A heart attack occurs when blood cannot reach the heart due to a blocked artery. Let’s find out how it works and how to avoid it. 

A heart attack is a serious, life-threatening medical event, the main symptom of which is severe and intense pain around the chest and rib cage [1.1]. Whether or not it is caused by a pre-existing condition, a heart attack is an absolute emergency that requires immediate care by emergency medical personnel, and rapid transportation to a hospital to prevent the imminent risk of death [1.2]. 
 

Heart attack: What is it? 

From a medical point of view, a heart attack refers to myocardial infarction, which is the partial destruction of the heart muscle because of the blockage of a coronary artery, and the resulting interruption or severe reduction of blood flow to the heart [1.3].

General symptoms 

The pain is often severe and intense and usually occurs around the rib cage. It lasts few minutes and sometimes radiates behind the breastbone, and can affect the back, shoulders, left arm and jaw. The patient may also experience severe anxiety, sweating and sudden dizziness or shortness of breath. Patients should definitely call for help, especially if the crushing chest pain is accompanied by sudden and unusual breathlessness. Finally, the interruption or sudden sharp decrease in blood flow to the heart is sometimes accompanied by nausea [1.4] [2.1]

Atypical symptoms in women 

Many people think the warning signs of a heart attack are sudden, like a movie heart attack, where someone clutches his chest and falls over. A real heart attack may look and feel very different for women. Women are more likely to have nontraditional symptoms of heart attack than men. And women are also more likely to have silent heart attacks [3.1].  

Heart disease is the number one killer of women in the United States. Some of the symptoms and risk factors for heart disease and heart attack are different for women than men. Your risk may also be different from other women. But every woman can take steps to prevent heart disease by knowing her risk factors and making healthy changes.

Women are more likely than men to have a different symptom of heart attack than chest pain or discomfort. These symptoms include:

• Pain in the back, neck, jaw, or throat
• Indigestion
• Heartburn
• Nausea (feeling sick to the stomach)
• Vomiting
• Extreme fatigue (tiredness)
• Problems breathing (shortness of breath).  

Heart attack: Causes 

Healthy arteries are flexible and allow unimpeded blood flow. In contrast, in the case of a heart attack, the artery supplying the heart is blocked by, for example, a fatty plaque that has broken away from a blood vessel. This piece of plaque creates a clot and slowly or suddenly reduces the diameter of the coronary artery, thus reducing the volume of blood that can actually reach the heart [1.5]. This leads to suffocation and this suffocation first affects the parts of the body surrounding the heart, hence the initial pain that may radiate to the sternum, shoulders, or left arm.  

In this sense, myocardial infarction can be considered one of the complications of arteriosclerosis and/or atherosclerosis of the coronary arteries. These two chronic arterial diseases involve, for the first, the normal ageing of the arteries with sometimes a deposit of lipids (cholesterol) in the form of atheromatous plaques, and for the second, the progressive stiffness of the deposits associated with arteriosclerosis [2.2].

Risk factors

Apart from heart disease already diagnosed, treated, and monitored by a doctor, the identification of risk factors can help reduce or prevent damage by implementing adaptive and preventive measures. Indeed, apart from family history, age and gender, all other risk factors for heart attack can be addressed, including smoking, alcohol, diabetes, high blood pressure, high cholesterol, overweight and obesity, low physical activity, and stress by modifying your lifestyle without waiting for angina or the first signs of a narrowing artery [2.3].  

Finally, the health news related to the Coronavirus adds a final risk factor to this extensive list. Indeed, a study recently published in Nature Med [3] confirms the observations of general practitioners and cardiologists around the world over the past two years. Even a mild COVID-19 infection could significantly increase the risk of cardiovascular events, including heart attacks [5.1]. 

How to prevent a heart attack 

It is therefore possible for everyone to take a range of actions to avoid a heart attack as far as possible. These actions fall into three main categories: prevention through lifestyle changes; acquiring detailed knowledge of myocardial infarction in order to act as quickly as possible in the event of an attack; and finally, excellent follow-up of any medical treatment(s).  
 

Prevention through a suitable lifestyle 

The vast majority of risk factors are individual lifestyle choices, and these are, by definition, actionable. In order to avoid a heart attack as much as possible, a healthy and balanced diet should be adopted, and harmful substances such as tobacco and alcohol should be severely limited or completely removed [2.4]. Finally, getting back into shape and engaging in physical activity on a weekly basis, even moderately, promotes the essential maintenance of muscles and helps to combat stress [2.4]. 

Awareness of symptoms and rapid response 

Knowledge of the range of warning signs of a heart attack and responsiveness at the onset of an attack can make the difference between an ultimately minor and quickly neutralised attack, a late-onset heart attack, one requiring surgery and its consequences, or even death [1.6]. 

Attendance and quality of medical follow-up 

Regular follow-up is a positive factor in the fight against potential heart attacks. Indeed, it is a matter of giving the best possible care to our body, whatever its condition, and of following your doctor’s recommendations as closely as possible.

Heart attack: Treatment

Prognosis

It can take a while to come to terms with having a heart attack, but everyone is different. For some people, their recovery will be quick. For others, it may take longer.

Some people worry about having another heart attack, or not being able to do as much as before. Try not to think too far ahead. Many people make a full recovery. It just takes time.

You may have times when you feel well, followed by days when you feel less well. This is normal and it’s important not to be too hard on yourself [9.1].

Treatment 

Indeed, the management and prevention of a heart attack starts with the correct identification of the symptoms and calling the emergency services immediately. In order to prevent imminent death from cardiac arrest, rescue workers may need to perform cardiac massage, resuscitation, or CPR, with the potential use of a defibrillator if available. The immediate supply of oxygen and transport of patients in an ambulance might be essential to provide the maximum possible care and to monitor the patient before arrival at the hospital (perfusion, ECG).  

In the ambulance and once in the hospital, an emergency doctor will try to restore the blood flow through the blocked artery as quickly as possible (thrombolysis or angioplasty) [2.6]. The complexity of the treatment will depend on many factors inherent to the patient. The severity of the heart attack will require different tests, but the aim is always to reduce the extent of heart muscle necrosis as much as possible [8]. In some cases, the implementation of coronary bypass surgery may also be required.  

In the vast majority of cases, a heart attack involves a stay in the intensive care unit, followed by a period of convalescence, close monitoring and adjustment to medication and lifestyle.

In conclusion, a heart attack, or myocardial infarction, is a life-threatening event that constitutes an absolute medical emergency, during which every minute counts. In addition to age, sex and hereditary factors [2.7], the main risk factors include smoking, high blood pressure, alcohol, stress, diabetes, obesity [7]. The likelihood of such an episode can be greatly reduced by adopting a healthy lifestyle, remaining vigilant and alert to warning signs and following the recommendations of health professionals.  

Therefore, if you experience sudden chest, back pain, dizziness, pain in your left arm or sudden nausea or vomiting, do not hesitate at all and call the emergency services.

References:

1. https://www.cdc.gov/heartdisease/heart_attack.htm - 1, 2, 3, 4, 5, 6
2. https://www.healthline.com/health/heart-attack - 1, 2, 3, 4, 5, 6, 7
3. https://ololrmc.com/blogs/heart-attack-symptoms-in-men-vs-women - 1, 2
4. https://www.womenshealth.gov/heart-disease-and-stroke/stroke/stroke-and-women - 1, 2
5. https://www.nature.com/articles/d41586-022-00403-0 - 1
6. https://www.stroke.org.uk/effects-of-stroke/emotional-changes - 1
7. https://health.ec.europa.eu/system/files/2017-12/chp_fr_english_0.pdf
8. https://www.cdc.gov/stroke/facts.htm
9. https://www.bhf.org.uk/informationsupport/conditions/heart-attack/recovering-after-a-heart-attack - 1