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Heart attack

A heart attack is a serious medical emergency in which the supply of blood to the heart is suddenly blocked, usually by a blood clot.

A heart attack is a serious medical emergency in which the supply of blood to the heart is suddenly blocked, usually by a blood clot. Lack of blood to the heart can seriously damage the heart muscle.

A heart attack is known medically as a myocardial infarction or MI.

Symptoms can include:

  • chest pain  the chest can feel like it is being pressed or squeezed by a heavy object, and pain can radiate from the chest to the jaw, neck, arms and back
  • shortness of breath
  • feeling weak and/or lightheaded
  • overwhelming feeling of anxiety

It is important to stress that not everyone experiences severe chest pain; the pain can often be mild and mistaken for indigestion.

It is the combination of symptoms that is important in determining whether a person is having a heart attack, and not the severity of chest pain.

Read more about the symptoms of a heart attack.

Treating heart attacks

A heart attack is a medical emergency. Dial 999 and ask for an ambulance if you think you or someone you know is having a heart attack.

If the casualty is not allergic to aspirin and it’s easily available, give them a tablet (ideally 300mg) to slowly chew and then swallow while waiting for the ambulance to arrive.

The aspirin will help to thin the blood and reduce the risk of a heart attack.

Treatment for a heart attack will depend on how serious it is. Two main treatments are:

  • using medication to dissolve blood clots
  • surgery to help restore blood to the heart

Read more about treating heart attacks.

What causes a heart attack?

Coronary heart disease (CHD) is the leading cause of heart attacks. CHD is a condition in which coronary arteries (the major blood vessels that supply blood to the heart) get clogged up with deposits of cholesterol. These deposits are called plaques.

Before a heart attack, one of the plaques ruptures (bursts), causing a blood clot to develop at the site of the rupture. The clot may then block the supply of blood running through the coronary artery, triggering a heart attack.

Your risk of developing CHD is increased by:

Read more about the causes of heart attacks.

Recovery

The time it takes to recover from a heart attack will depend on the amount of damage to the heart muscle. Some people are well enough to return to work after two weeks. Other people may take several months to recover. The recovery process aims to:

  • reduce your risk of another heart attack through a combination of lifestyle changes, such as eating a healthy diet, and medications, such as statins (which help lower blood cholesterol levels)
  • gradually restore your physical fitness so you can resume normal activities (known as cardiac rehabilitation)

Most people can return to work after having a heart attack, but how quickly will depend on your health, the state of your heart and the type of work you do.

Read more about recovering from a heart attack.

Who is affected

Heart attacks are one of the most common reasons why a person requires emergency medical treatment.

Men are more likely to have a heart attack than women. The British Heart Foundation estimates that around 50,000 men and 32,000 women have a heart attack each year in England.

Most heart attacks occur in people aged over 45.

Complications

Complications of heart attacks can be serious and possibly life-threatening. These include:

  • arrhythmia – this is an abnormal heartbeat, where the heart begins beating faster and faster, then stops beating (cardiac arrest)
  • cardiogenic shock – where the heart's muscles are severely damaged and can no longer contract properly to supply enough blood to maintain many body functions
  • heart rupture – where the heart’s muscles, walls or valves split apart (rupture)

These complications can occur quickly after a heart attack and are a leading cause of death.

Many people will die suddenly from a complication of a heart attack before reaching hospital.

Read more about the complications of a heart attack.

Outlook

The outlook for people who have had a heart attack can be highly variable, depending on:

  • their age – the older you are, the more likely you are to experience serious complications
  • the severity of the heart attack – specifically, how much of the heart's muscle has been damaged during the attack
  • how long it took before a person received treatment – the longer the delay, the worse the outlook tends to be

In general, around one third of people who have a heart attack die as a result. These deaths often occur before a person reaches hospital or, alternatively, within the first 28 days after the heart attack.

If a person survives for 28 days after having a heart attack, their outlook improves dramatically and most people will go on to live for many years.



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Heart attack

Heart attacks are caused by the blood supply to the heart being suddenly interrupted.

Heart attacks are caused by the blood supply to the heart being suddenly interrupted.

Like all other tissues and organs in the body, the heart needs a constant supply of oxygen-rich blood. Without this supply, heart muscles may be damaged and begin to die.

If this is not treated, heart muscles will experience irreversible damage. If a large portion of the heart is damaged in this way, the heart will stop beating (known as a cardiac arrest), resulting in death.

Coronary heart disease (CHD)

Coronary heart disease (CHD) is the leading cause of heart attacks. CHD is a condition in which the coronary arteries (the major blood vessels that supply the heart with blood) get clogged up with deposits of cholesterol. These deposits are called plaques.

During a heart attack, one of the plaques ruptures (bursts), causing a blood clot to develop at the site of the rupture. The clot may then block the blood supply running through the coronary arteries to the heart, triggering a heart attack.

Who's at risk

Risk factors for CHD, many of which are related to each other, are outlined below.

Smoking

Carbon monoxide (from the smoke) and nicotine both put a strain on the heart by making it work faster. They also increase your risk of blood clots.

Other chemicals in cigarette smoke damage the lining of your coronary arteries, leading to furring of the arteries. If you smoke, you increase your risk of developing heart disease by 24%.

Diet

If you eat a diet high in saturated fat, your blood cholesterol levels will rise. This leads to an increase in your risk of CHD and heart attacks. Read more about high cholesterol.

Some foods, such as oily fish, can help lower cholesterol levels. Read our page on preventing a heart attack for more information about how diet can influence your heart attack risk.

High blood pressure

Having poorly controlled high blood pressure (hypertension) can weaken the coronary arteries, making them more vulnerable to CHD. The higher your blood pressure, the greater your risk of CHD and heart attacks.

Diabetes

The increased levels of blood glucose associated with type 1 diabetes and type 2 diabetes can damage the coronary arteries, making them more vulnerable to CHD.

It is estimated that people with diabetes are two to five times more likely to develop CHD than the general population.

Being overweight or obese

Being overweight or obese does not directly increase your risk of CHD and heart attacks, but leads to related risk factors that do. In particular, people who are overweight or obese:

  • have an increased risk of developing high blood pressure
  • tend to have higher levels of cholesterol as a result of eating a high-fat diet
  • have an increased risk of developing type 2 diabetes

Lack of exercise

Lack of exercise is not directly related to an increased risk of CHD and heart attacks. However, it is linked to an increased risk of being overweight or obese and having high blood pressure.

Alcohol

Excessive alcohol consumption can cause high blood pressure and increased blood cholesterol levels, thereby increasing the risk of developing CHD.

Most heavy drinkers tend to have unhealthy lifestyles, such as smoking, eating a high-fat diet and not exercising enough. Read more information about managing your alcohol intake.

Age and sex

The older you get, the more likely you are to develop some degree of CHD.

Men are two to three times more likely to have a heart attack than women.

A number of theories have been suggested to explain this increased risk, such as:

  • higher rates of excessive alcohol consumption in men
  • more men are overweight than women (although obesity levels are roughly the same for both sexes)
  • men may be less effective at coping with stress than women, and increased stress levels may affect their physical wellbeing
  • women may be protected by hormones before the menopause

Family history

If you have a first-degree relative (a parent, brother or sister) with a history of heart disease – such as angina, heart attack or stroke – you are twice as likely to develop similar problems, compared to the general population.

Ethnicity

Rates of high blood pressure and diabetes are higher in people of African and African-Caribbean descent, which means that they also have an increased risk of CHD and heart attacks.

People of South Asian descent (those of Sri Lankan, Indian, Bangladeshi and Pakistani origin) are five times more likely to develop diabetes than the general population. Again, this increases their risk of CHD and heart attacks.

Read more information about health issues for black people and South Asian health.

Air pollution

Research has found that exposure to air pollution – specifically traffic pollution – can cause a significant rise in your chance of developing CHD and, in turn, heart attacks.

Research carried out in 2011 estimated that air pollution could play a part in as many as 1 in 13 cases of heart attacks.

Less common causes

Some less common causes are described below.

Drug misuse

Stimulants such as cocaine, amphetamines (speed) and methamphetamines (crystal meth) can cause coronary arteries to narrow, restricting blood supply and triggering a heart attack. Heart attacks from the use of cocaine are one of the most common causes of sudden death in young people.

Lack of oxygen in the blood (hypoxia)

If levels of oxygen in the blood decrease due to carbon monoxide poisoning or a loss of normal lung function, the heart will receive un-oxygenated blood. This will result in the heart muscles being damaged, triggering a heart attack.

Aneurysm

An aneurysm is a weakness in a blood vessel wall. If the blood vessel wall becomes weakened beyond a certain point, it will no longer be able to withstand the pressure of blood running through it and will rupture (burst).

Sometimes, an aneurysm can develop inside the coronary arteries, although this is much less common than other types of aneurysm. If a coronary artery aneurysm ruptures, the blood supply to the heart will stop, triggering a heart attack.


Angina
Angina is chest pain caused by a reduced flow of blood to the heart, typically resulting from heart disease.
Artery
Arteries are blood vessels that carry blood from the heart to the rest of the body.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Cholesterol
Cholesterol is a fatty substance made by the body found in blood and tissue. It is used to make bile acid, hormones and vitamin D.
Heart
The heart is a muscular organ that pumps blood around the body.
Heart attack,
A heart attack happens when there is a blockage in one of the arteries in the heart.
Heart bypass
A heart (coronary) bypass is surgery to redirect the flow of blood around a clogged artery, by creating a new pathway for blood to travel in.
High blood pressure
Hypertension is when the pressure of the blood in your bloodstream is regularly above 140/90 mmHG.
Obese
Obesity is when a person has an abnormally high amount of body fat.
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Heart attack

If a heart attack is suspected, you should be admitted to hospital immediately. You will usually be admitted to an acute cardiac care unit (ACCU) so the diagnosis can be confirmed and treatment begin.

If a heart attack is suspected, you should be admitted to hospital immediately. You will usually be admitted to an acute cardiac care unit (ACCU), or directly to the cardiac catheterisation unit, to confirm the diagnosis and begin treatment.

Electrocardiography

An electrocardiogram (ECG) is an important test in suspected heart attacks. It should be carried out within 10 minutes of being admitted to hospital.

An ECG measures the electrical activity of your heart. Every time your heart beats, it produces tiny electrical signals. An ECG machine records these signals onto paper, allowing your doctor to see how well your heart is functioning.

An ECG is painless and takes about five minutes to perform. During the test, electrodes (flat metal discs) are attached to your arms, legs and chest. Wires from the electrodes are connected to the ECG machine, which records the electrical impulses.

An ECG is so important because:

  • it helps confirm the diagnosis of a heart attack
  • it helps determine what type of heart attack you have had, which will help determine the most effective treatment

Types of heart attack

Heart attacks can be classified by a measurement known as the ST segment. The ST segment is an electrical measurement recorded by an ECG. It corresponds to the level of damage inflicted on the heart.

The higher the ST segment, the greater the likely damage.

Acute coronary syndrome

A heart attack is a form of acute coronary syndrome (ACS), where there is a significant blockage in the coronary arteries.

There are three main types of ACS:

  • ST segment elevation myocardial infarction (STEMI)
  • non-ST segment elevation myocardial infarction (NSTEMI)
  • unstable angina

The three types are described in more detail below.

ST segment elevation myocardial infarction (STEMI)

A STEMI is the most serious type of heart attack, where there is a long interruption to the blood supply. This is caused by a total blockage of the coronary artery, which can cause extensive damage to a large area of the heart.

A STEMI is what most people think of when they hear the term "heart attack".

Non-ST segment elevation myocardial infarction (NSTEMI)

An NSTEMI can be less serious than a STEMI. This is because the supply of blood to the heart is only partially, rather than completely, blocked.

As a result, a smaller section of the heart is damaged. However, NSTEMI is still regarded as a serious medical emergency.

Unstable angina

Unstable angina is the least serious type of ACS although, like NSTEMI, it is still regarded as a medical emergency.

In unstable angina, the blood supply to the heart is still seriously restricted, but there is no permanent damage, so the heart muscle is preserved.

Other tests

A number of other tests can be used to assess the state of your heart and check for related complications. However, because heart attacks are medical emergencies, some tests are usually only carried out once your initial treatment has begun and your condition has been stabilised.

Blood tests

Damage to your heart from a heart attack causes certain proteins to slowly leak into your blood. Enzymes are special proteins that help regulate chemical reactions that take place in your body.

If you have had a suspected heart attack, a sample of your blood will be taken so it can be tested for these heart proteins (known as cardiac markers). Your protein levels will be measured through a series of blood samples taken over the course of a few days.

This will allow damage to your heart to be assessed, and also help determine how well you are responding to treatment.

Read more information about blood tests.

Chest X-ray

A chest X-ray can be useful if diagnosis of a heart attack is uncertain and there are other possible causes of your symptoms, such as a pocket of air trapped between the layers of your lungs (pneumothorax).

A chest X-ray can also be used to check whether complications have arisen from the heart attack, such as a build-up of fluid inside your lungs (pulmonary oedema).

Echocardiogram

An echocardiogram is a type of ultrasound scan that uses sound waves to build up a picture of the inside of your heart.

This can be useful to identify exactly which areas of the heart have been damaged and how this damage has affected your heart’s function.

Coronary angiography

Coronary angiography can help determine whether a blockage or narrowing has occurred in the coronary arteries and, if so, to locate the exact location of the blockage or narrowing.

The test involves inserting a thin tube, known as a catheter, into one of the blood vessels in your groin or arm. The catheter is guided into your coronary arteries using X-rays.

A special fluid, known as a contrast agent, is pumped through the catheter. This fluid shows up on X-rays, and studying how it flows around and through your heart can help locate the site of any blockage or narrowing.

A coronary angiogram is often performed just before surgery, as the results can help guide the efforts of the surgeon. Read our page on treating a heart attack for more information.


Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
ECG
An ECG (electrocardiogram) is a test that measures electrical activity in the heart and is used to identify heart problems. 
Enzyme
Enzymes are proteins that speed up and control chemical reactions, such as digestion, in the body.
Heart
The heart is a muscular organ that pumps blood around the body.
Heart attack
A heart attack happens when there is a blockage in one of the arteries in the heart.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Kidney
Kidneys are a pair of bean-shaped organs located at the back of the abdomen, which remove waste and extra fluid from the blood and pass them out of the body as urine.
Liver
The liver is the largest organ in the body. Its main jobs are to secrete bile (to help digestion), detoxify the blood and change food into energy.
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Heart attack

Potential complications from a heart attack can vary widely, from mild to life threatening.

Potential complications from a heart attack can vary widely, from mild to life threatening.

Some people experience what is sometimes referred to as a "minor" heart attack (although it is still very serious) with no associated complications. This is also known as an uncomplicated heart attack.

Other people experience a major heart attack, which has a wide range of complications and may require extensive treatment.

Some common complications of a heart attack are discussed in more detail below.

Arrhythmia

An arrhythmia is an abnormal heartbeat  this includes beating too quickly (tachycardia), too slowly (bradycardia) or irregularly (atrial fibrillation).

Arrhythmias can develop after a heart attack as a result of damage to the muscles. Damaged muscles disrupt electrical signals used by the body to control the heart. Some arrhythmias, such as tachycardia, are mild and cause symptoms such as:

  • palpitations (the sensation of your heart racing in your chest or throat)
  • chest pain
  • dizziness
  • lightheadedness
  • fatigue (tiredness)
  • breathlessness

Other arrhythmias can be life threatening, such as:

  • complete heart block, where electrical signals are unable to travel from one side of your heart to the other, so your heart cannot pump blood properly
  • ventricular arrhythmia, where the heart begins beating faster before going into a spasm and stops pumping altogether; this is known as sudden cardiac arrest – see symptoms of a heart attack for more information

These life-threatening arrhythmias can be a major cause of death during the 24 hours after a heart attack.

However, survival rates have improved significantly since the invention of the portable defibrillator – an external device that delivers an electric shock to the heart and "resets" it to the right rhythm.

Mild arrhythmias can usually be controlled with medication such as beta-blockers.

More troublesome arrhythmias that cause repeated and prolonged symptoms may need to be treated with a pacemaker. This is an electric device surgically implanted in the chest, which is used to help regulate the heartbeat.

Heart failure

Heart failure happens when your heart is unable to effectively pump blood around your body. It can develop after a heart attack if muscles in your heart are extensively damaged. This usually occurs in the left side of the heart (the left ventricle).

Symptoms of heart failure include:

  • shortness of breath
  • fatigue
  • swelling in your arms and legs due to a build-up of fluid

Heart failure can be treated with a combination of medications and, in some cases, surgery.

Read more about the treatment of heart failure.

Cardiogenic shock

Cardiogenic shock is similar to heart failure, but more serious. It develops when the heart’s muscles have been damaged so extensively it can no longer supply enough blood to maintain many of the body's functions.

Symptoms include:

  • mental confusion
  • cold hands and feet
  • decreased or no urine output
  • rapid heartbeat and breathing
  • pale skin

Cardiogenic shock can be treated using blood-thinning medication, which makes the blood easier to pump. A type of medication called vasopressors may be used. Vasopressors help constrict (squeeze) the blood vessels, which increases the blood pressure and improves blood circulation.

Once the initial symptoms of cardiogenic shock have been stabilised, surgery may be required to improve the functioning of the heart. This may still include PCI, alongside the insertion of a small pump, known as an intra-aortic balloon pump. This can help improve the flow of blood away from the heart.

Another option is a coronary artery bypass graft (where a blood vessel from another part of your body is used to bypass any blockage).

Heart rupture

A heart rupture is a serious and relatively common complication of heart attacks, occuring in around 1 in 10 cases.

A heart rupture is where the heart’s muscles, walls or valves rupture (split apart). It can occur if the heart is significantly damaged during a heart attack. It usually happens 1 to 5 days after a heart attack.

Symptoms are the same as those of cardiogenic shock. Open heart surgery is usually required to repair the damage.

The outlook for people who have a heart rupture is not good, and it is estimated that half of all people die within 5 days of the rupture occurring.


Aneurysm
An aneurysm is a blood-filled sac that forms in a weakened part of a blood vessel.
Blood
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Depression
Depression is when you have feelings of extreme sadness, despair or inadequacy that last for a long time.
Heart
The heart is a muscular organ that pumps blood around the body.
Heart Attack
A heart attack happens when there is a blockage in one of the arteries in the heart.
Inflammation
Inflammation is the body's response to infection, irritation or injury, which causes redness, swelling, pain and sometimes a feeling of heat in the affected area.
Lungs
Lungs are a pair of organs in the chest that control breathing. They remove carbon dioxide from the blood and replace it with oxygen.
Oxygen
Oxygen is an odourless, colourless gas that makes up about 20% of the air we breathe.
Pain
Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign it has been damaged.
Rupture
A rupture is a break or tear in an organ or tissue.
Tissue
Body tissue is made up of groups of cells that perform a specific job, such as protecting the body against infection, producing movement or storing fat.
Veins
Veins are blood vessels that carry blood from the rest of the body back to the heart.
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Heart attack

Recovering from a heart attack can take several months, and it is very important not to rush your rehabilitation.

Recovering from a heart attack can take several months, and it is very important not to rush your rehabilitation.

During your recovery period, you will receive help and support from a range of healthcare professionals, which may include:

  • nurses
  • physiotherapists
  • dietitians
  • pharmacists
  • exercise specialists

These healthcare professionals will support you physically and mentally to ensure your recovery is conducted safely and appropriately.

The recovery process will usually take place in stages, starting in hospital, where your condition can be closely monitored and your individual needs for the future can be assessed. After being discharged, you can continue your recovery at home.

The two most important aims of the recovery process are:

  • to gradually restore your physical fitness so you can resume normal activities (known as cardiac rehabilitation)
  • to reduce your risk of another heart attack

Cardiac rehabilitation

Your cardiac rehabilitation programme will begin when you are in hospital.

A member of the cardiac rehabilitation team will visit you in hospital and provide detailed information about:

  • your state of health and how the heart attack may have affected it
  • the type of treatment you received
  • what medications you will need when you leave hospital
  • what specific risk factors are thought to have contributed to your heart attack
  • what lifestyle changes you can make to address those risk factors

Once you return home, it is usually recommended that you rest and only do light activities, such as walking up and down the stairs a few times a day or taking a short walk.

Gradually increase the amount of activity you do each day over several weeks. How quickly you can do this will depend on the condition of your heart and your general health. Your care team can provide more detailed advice about a recommended plan to increase your levels of activity.

You may also be invited to a cardiac rehabilitation programme at your local hospital four to eight weeks after leaving hospital. The programme consists of one to two hour exercise sessions, once or twice a week.

The type of exercise can vary depending on the programme, but should mainly be aerobic.

Aerobic exercises are designed to strengthen the heart, improve circulation and lower blood pressure. Examples of aerobic exercises include riding an exercise bike, jogging on a treadmill and swimming.

Returning to work

Most people can return to work after having a heart attack, but how quickly will depend on your health, the state of your heart and the kind of work you do. If your job involves light duties – for example, if you work in an office, you may be able to return to work in as little as two weeks.

However, if your job involves heavy manual work or your heart was extensively damaged, it may be several months before you can return to work.

Your care team will provide a more detailed prediction of how long it will take for you to return to work.

Sex

According to the British Heart Foundation, you are usually able to start having sex again once you feel well enough, usually about four to six weeks after having a heart attack. Having sex will not put you at further risk of having another heart attack.

Following a heart attack, about one in three men have erectile dysfunction, which may make having sex difficult.

This is most commonly due to anxiety and the emotional stress associated with having a heart attack.

Less commonly, erectile function is caused by a side effect of beta-blockers.

If you experience erectile dysfunction, speak to your GP. They may be able to recommend treatment.

For example, you may be prescribed medication that stimulates the flow of blood to your penis, which makes it easier to get an erection. Read more about treating erectile dysfunction here.

Driving

If you drive a car or motorcycle and you have a heart attack, you do not have to inform the Driver and Vehicle Licensing Agency (DVLA).

However, the DVLA strongly recommends you stop driving for at least four weeks after a heart attack. After this, you will be able to drive, providing you do not have any other condition or complication that would disqualify you from driving.

If you drive a large goods vehicle or passenger-carrying vehicle, you must inform the DVLA if you have a heart attack.

Your license will be temporarily suspended, for a minimum of six weeks, until you have adequately recovered.

Your license will be reissued if you can pass a basic health and fitness test, and do not have any other condition that would disqualify you from driving.

Depression

Having a heart attack can be frightening and traumatic, and it is common to have feelings of anxiety afterwards. For many people, the emotional stresses can cause them to feel depressed and tearful for the first few weeks after returning home from hospital.

If feelings of depression persist, speak to your GP because you may have a more serious form of depression.

It is important that you seek advice, because serious types of depression often do not get better without treatment.

Your emotional state could also have an adverse effect on your physical recovery.

Reducing your risk

Reducing your risk of having another heart attack involves making lifestyle changes and taking a long-term course of different medications.

Diet

It is recommended you eat two to four portions of oily fish a week. Oily fish contains a type of fatty acid known as omega-3, which can help lower your cholesterol levels.

Good sources of omega-3 include:

  • herring
  • sardines
  • mackerel
  • salmon
  • trout
  • tuna

Never take a food supplement without first consulting your GP. Some supplements, such as beta-carotene, could be potentially harmful.

It is also recommended that you eat a Mediterranean-style diet. This means eating more bread, fruit, vegetables and fish, and less meat. Replace butter and cheese with products based on vegetable and plant oil, such as olive oil.

For more dietary information and advice, see changing your diet after a heart attack.

Smoking

If you smoke, it is strongly recommended you quit as soon as possible. The NHS Smokefree website can provide you with support and advice.

Your GP can also recommend and prescribe medication to help you give up. Read our page on treatments for quitting smoking for more information.

Alcohol

If you drink alcohol, do not exceed the recommended daily limits (no more than three to four units a day for men, and two to three units a day for women). A unit of alcohol is roughly half a pint of normal strength lager, a small glass of wine or a single measure (25ml) of spirits.

Regularly exceeding the recommended alcohol limits will raise your blood pressure and cholesterol level, thereby increasing your risk of another heart attack.

Avoid binge drinking (drinking lots of alcohol in a short space of time or drinking to get drunk). Binge drinking can cause a sudden and large rise in your blood pressure, which could be potentially dangerous.

Research has found that people who have had heart attacks and continue to binge drink are twice as likely to die of a serious health condition, such as another heart attack or stroke, compared to people who moderate their drinking after having a heart attack.

Contact your GP if you find it difficult to moderate your drinking. Counselling services and medications can help you reduce your alcohol intake. For more information, read our page on treatment for alcohol misuse.

Weight management

If you are overweight or obese, it is recommended that you lose weight and then maintain a healthy weight, using a combination of exercise and a calorie-controlled diet.

Read more about treating obesity.

Regular physical activity

Once you have made a sufficient physical recovery from the effects of a heart attack (see cardiac rehabilitation, below, for more information about how long this usually takes), it is recommended that you do regular physical activity.

Adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (such as cycling or fast walking) every week.

The level of activity should be strenuous enough to leave you slightly breathless.

If you find it difficult to achieve 150 minutes of activity a week, start at a level that you feel comfortable with (for example, 5-10 minutes of light exercise a day) and gradually increase the duration and intensity of your activity as your fitness begins to improve.

Medication

There are currently four types of medication widely used to reduce the risks of a heart attack.

These are:

  • angiotensin-converting enzyme (ACE) inhibitors
  • anti-platelets
  • beta-blockers
  • statins

ACE inhibitors

ACE inhibitors are often used to lower blood pressure, as they block the actions of some of the hormones that help regulate blood pressure. By stopping these hormones from working, the medicine helps reduce the amount of water in your blood and also widens your arteries, both of which will reduce your blood pressure.

ACE inhibitors have been known to reduce the supply of blood to the kidneys, which can reduce their efficiency. Therefore, blood and urine tests may be carried out before you start taking ACE inhibitors, to make sure there are no pre-existing problems with your kidneys.

Annual blood and urine tests may be required if you continue to use ACE inhibitors.

The side effects of ACE inhibitors can include:

  • dizziness
  • tiredness or weakness
  • headaches 
  • a persistent, dry cough

Most of these should pass within a few days, although some people continue to have a dry cough.

If ACE inhibitors are taken with other forms of medication, including over-the-counter (OTC) medicines, they can cause unpredictable effects.

Therefore, check with your GP or pharmacist before taking anything in combination with ACE inhibitors.

It is usually recommended that you begin taking ACE inhibitors immediately after having a heart attack and, in most cases, continue taking them indefinitely. In some individuals who prove intolerant of ACE inhibitors, a related alternative medication – an angiotensin receptor blocker (ARB) – may be prescribed.

Anti-platelets

Anti-platelets are a type of medication that can help prevent blood clots. They work by reducing the "stickiness" of platelets, which are tiny particles in the blood that help it to clot.

It is usually recommended you take low-dose aspirin, which has blood-thinning properties, as well as being a painkiller.

You may also be given an additional anti-platelet medication, such as clopidogrel, prasugrel or ticagrelor. These can also be used if you are allergic to aspirin.

Side effects can include:

As with ACE inhibitors, treatment with anti-platelets usually begins immediately after a heart attack. The amount of time for which you are prescribed these medications can be anywhere between 4 weeks and 12 months, and depends on the type of heart attack you have had and the other treatment you have received.

It is usually recommended you take aspirin indefinitely. If you experience troublesome side effects due to aspirin, you should contact your GP for advice. Do not suddenly stop taking the aspirin, as this could increase your risk of another heart attack.

You may occasionally also be put on another blood thinning medication, called warfarin. This usually only happens if you have remained in an irregular heart rhythm (atrial fibrillation) or have sustained severe damage to your heart.

Excessive bleeding is the most serious side effect of warfarin. Seek immediate medical attention and have an urgent blood test if you experience any of the following side effects:

  • passing blood in your urine or faeces (stools or "poo")
  • passing black faeces
  • severe bruising
  • prolonged nosebleeds (that last longer than 10 minutes)
  • blood in your vomit
  • coughing up blood
  • unusual headaches
  • in women, heavy or increased bleeding during your period or any other bleeding from the vagina

Immediate medical attention must also be sought if you:

Beta-blockers

Beta-blockers are a type of medication used to protect the heart from further damage after a heart attack. They help relax the heart’s muscles so the heart beats slower and the blood pressure drops, both of which will help reduce the strain on your heart.

It is usually recommended that you begin treatment with beta-blockers as soon as your condition stabilises, and continue taking them indefinitely.

Fairly common side effects of beta-blockers include:

  • tiredness
  • cold hands and feet
  • slow heartbeat
  • diarrhoea
  • feeling sick

Less common side effects include:

  • sleep disturbances
  • nightmares
  • inability to obtain or maintain an erection (erectile dysfunction or "impotence")

Beta-blockers can also interact with other medicines, causing possible adverse side effects.

Therefore, check with your GP or pharmacist before taking other medicines, including OTC medication, in combination with beta-blockers.

Statins

Statins are a type of medication used to lower your blood cholesterol level. This will help prevent further damage to your coronary arteries and should reduce the risk of another heart attack.

Statins block the effects of an enzyme in your liver called HMG-CoA reductase, which is used to make cholesterol.

Statins sometimes have mild side effects, including:

Occasionally, statins can cause muscle pain, weakness and tenderness. Contact your GP if you experience these symptoms as your dosage may need to be adjusted.

It is usually recommended that you take statins indefinitely.



Content Supplied by NHS Choices

Heart attack

Mike Smith has had three heart attacks. As he nears 60 and enjoys life to the full, he explains how the attacks affected him.

Mike Smith has had three heart attacks. As he nears 60 and enjoys life to the full, he explains how the attacks affected him.

"My first experience was many years ago. I thought it was heartburn but ended up at my local hospital, where they told me I’d had a heart attack.

"After that, I was put on a course of tablets and didn’t have any more problems for the next 14 years. I stopped smoking and, with the help of the tablets, I was leading a normal life.

"However, I started smoking again, which was not the wisest thing to do. I was feeling so fit and healthy that I thought I'd never have a heart attack again, but I did. And after this second heart attack, I had another one a month or two later. The doctors decided that I needed a heart bypass operation.

"I remember waking up in intensive care about 10 hours after the operation. I stayed there for about two days, before being moved to the normal ward. The doctors had me up and walking pretty much immediately. I was in hospital for about a week.

"On my first day home, I was visited by a cardiac nurse. For the next week or so, I had to hold a cushion every time I was about to sneeze because it hurt. 

"Once I'd recovered, I went to the gym in my local community centre, where I met other people who'd had the same problem. It was useful chatting with them about a common condition.

"I now take three tablets every morning and one at night. It's a small price to pay.

"You don’t have to sit in a corner and be woeful all day. I got married and had a son after my first heart attack. Life certainly doesn’t end after you’ve had a heart attack."

Content Supplied by NHS Choices

Heart attack

After a heart attack Debbie Siddons was too scared to pick up her 18-month-old baby. Rehabilitation helped her move on.

After a heart attack, 36-year-old Debbie Siddons was too scared to pick up her 18-month-old baby. Rehabilitation helped her move on.

It was the usual rush in the Siddons household as Debbie raced around getting her four children ready for school. But as she walked into the living room to summon her eldest, she was suddenly stopped by a sharp pain in her chest.

“My heart was racing, the pain was awful and I had pins and needles in my lower jaw and down both arms,” she says. “I sat down on the sofa hoping the pain would stop, but it didn’t. I knew something was very wrong. I was on my own with the kids, so I got my eldest to bring me the phone. I called my mother-in-law and my father, and told them I didn’t feel very well. My dad was over in 10 minutes. He took one look at me and called an ambulance.”

In the ambulance, paramedics gave Debbie an electrocardiogram (ECG) to test the electrical activity in her heart. She was then given an aspirin to chew. Once she got to the hospital, doctors gave her a drug to dissolve any clots in her blood that might have caused the heart attack.

“I knew it was serious, but I didn’t guess how serious,” she says. “When I got to the hospital, it was madness. Everyone was rushing around, hooking me up to machines. It didn’t take the doctor long to tell me I’d had a heart attack. It didn’t quite sink in until my mother-in-law got to the hospital and I had to tell her what had happened to me.”

Debbie stayed in hospital for a week. On the sixth day, she began to experience pins and needles in her left arm. Doctors were concerned that she might be having another heart attack. As a precaution, she was given another ECG and sent for an angiogram – a procedure that checks the arteries for blockages. The angiogram was clear and Debbie didn’t have another attack. The cause of her original attack is still unknown.

Back at home, she realised how much the experience had shaken her. “I was frightened to do anything. I was nervous about going up the stairs and I was too scared to pick up my 18-month-old daughter in case I had another heart attack,” she says.

“Then I was sent for rehabilitation, which really helped. We learned about healthy eating and exercise, but a big part of it was finding the confidence to carry on with our lives. The nurses reassured me that I could live a perfectly normal life again and they were right. By the end of the six-week course, I’d got my confidence back.”

Debbie sees a consultant once a year and hasn’t had another heart attack. “It was a very frightening experience, but I came through it,” she says. “I’d urge anyone who’s had a heart attack to make the most of rehabilitation and use all the help they can get. It certainly helped me to move on.”

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