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A heart attack is a disease of the heart in which the blood vessels supplying the muscle of the heart become blocked with plaque and blood clots, causing heart muscle to die. It turns the heart muscle into non-beating fibrous tissue which weakens the heart and can cause rupture of the heart or a heart arrhythmia. Failure of the heart to pump blood efficiently is one of the problems of having a heart attack.

The cause of a heart attack is a blockage by a blood clot in one of several coronary arteries. The coronary arteries can be clear before the blood clot but are usually already blocked partially with plaque in the coronary arteries. Plaque is made from cholesterol and calcium and builds up over time, especially in persons with risk factors for plaque buildup such as diabetes, smoking history or high cholesterol. A heart attack can also result from spasm of otherwise normal coronary articles. Such spasm can occur out of the blue and can cause a heart attack because blood can't flow through the spasmed coronary arteries. A heart attack can also occur if a blood clot travels from another body area to a vessel supplying the heart muscle (a coronary artery). Emotional or physical stress can trigger a heart attack in an otherwise healthy individual.

Risk factors for heart disease include increasing age. Being older than sixty five can trigger a heart attack. Being male makes you at higher risk for heart attack and having diabetes, a family history of heart disease, a smoking history, high blood pressure or a fatty diet puts you at higher risk. Elevated cholesterol contributes to heart disease, as does chronic kidney disease.

Symptoms of heart disease include chest pain located in the center or left-hand side of the chest. The pain may radiate to the left shoulder, the arms, the neck, the jaw, the abdomen or to the back. The pain can feel like a case of indigestion or a tight band around the chest. It can feel heavy, as though someone is sitting on your chest and it can feel as though something is squeezing the chest itself. The pain is usually not fleeting and lasts for at least twenty minutes. It is unrelieved by rest or nitroglycerin. Other symptoms of a heart attack include having a cough, anxiety, passing out, feeling dizzy or light-headedness, nausea, vomiting, irregular heartbeat, sweating or shortness of breath.

Tests for heart disease or a heart attack include doing an electrocardiogram or ECG/EKG. This can show abnormalities consistent with a heart attack. A Doppler echocardiogram can show an area of lack of movement of the heart. Blood tests can show an elevated CPK and LDH consistent with muscle loss within the heart. These tests are done serially as just one test might not show an elevation in these enzymes right away and it may take several hours or a day or so before these enzymes are elevated. They are released when the heart muscle dies and releases enzymes into the bloodstream. A troponin level is a newer test of the functioning of the heart muscle. The doctor may also note an irregular heart beat consistent with damage to the electrical parts of the heart and the pulse may be too fast or too slow.

Other tests for a heart attack include a coronary angiography, which can tell exactly where there are blockages of the heart vessels. A CT scan or MRI of the heart can show plaques in the coronary arteries and blockages if done specifically for that purpose.

The treatment of a heart attack includes rest on the heart and a stay in the hospital on a cardiac monitor. Arrhythmias are treated with anti-arrhythmic medications so the heart doesn't go into a bad rhythm. Oxygen is given to give as much of the lifesaving substance to the heart muscle. IV fluids are given and sometimes Lasix is given in order to draw fluid off the body to put less stress on the heart.

In some cases, an angioplasty is performed which involves putting a catheter into the groin and passing it up into the heart vessels. The blocked vessels are popped open with the catheter and a stent is placed to keep the blood vessel open. It needs to be done within twelve hours of a heart attack, preferably as soon as possible.

Clot busting drugs are used to dissolve the clot when given within three hours of a heart attack. It can't be used in people who have a bleeding site in their brain or have malformations in the brain that bleed. A stroke is a contraindication to having clot busting drugs and you can't have had a head injury within three months of having a heart attack.

Anti-platelet drugs are used to keep the blood thin, such as aspirin and Plavix. Beta blockers slow the heart and keep the stress off the heart. ACE inhibitors are used to prevent failure of the heart and lipid lowering drugs are used to keep the cholesterol at a normal level.

In severe cases, bypass surgery is used. This uses a vein or an artificial vein to bypass the blockage in the heart. It is often used to prevent further heart attacks and can't often be done to treat an existing heart attack.

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