harden and narrow the coronary arteries. Plaque can also slow or completely block blood flow to the heart. When plaque blocks the blood supply to your heart, your heart cannot get the oxygen it needs.
Atherosclerosis is the general medical term for plaque buildup that clogs arteries. Coronary artery disease (CAD) is the medical term for atherosclerosis in the coronary arteries. So atherosclerosis or CAD-whichever term you use-can cause heart attacks.
For many decades doctors thought that heart attacks-and CAD in general affected mostly men. Doctors are now realizing that heart disease is just as common in women. As a result, more clinical studies are being done to learn about how heart attacks differ in men and women.
The key to preventing a heart attack is managing your risk factors. In particular, the risk factors you can control often make a major difference in how likely you are to have a heart attack. The more risk factors you have, the greater your chances of developing CAD.
Risk factors you can change
Risk factors you cannot change
Other health conditions that can increase your risk
To learn more, go to the Risk Factors section and the Health Conditions section (to learn about diabetes and high blood pressure).
You may know that the classic symptom of a heart attack is chest pain (angina) that doesn’t go away when you rest. However, doctors have recently found that this is more likely a common symptom for men than women. Earlier studies of heart attacks focused mostly on men. Now studies are looking at heart attacks in women too. So now doctors know that the symptoms for men and women can differ. The most common symptoms for men and women-just before or during a heart attack-are as follows. Traditional symptoms (from studies done mostly on men)
Women’s symptoms (from newer studies done on women)
Researchers have found that women may notice symptoms earlier than men. Men usually have symptoms right before or during a heart attack. But women can have symptoms for weeks before the attack. Here are the most common symptoms that women notice for a month or more before a heart attack:
Some people who have heart attacks never have any symptoms. These “silent heart attacks” can do just as much damage to your heart.
But if you notice symptoms, don’t just wait to see if they go away. Get help by calling 911 right away. Once paramedics arrive, in addition to assessing your condition, they may have you chew aspirin on the way to the hospital. Quick treatment with special medications at the hospital can help avoid lasting damage to your heart.
A heart attack not only damages heart tissue. In some people, a heart attack can increase the chances of arrhythmias or sudden cardiac death (SCD). Therefore it’s essential to get proper testing and treatment if you think you are having (or may have had) a heart attack.
If you have had or are at risk of having a heart attack, your doctors may run one or more tests to help with diagnosis. The test results can also help your doctor choose the best treatment(s) for you. In some cases you may be sent to specialists for diagnosis and testing- and sometimes for treatment. To learn more, go to the Your Treatment Team section.
An angiogram is an image of your blood vessels, similar to an x-ray. An angiogram shows:
An angiogram might be ordered if your doctor suspects blockages in:
The angiogram begins with a cardiac catheterization. During a cardiac catheterization, a small, flexible tube called a catheter is inserted into a blood vessel in your groin or arm. Your doctor gently “steers” the catheter toward your blocked blood vessel. Once the catheter is in place, your doctor injects dye to begin the angiogram. The dye allows your blood vessels to show up as images on a monitor-almost like roads on a map. If the angiogram shows a blocked artery, your doctor may be able to treat it at the time with a procedure such as balloon angioplasty.
Your test will be performed in a “cath lab.” When you have an angiogram you undress and put on a hospital gown or sheet. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. The doctor makes a small incision for the catheter. The area of the incision will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. When the doctor injects the dye, you might notice a:
A chest x-ray produces an image of your heart, lungs, and nearby blood vessels. It reveals the:
An x-ray can help diagnose many different conditions, including heart diseases. And if you have a cardiac device like a pacemaker, the x-ray also shows the device and the coated wires (leads) that carry the energy to your heart.
When you have a chest x-ray you undress from the waist up and put on a hospital gown. You are partly covered by a shield-a heavy apron made of flexible lead-to protect you from any excess radiation. (X-rays use only a small amount of radiation to create the image.) You stand in front of the x-ray machine and hold your breath while the image is taken. Your doctor usually orders two views: one from the back and one from the side.
A cholesterol test is a simple blood test that measures the amount of cholesterol and other fatty substances (triglycerides) in your blood. Cholesterol and other fats can build up in your blood vessels, especially your arteries. Over time this buildup can form plaque, which can narrow and harden the arteries. Plaque in a blood vessel causes atherosclerosis, which can slow blood flow through the vessel. Over time this plaque can clog arteries:
So cholesterol test results are important in revealing if you are at risk for these health problems. The test looks at overall cholesterol levels as well as triglyceride levels. It also looks at two specific types of cholesterol:
Cholesterol is measured in milligrams per deciliter of blood, or mg/dl. The goal for each level is as follows:
However, only your doctor can tell you what level of cholesterol is “high” for you. Your doctor considers your other risk factors when making that decision. For example, if you have no family history of heart disease, an LDL level of 160 mg/dl may be high. For someone with a strong family history of heart disease, an LDL level of 130 mg/dl or lower may be high.
When you have a cholesterol test, you are usually told to fast (no food or beverages, except water) for 12 hours before your blood is drawn. The technician inserts a needle into your arm, usually at the bend inside your elbow. A sample of your blood flows into a small tube, which goes to the lab to be studied.
An echocardiogram (also called an echo) is a three-dimensional, moving image of your heart. An echo uses Doppler ultrasound technology. It is similar to the ultrasound test done on pregnant women. The echo machine emits sound waves at a frequency that people can’t hear. The waves pass over the chest and through the heart. The waves reflect or “echo” off of the heart, showing:
When you have an echocardiogram, you undress from the waist up, put on a hospital gown, and lie on an exam table. The technician spreads gel on your chest and side to help transmit the sound waves. The technician then moves a pen-like instrument (called a transducer) around on your chest or side. The transducer records the echoes of the sound waves. At the same time, a moving picture of your heart is shown on a special monitor. You may be asked to lie on your back or your side during different parts of the test. You may also be asked to hold your breath briefly so that the technician can get a good image of your heart. An echo is a painless test. You feel only light pressure on your skin as the transducer moves back and forth.
An electrocardiogram (ECG or EKG) reveals how your heart’s electrical system is working. The ECG senses and records your heartbeats, or heart rhythms. The results are printed on a strip of paper. An ECG can also help your doctor diagnose whether:
In all, there are three kinds of tests that record your heart’s electrical activity, each for a different period of time:
The peaks on an electrocardiogram (ECG) strip are called waves. Together, all the peaks and valleys give your doctor important information about how your heart is working:
When you have an electrocardiogram (ECG) you undress from the waist up, put on a hospital gown, and lie on an exam table. As many as 12 small patches called electrodes are placed on your chest, neck, arms, and legs. The electrodes, which connect to wires on the ECG machine, sense the heart’s electrical signals. The machine then traces your heart’s rhythm on a strip of graph paper.
Heart attacks can often be prevented. So part of your treatment may include living a healthier lifestyle. If you don’t get enough exercise, for example, your doctor or nurse might suggest ways you can make exercise a habit. To learn more, go to the Risk Factors section.
Your doctor may recommend cardiac rehabilitation as part of your treatment. In cardiac rehabilitation, you work with a team of healthcare experts that helps you recover. To help you learn how to avoid future heart-related problems, the team:
Other types of treatment depend on your test results. Your doctor might suggest one or more of these medications or procedures. Medications
Procedures
If you have a heart or blood vessel condition, you might want to know more about some of the medications you take. The information in this section describes some medications commonly prescribed for heart or blood vessel conditions. It also includes some tips to help you take your medications as ordered. Make sure you tell your doctor-or any new doctor who prescribes medication for you-about all the medications and supplements you take. Your doctor can then help make sure you get the most benefit from your medications. Telling your doctor this information also helps avoid harmful interactions between medications. You may also want to discuss these topics with your doctor or nurse each time you get a new medication:
In some cases, your heart needs several months to adjust to new medications. So you may not notice any improvement right away. It also may take time for your doctor to determine the correct dosage. Blood tests are sometimes necessary for people who take heart medications. The blood tests help your doctor determine the correct dosage- and therefore help avoid harmful side effects. Never stop taking your medication or change the dosage on your own because you don’t believe you need it anymore, don’t think it’s working properly, or feel fine without it. Be sure to talk to your doctor or nurse if you have:
And don’t hesitate to ask your pharmacist if you have questions about how and when to take your medications.
“ACE” is short for “angiotensin-converting enzyme.” ACE inhibitors are medications that help prevent your body from producing too much of a natural chemical called angiotensin II.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
ACE inhibitors block an enzyme that is needed to produce angiotensin II. The body uses angiotensin II to maintain proper blood pressure and fluid balance. But angiotensin II can have harmful long-term effects on your heart and blood vessels. It can cause blood vessels to narrow and can also raise blood pressure. Taking ACE inhibitors can:
You can understand the purpose of anticoagulants by looking at the root words of the term. Anti = counter or against; coagulant = thicken or clot.
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To reduce the risk of blood clots that could lead to stroke and other medical conditions
Anticoagulants are often called blood thinners, although they don’t actually thin the blood. Rather, they help prevent clots from forming in your blood.
These medications treat conditions related to atherosclerosis, or arteries blocked by plaque. Plaque buildup can lead to a blood clot.
Taking anticoagulant medications can:
Beta blockers get their name because they “block” the effects of substances like adrenaline on your body’s “beta receptors.”
All medications are approved by the Food and Drug Administration (FDA) for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
To treat high blood pressure To slow fast arrhythmias (abnormal heartbeats, or heart rhythms) To prevent angina (chest pain due to blocked blood flow to parts of the heart) To prevent long-term damage after a heart attack To treat heart failure and related conditions, such as low ejection fraction (EF)
These medications block activity of your sympathetic nervous system. The sympathetic nervous system reacts when you are stressed or when you have certain health conditions. When your system responds, your heart beats faster and with more force. Your blood pressure also goes up. Beta blockers block signals from the sympathetic nervous system. This slows your heart rate and keeps your blood vessels from narrowing. These two actions can result in: Lower heart rate Lower blood pressure Less angina (chest pain related to the heart) Fewer arrhythmias (abnormal heartbeats, or heart rhythms)
Statins are commonly called cholesterol-lowering medications.
All medications are approved by the Food and Drug Administration FDA for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
What they’re used for To lower cholesterol levels To reduce the risk of conditions related to high cholesterol:
Statin medications affect three types of fats in the blood. They work by:
Lowering the levels of LDL or low-density lipoprotein, also called bad cholesterol
Lowering triglycerides
Raising the levels of HDL or high-density lipoprotein, also called good cholesterol
Your liver makes most of your cholesterol. In people with high cholesterol, the liver forms more cholesterol than the body needs. The extra cholesterol goes into your blood. Statins block liver cells from producing too much cholesterol.
One purpose of vasodilators is to lower blood pressure. To understand how vasodilators work, imagine the same amount of water moving through a 1-inch diameter hose versus a 2-inch diameter hose. The bigger the hose, the less pressure on the walls of the hose. Medications such as vasodilators can help relax and dilate blood vessels that have become narrowed (constricted).
All medications are approved by the Food and Drug Administration FDA for a specific patient group or condition. Only your doctor knows which medications are appropriate for you.
You may have heard of other types of vasodilators. Beta blockers, which are a common heart and blood vessel medication, are one type of vasodilator. Another type is calcium channel blockers.
To treat high blood pressure
To treat/prevent angina (chest pain related to the heart) which can result from atherosclerosis (blocked blood vessels) and coronary artery disease (CAD)
Vasodilators help relax and dilate the blood vessels, so blood moves through them more easily. This helps to: Lower blood pressure Allow the heart to work with less effort Decrease the amount of angina (chest pain)
An atherectomy opens blocked blood vessels by cutting away plaque buildup. It is a procedure that uses local numbing. General anesthesia is usually not needed.
Cutting away the plaque opens the artery and allows the blood to flow more freely, which can reduce your:
An atherectomy begins with a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel. Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of an atherectomy.
Once there is a clear image of the blockage, your doctor begins the atherectomy. The doctor uses a special catheter with a tiny cutting tool on the end. The tool scrapes away the plaque on the inside of the artery. The tool is specially designed to cut only the plaque and not to damage the blood vessel in any way. Without the plaque blocking the vessel, blood may be able to flow more freely.
After the atherectomy, your doctor may use another catheter to implant a stent. A stent is a tiny mesh tube that holds your artery open. The stent may help prevent your artery from becoming blocked again.
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the atherectomy your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight. But most people have a fairly quick recovery.
A balloon angioplasty opens blocked blood vessels by pressing plaque against the artery wall. It is a procedure that uses local numbing. General anesthesia usually is not needed. This procedure opens the artery and allows blood to flow more freely, which can reduce your:
A balloon angioplasty typically begins with a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel. Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of the procedure. Once there is a clear image of the blockage, your doctor begins the angioplasty.
During angioplasty, the doctor uses a special catheter with a small balloon on the end. The doctor inflates the balloon near the blockage in your artery. The inflated balloon presses the plaque against the artery wall, allowing for better blood flow.
After the balloon angioplasty, your doctor may use another catheter to implant a stent. A stent is a tiny mesh tube that holds your artery open. The stent may help prevent your artery from becoming blocked again.
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the angioplasty your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight. But most people have a fairly quick recovery.
If you have one or more blocked coronary arteries, your heart may not be getting enough blood and oxygen. If a less invasive procedure, like a balloon angioplasty, isn’t likely to open your arteries, your doctor may recommend bypass surgery. During bypass surgery, your doctor creates new pathways to route blood around blocked vessels. A bypass is an open-heart surgery that requires general anesthesia. The full name for a bypass is a coronary artery bypass graft (or CABG, pronounced “cabbage”).
During bypass surgery your doctor takes (harvests) a piece of a healthy blood vessel- often from your chest, arm, or leg. This harvested vessel becomes the new path for blood flow around the blocked artery. Your doctor chooses the healthy vessel(s) based on the size and location of your blocked artery. Doctors usually choose from among these three options when taking vessels for bypass:
It’s okay to remove pieces of these blood vessels for bypass because other vessels take over for them. Doctors more often choose arteries, rather than veins, for grafts. Veins sewn-or “grafted”–to heart arteries sometimes clog up again. Arteries are less likely to do so.
Traditional bypass surgery begins with an incision in your breastbone (sternum). With the traditional form of bypass surgery, your doctor needs to operate on a completely still heart. So you receive medications to stop your heart. A heart-lung machine then does the job of both the heart and the lungs:
Your doctor sews (grafts) one end of the healthy blood vessel just below the blocked artery. The other end of the healthy vessel is then sewn above the blocked artery. Blood flows through the new vessel, around the blocked area. This “detour” is the bypass graft. After bypass surgery, your blood flows more freely through your coronary arteries. So bypass surgery can lower your risk of heart attack. A single bypass detours around one blocked artery. A double bypass detours around two blockages, and so on.
In addition to traditional bypass, some less invasive kinds of bypass surgery now exist. Neither of these two types of surgery uses the heart-lung machine. Your doctor can tell you whether either of these less invasive surgeries might work for you. Minimally invasive bypass surgery-this requires a smaller incision near your ribs instead of the large incision through the breastbone. Off-pump bypass surgery- a tool holds part of your heart still while the doctor operates. The rest of your heart beats as usual during this type of surgery.
Coronary bypass surgery is the most common type of vessel bypass. But blood vessels outside the heart-peripheral vessels- can also become blocked. This is called peripheral vascular disease (PVD), or peripheral artery disease. A bypass is sometimes needed to treat PVD. The blood vessels in the leg are the peripheral vessels that most often get blocked. For bypass surgery on leg arteries, the healthy vessel is either another vessel from the leg or an artificial vessel. Peripheral artery bypass requires general anesthesia. However, because it is not a heart surgery, the heart-lung machine is not needed.
Usually you are told not to eat or drink anything for a number of hours before your surgery. You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the surgery. You are then wheeled into the operating room, where you receive medication that makes you unconscious during the surgery. After surgery you may spend a few days in the intensive care unit (ICU). That’s to make sure your heart is pumping normally and your chest is healing normally. You are usually out of the hospital within a week. You may have pain at the incision site for several weeks, but medication is provided for pain. At home, recovery often takes 4-6 weeks. After your bypass surgery, your doctor may recommend cardiac rehabilitation. This involves a team of healthcare experts who work with you to help you recover. To avoid future heart-related problems, the team:
A stent is a tiny mesh tube that helps keep an artery open. Your doctor implants a stent in a newly opened artery to reduce the risk of repeat blockage or narrowing following an angioplasty procedure. Stents are often implanted in arteries supplying blood to your heart (coronary arteries) or neck (carotid arteries). A stent implant is a procedure that uses local numbing. General anesthesia is usually not needed.
There are two kinds of coronary artery stents: bare metal and drug-coated. A drug-coated stent is a bare-metal stent coated with a special medication, or drug, to help reduce the chance of the artery becoming blocked again. The drug coating is released from the stent over the period of time when a new blockage is most likely to happen.
A drug-coated stent implant may reduce your need for a second procedure (such as a coronary stent procedure or bypass surgery) to re-open the artery.
Before a stent implant, your doctor may open the blocked artery by performing an atherectomy or a balloon angioplasty. Those procedures-and the stent implant-involve a catheterization. During a catheterization, a small, flexible tube called a catheter is inserted through a blood vessel in your groin (or sometimes in your arm). Your doctor gently “steers” the catheter toward your blocked vessel. Dye put in through the catheter allows your blood vessels to show up as images on a monitor-almost like roads on a map. (This part of the procedure is called an angiogram.) The catheterization and angiogram are typically part of a stent implant. After clearing the blockage, the doctor uses a special catheter to place the stent in your newly opened artery. The stent helps:
Usually you are told not to eat or drink anything for a number of hours before the procedure. Your procedure will be performed in a “cath lab.” You lie on an exam table and an intravenous (IV) line is put into your arm. The IV delivers fluids and medications during the procedure. The medication makes you groggy, but not unconscious. The doctor makes a small incision for the catheter. The area will be numbed so you shouldn’t feel pain, but you may feel some pressure as the catheter is inserted. During the stent implant your doctor or nurse might ask you questions to make sure you are not feeling pain, for instance. You may be in the hospital overnight, and there may be tenderness at the incision site. Most people have a fairly quick recovery.
Our knowledgeable and courteous staff will help set up a consultation for you, schedule surgical procedures, discuss your insurance, and answer any questions you may have.
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