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Heart Attack (Myocardial Infarction): Symptoms

A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked. If blood flow isn't restored quickly, the section of heart muscle begins to die.

PubMed Health Glossary
(Source: NIH - National Heart, Lung, and Blood Institute)

Symptoms of a Heart Attack

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic.

The symptoms of a heart attack can vary from person to person. Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one. It is important for you to know the most common symptoms of a heart attack and also remember these facts:

  • Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours.
  • People who have high blood sugar (diabetes) may have no symptoms or very mild ones.
  • The most common symptom, in both...

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What works? Research summarized

Evidence reviews

The Management of Lower Urinary Tract Symptoms in Men [Internet]

The guideline covers men (18 and over) with a clinical working diagnosis of lower urinary tract symptoms (LUTS). Options for conservative, pharmacological, surgical, and complementary or alternative treatments are considered in terms of clinical and cost effectiveness.

Identification and Management of Familial Hypercholesterolaemia (FH) [Internet]

While the NHS in England and Wales has made spectacular progress in improving the secondary prevention of cardiovascular disease, we now need to work harder to identify those who are at particularly high risk of myocardial infarction.

Type 1 Diabetes in Adults: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

Type 1 diabetes can, if poorly controlled, produce devastating problems in both the short and the long term. Good control of blood glucose levels reduces the risk of these problems arising, but can be very difficult for patients and carers to achieve. This guideline emphasises that the NHS should provide all patients with the means – and the necessary understanding – to control their diabetes, and that it should help patients integrate the disease management with their other activities and goals. It argues that every person with diabetes should be able to develop their own care plan and utilise effective treatment in a way agreeable to them. The input of various health professionals may be needed to achieve this, and should be readily available. A system of regular monitoring, so that any complications which do develop are picked up at an early stage and treated appropriately, should also be provided.

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Summaries for consumers

Early invasive versus conservative strategies for unstable angina and non‐ST elevation myocardial infarction in the stent era

Patients with prolonged or recurrent chest pain may have a condition called unstable angina or suffer a certain type of heart attack called non‐ST elevation myocardial infarction. These conditions can be managed with two main treatment strategies. Several studies have been done to determine which strategy is superior. In one strategy, the routine invasive strategy, all patients have a catheter inserted to image their coronary arteries and look for atherosclerotic narrowing. If a significant narrowing or complicated plaque is found then the artery may be dilated by means of a balloon catheter that is inserted and inflated across the narrowing. The patency of the vessel is maintained by insertion of a metallic stent. In some cases, the narrowing will not be amenable to this approach and surgery to bypass the narrowing is required. In the other conservative strategy, patients are initially treated with drugs and only those who suffer more chest pain while receiving the drugs or who demonstrate evidence of atherosclerotic narrowing as suggested by other non‐invasive tests, such as stress testing or imaging, undergo coronary angiography and revascularization if indicated.

In people who have had a heart attack because of blocked heart arteries insertion of thin metal tubes (stents) were better than using small balloons to open the arteries up again

Arteries can become clogged and narrowed with deposits of fat, cholesterol and other substances. This is called atherosclerosis and can cause heart attack. Two methods to open narrowed or clogged arteries in people who have had a recent heart attack are inserting a deflated small balloon in the artery and expand it to open the vessel (balloon angioplasty) or to insert a thin metal tube or sleeve (stent) into the artery to scaffold the artery open. This review compared these treatments and found both were equally effective at preventing death but using stents was better than balloon angioplasty because fewer arteries needed to be re‐cleared and stents prevented more heart attacks than balloon angioplasty.

Psychological interventions for coronary heart disease

Heart attacks and cardiac surgery may be frightening and traumatic, and can lead some patients to experience psychological problems. In addition, some psychological characteristics are linked to the development and progression of cardiac complaints. Psychological treatments for depression, anxiety, stress or maladaptive behaviours are sometimes offered to patients, either individually or as part of a comprehensive package of cardiac rehabilitation. This review examined studies where the effect of these psychological interventions could be distinguished from other components of rehabilitative treatment (e.g. exercise). We found evidence that psychological interventions may produce small to moderate reductions in depression and anxiety, and may also reduce cardiac mortality, but did not find evidence that they reduced the rate of heart attack or need for cardiac surgery, or total mortality.

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Terms to know

Coronary Artery
A principal artery that originates in the aorta. It supplies blood to the muscular tissue of the heart.
Diabetes (Diabetes Mellitus)
A disease in which the body does not control the amount of glucose (a type of sugar) in the blood and the kidneys make a large amount of urine. This disease occurs when the body does not make enough insulin or does not use it the way it should.
The hollow, muscular organ that maintains the circulation of the blood.
Muscles function to produce force and motion. They are primarily responsible for maintaining and changing posture, locomotion, as well as movement of internal organs, such as the contraction of the heart and the movement of food through the digestive system.
A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.

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Other terms to know: See all 5
Coronary Artery, Diabetes (Diabetes Mellitus), Heart

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