I’ve worked for cardiologists Dr. Nero & Wagner for almost 2 months and I haven’t taken the time to define what a heart attack is. Here goes:
A heart attack is medically called a myocardial infarction (MI). An MI happens when there’s a lack of blood flow to a particular part of your heart because of a blockage - that lack of blood flow causes damage to that heart muscle or necrosis to that part of the heart muscle (myocardium).
What causes a heart attack? ANSWER: plaque build up.
Everyone has veins and arteries. Duh. Arteries take blood AWAY from the heart to the rest of the body and veins RETURN blood from the body back to the heart (remember A&A: arteries away from the heart!). Your arteries have three layers: the outermost tunica externa/tunica adventitia, the tunica media (or just media), and the innermost tunica intima (or just intima) as well as an internal hollow cavity called the lumen. Blood flows from the heart throughout the rest of the body through the lumen. The intima is directed related with blood flow: blood flow = happy heart = happy body!
Plaque will build up just outside the innermost layer of the arterial wall, i.e. the media. When sufficient plaque builds up in this layer, it begins to put additional pressure on the intima and the lumen. Hence, high blood pressure.
Plaque can (and will) continue to build up and this is where a few things can happen:
1. The innermost layer of the artery (the intima) will break because of the pressure, but fibrosis will quickly occur. Fibrosis = formation of connective tissue as a repair process. When the intima layer breaks, all that plaque that has been previously building up will start to fill that lumen space. BUT, the body has an incredible reparative process, which is where fibrosis comes into play. At this point, you MAY not have any symptoms and you have a 20-50% narrowing (or stenosis) in one of your coronary arteries (arteries that provide blood for the myocardium).
2. The intima will break because of the pressure and fibrosis will take a while to occur. Same as #1, but for some unknown physiological reason, your body may not recognize the torn intima as quickly as it should, so you may have a 50-95% stenosis. Again, you MAY not have symptoms at all - terrifying, I know.
3. The intima will break because of the pressure and fibrosis will not occur. AS I’m sure you can deduce by this point, the intima will fill up with plaque. That area of the torn artery will not fibrosis —> causing a blockage in blood flow to a section of heart muscle —> causing that heart attack —> potentially causing Sudden Cardiac Death (SCD).
I said earlier that there are several different combinations of the three options. Once you have plaque build-up, you could go just to #1, OR you could go #1 and then #2, OR you could go straight to #2, OR you could go straight to #3, etc. Going straight to #3 = silent MI, silent meaning that you had no symptoms prior to the heart attack.
What if you DO have symptoms? The most important symptom you’ll have is:
1. Chest pain/ discomfort/ tightness/ fullness/ “squeezing”: people will describe their pain/discomfort differently, but there are general “red flag” phrases, most commonly: “I feel like there’s an elephant/big track/ [insert heavy object here] sitting on my chest.” This symptom will last at least 10 minutes and can either refuse to go away OR the symptom can go away and return back at the same or higher intensity.
2. Jaw pain
3. Back and/or neck pain
4. Arm pain
6. Nausea and/or dizziness and/or lightheadedness and/or “indigestion”: some heart attack victims will describe a feeling of “indigestion” in their chest.
7. Shortness of breath
9. Moderate to heavy perspiration/sweating
Oftentimes, women, diabetes, or elderly people will describe little to no chest pain - instead, it might just simply be a discomfort. There are some people who won’t have any chest pain, but will have some of the other symptoms mentioned above (#2-9). Or, some people will have the silent MI - no symptoms at all.
Heart attacks are treatable medical conditions. You may have a stent put into one of your coronary arteries (a stent is a small, hollow, metallic tube that is placed in the blocked artery to reestablish blood flow) to get blood flow back to the affected part of the heart muscle. And, you’ll have to be on certain medications either lifelong or for a certain length of time.
WHICH is why there are certain things you SHOULD do to prevent a heart attack: a good diet, regular exercise, and smoking cessation. Things that can put you at higher risk for a heart attack are: age, genetics/family history, smoking, lack of exercise, overweight/obesity, poor diet, high cholesterol, diabetes, hypertension (high blood pressure). Those risk factors were listed in no particular order, but it’s really important for you to be able to control the changeable factors - everything but age and genetics. As you get older, your risk for a heart attack increases (if you’re over 65, your chances are about 5-10% ever year); having a family history of heart problems/attacks, hypertension, high cholesterol and/or diabetes is obviously something you can’t control, but you can decrease your chances of getting any of the above.
Here’s a simplified version of the ins and outs of a heart attack - hope it makes sense!