Your arms are tingling. You have chest pain. You feel sweaty.
These aren’t symptoms to wait out. Every year, over half a million Americans experience them. And in that moment, hesitating could be deadly.
Heart disease is the leading cause of death in the U.S., the Centers for Disease Control and Prevention reports. According to CDC statistics:
— About 702,880 people die of heart disease in the U.S. every year — that’s 1 in every 5 deaths.
— Heart disease is the leading cause of death for both men and women.
— Coronary heart disease is the most common type of heart disease, killing more than 371,506 people annually.
— Every year about 805,000 Americans have a heart attack. Of these, 605,000 are a first heart attack, and the rest occur in people who have already had a heart attack.
Whether you want to protect your own health, or are searching for answers while your loved one is at risk or in the hospital, understanding the signs, treatments and prevention methods of heart attacks can be lifesaving.
[READ How to Assess Your Heart Health]
What Is a Heart Attack?
A heart attack, also called a myocardial infarction, is a lack of oxygen supply to the heart.
The heart’s job is to pump oxygen-rich blood to the entire body. But the heart itself also needs oxygen to survive. When blood flow to the heart muscle is severely reduced or cut off completely, the heart is unable to function properly. The part that is deprived of oxygen begins to die. That is a heart attack — and according to the American Heart Association, someone in the U.S. has one about every 40 seconds.
There are a few types of heart attacks, which medical professionals diagnose through an electrocardiogram and a physical evaluation. No matter what type of heart attack it is, time is of the essence. Delaying treatment means delaying adequate oxygen supply to the heart, and the tissues and muscles in the heart start to die.
Cardiac Arrest vs. Heart Attack
Cardiac arrest is when someone’s heart stops beating effectively. You’ve probably seen it depicted in movies as a dramatic flat line on a cardiac monitor with a stagnant beep. Cardiac arrest, however, can also be when the heart continues to beat, but in ineffective patterns.
Cardiac arrest is not the same as a heart attack, but the two can be linked. A heart attack occurs when blood flow to the heart is blocked. In sudden cardiac arrest, the heart suddenly stops beating. As the AHA puts it, a heart attack is a “circulation” problem, and sudden cardiac arrest is an “electrical” problem.
Sudden cardiac arrest occurs, as the name implies, suddenly and usually without any advanced warning. It is triggered by a disruption of the electrical currents that keep the heart beating. This disruption, called an arrhythmia, stops the heart from pumping blood to the brain, lungs and other organs. The person can lose consciousness within seconds and may have little or no pulse. If the person does not receive treatment within minutes, cardiac arrest will cause death.
A heart attack increases the risk of sudden cardiac arrest, which can occur after a heart attack or during recovery. However, most heart attacks do not lead to sudden cardiac arrest.
Arrhythmia, also known as an irregular heartbeat, may be caused by:
— Cardiomyopathy, which is thickening of the heart muscle
— Damage to the areas of the heart that control the electrical currents that keep the heart pumping rhythmically
A heart in cardiac arrest can be restarted through CPR. If there is still a heart rhythm, the use of a defibrillator may also be used to shock the heart back into a normal beating rhythm.
[READ: Heart Palpitations After Eating: When to Be Concerned.]
Causes
The cause of a heart attack is generally a lack of proper blood flow. This can happen from various conditions.
Atherosclerosis
Blood flow can be blocked when the coronary arteries, which supply the heart muscle with blood, become narrowed from plaque — a buildup of fat, cholesterol and other substances. This is known as atherosclerosis, sometimes called hardening of the arteries. The plaque can constrict the artery, slowing blood flow. Sometimes, the plaque breaks, forming a blood clot. The clot can completely block the blood flow through the artery to the heart muscle.
Ischemia
When the heart muscle is oxygen-deprived, the condition is called ischemia. If that leads to damage or death of part of the heart muscle, it is called an ischemic heart attack, or a myocardial infarction.
Spasm
A coronary artery may contract or go into spasm, causing the artery to narrow and slow or stop blood flow to part of the heart. Spasms can be caused by stress due to high blood pressure, smoking or environmental factors. They can occur in both seemingly normal vessels and in those with atherosclerosis. If the spasm is severe enough, it can cause a heart attack.
Coronary artery dissection
Another possible, though very rare, cause of heart attack is spontaneous coronary artery dissection. This is when the arterial wall rips or tears, causing loss of blood flow to the heart. It’s not clear what causes this, but researchers believe it could be because of underlying artery abnormalities, hormonal changes or physical and emotional stressors.
[READ: Broken Heart Syndrome: Symptoms, Causes and Treatments]
Warning Signs
Unfortunately, atherosclerosis has no symptoms of its own. When a coronary artery afflicted with atherosclerosis narrows and blocks blood flow, other blood vessels that serve the same area of the heart can expand to compensate for the weaker artery. This network of expanded blood vessels is called collateral circulation. This mechanism protects some people from heart attacks by delivering needed blood to the heart. It also may explain why those with atherosclerosis have no advanced warning. Collateral circulation can also help after a heart attack by bringing added blood to the heart muscle to help it recover.
The most common warning sign of a weakened heart is angina. This is defined as recurring chest discomfort that typically lasts only a few minutes. Angina is not the same as a heart attack, because angina attacks don’t cause permanent damage to the heart muscle. Still, any unexplained chest discomfort, such as angina, warrants a visit to the doctor.
There are different types of angina:
— Stable angina, or angina pectoris, occurs during exercise or emotional stress, as blood pressure and heart rate increase and the heart struggles to get adequate blood flow.
— Unstable angina, or acute coronary syndrome, can occur while resting or sleeping and often is unexpected. The AHA says unstable angina can lead to a heart attack and should be treated as an emergency.
Risk Factors
General risk factors for heart attacks include:
— History of a previous heart attack or stroke
— Being male
— Being 65 or older
— Comorbid conditions, such as diabetes, high blood pressure, high cholesterol or obesity
— Your genetics
— Lifestyle factors, such as smoking, poor diet and a sedentary lifestyle
Risk factors in women
There’s growing understanding that heart disease isn’t caused by just one or two risk factors, and that’s especially true for women, says Dr. Louise Spadaro, a cardiologist at St. Francis Hospital & Heart Center in Roslyn, New York.
Spadaro says risk factors include:
— Sleep apnea: “Untreated sleep apnea leads to poor oxygenation at night, high blood pressure and increased stress on the heart.” Spadaro adds that sleep apnea is often underdiagnosed in women due to the sleepiness and insomnia being attributed to aging and menopause.
— Early menopause in women: “When a woman experiences menopause before age 45, she loses the protective effects of estrogen sooner than expected.” Estrogen protects the heart by fighting inflammation and helping keep the blood vessels healthy. “Women in early menopause should have their heart health screened and monitored closely,” she adds.
— Autoimmune diseases: “Conditions such as lupus and rheumatoid arthritis, which are more common in women, can damage blood vessels.”
— History of pregnancy complications, such as gestational diabetes or preeclampsia: “These aren’t just obstetric issues; they’re cardiovascular warning signs for the future.”
— Chronic stress and mental health: “We don’t always link emotional well-being to heart health, but we should. Stress can influence blood pressure, weight, sleep and coping behaviors like smoking or poor diet.”
Symptoms
Many people envision a heart attack as it’s often shown in movies or on TV: chest-clutching pain followed by a collapse to the floor. While that can happen, it is far from typical. Most heart attacks begin with mild pain or discomfort. Heart attack symptoms can last for hours, days or weeks. And, unlike with sudden cardiac arrest, the heart usually keeps beating during a heart attack.
The following symptoms can suggest a heart attack is happening:
— Discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
— Pain, discomfort or tingling in other parts of the body, such as one or both arms, the back, neck, jaw or stomach
— Shortness of breath, with or without chest discomfort
— A cold sweat, nausea or lightheadedness
Symptoms for women
Understanding that the early warning signs of a heart attack may differ in woman and younger adults compared with older men is critical and may be lifesaving, says Dr. Joy Gelbman, cardiologist at Weill Cornell Medicine in New York City.
While women also experience chest pain or discomfort, they are more likely to notice some of the other symptoms:
— Shortness of breath
— Nausea or vomiting
— Back or jaw pain
Women often fail to recognize these as symptoms of a heart attack, thinking they are caused by less dangerous conditions, such as acid reflux, the normal aches and pains of aging or the flu. But heart disease is the No. 1 killer of women — and men — in the U.S., so they must take these symptoms seriously.
Treatment
If you experience heart attack warning signs or symptoms, don’t wait.
Even if you aren’t sure it’s a heart attack, immediately call 911, says Dr. Keith Churchwell, the AHA volunteer president and an associate clinical professor of medicine at Yale School of Medicine in New Haven, Connecticut. Churchwell is also an adjunct associate professor of medicine at the Vanderbilt School of Medicine in Nashville.
If you call 911, emergency medical services staff can begin treatment when they arrive, up to an hour sooner than if someone gets to the hospital by car, Churchwell says.
“People who arrive at the hospital by ambulance also usually receive faster treatment,” he adds.
While in the hospital, you’ll receive treatment from the medical team, which may include:
— Medications for pain control
— Oxygen supplementation
— Medications to help reduce blood clotting
— A procedure to help restore blood flow, which varies depending on the type of heart attack and its severity. It may include a stent placement or a balloon angioplasty.
Prevention
Most heart disease, including heart attacks, is preventable by reducing health risks, Churchwell says.
Churchwell says the ‘prescription’ for ideal cardiovascular health is outlined in the American Heart Association’s Life’s Essential 8:
1. Eat better.
2. Be more active.
3. Manage weight.
4. Control cholesterol.
5. Quit tobacco.
7. Get healthy sleep.
With your clinician, work on a plan to employ these lifestyle habits.
“This will lead to living a healthier and more productive and joyful life,” Churchwell says.
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A Patient’s Guide to Heart Attacks originally appeared on usnews.com
Update 06/04/25: This story was published at an earlier date and has been updated with new information.
