Introduction

A heart attack (myocardial infarction or MI) 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 medical emergency. Dial 999 and ask for an ambulance if you suspect a heart attack.

A lack of blood to the heart may seriously damage the heart muscle and can be life-threatening.

Symptoms of a heart attack

Symptoms of a heart attack can include:

  • chest pain – the chest can feel like it's 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's important to stress that not everyone experiences severe chest pain; the pain can often be mild and mistaken for indigestion.

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

Read about the symptoms of a heart attack.

Treating heart attacks

While waiting for an ambulance, it may help to chew and then swallow a tablet of aspirin (ideally 300mg) – as long as the person having a heart attack isn't allergic to aspirin.

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

In hospital, treatment for a heart attack depends on how serious it is. The two main treatments are:

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

Read about treating heart attacks.

Causes of a heart attack

Coronary heart disease (CHD) is the leading cause of heart attacks.

CHD is a condition in which the major blood vessels that supply the heart get clogged up with deposits of cholesterol, known as 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 block the supply of blood to the heart, triggering a heart attack.

Read about the causes of a heart attack.

Recovering from a heart attack

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 depends on your health, the state of your heart and the type of work you do.

Read about recovering from a heart attack.

Complications of a heart attack

Complications of a heart attack 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 die suddenly from a complication of a heart attack before reaching hospital, or within the first month after a heart attack.

The outlook often depends on:

  • age – serious complications are more likely as you get older
  • the severity of the heart attack – how much of the heart's muscle has been damaged during the attack
  • how long it took before a person received treatment – treatment for a heart attack should begin as soon as possible

Read about complications of a heart attack.

Preventing a heart attack

There are five main steps you can take to reduce your risk of having a heart attack (or having another heart attack):

  • smokers should quit smoking
  • lose weight if you're overweight or obese
  • take regular exercise – adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity each week, unless advised otherwise by the doctor in charge of your care
  • eat a low-fat, high-fibre diet, including whole grains and plenty of fresh fruit and vegetables (at least five portions a day)
  • moderate your alcohol consumption – read more about alcohol units

Read about how to prevent a heart attack.

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Symptoms

If you suspect the symptoms of a heart attack, dial 999 immediately and ask for an ambulance.

Don't worry if you have doubts. Paramedics would rather be called out to find an honest mistake has been made than be too late to save a person's life.

Symptoms of a heart attack can include:

  • chest pain – a sensation of pressure, tightness or squeezing in the centre of your chest
  • pain in other parts of the body – it can feel as if the pain is travelling from your chest to your arms (usually the left arm is affected, but it can affect both arms), jaw, neck, back and abdomen
  • feeling lightheaded or dizzy
  • sweating
  • shortness of breath
  • feeling sick (nausea) or being sick (vomiting)
  • an overwhelming sense of anxiety (similar to having a panic attack)
  • coughing or wheezing

Although the chest pain is often severe, some people may only experience minor pain, similar to indigestion. In some cases, there may not be any chest pain at all, especially in women, the elderly and p

eople with diabetes.

It's the overall pattern of symptoms that helps to determine whether you are having a heart attack.

Waiting for the ambulance

If someone has had a heart attack, it's important to rest while they wait for an ambulance, to avoid unnecessary strain on the heart.

If aspirin is easily available and the person who has had a heart attack isn't allergic to it, slowly chew and then swallow an adult-sized tablet (300mg) while waiting for the ambulance.

The aspirin helps to thin the blood and restore the heart's blood supply.

Cardiac arrest

In some cases a complication called ventricular arrhythmia can cause the heart to stop beating. This is known as sudden cardiac arrest.

Signs and symptoms suggesting a person has gone into cardiac arrest include:

  • they appear not to be breathing
  • they're not moving
  • they don't respond to any stimulation, such as being touched or spoken to

If you think somebody has gone into cardiac arrest and you don't have access to an automated external defibrillator (AED), you should perform chest compressions, as this can help restart the heart.

Chest compression

To carry out a chest compression on an adult:

  • Place the heel of your hand on the breastbone at the centre of the person's chest. Place your other hand on top of your first hand and interlock your fingers.
  • Using your body weight (not just your arms), press straight down by 5-6cm on their chest.
  • Repeat this until an ambulance arrives.

Aim to do the chest compressions at a rate of 100-120 compressions a minute. You can watch a video on CPR for more information about how to perform "hands-only" CPR.

Read information about how to resuscitate a child.

Automated external defibrillator (AED)

If you have access to a device called an AED, you should use it. An AED is a safe, portable electrical device that most large organisations keep as part of their first aid equipment.

It helps to establish a regular heartbeat during a cardiac arrest by monitoring the person's heartbeat and giving them an electric shock if necessary.

You can read more information about CPR and AEDs on the Arrhythmia Alliance website.

Angina and heart attacks

Angina is a syndrome (a collection of symptoms caused by an underlying health condition) caused when the supply of oxygen-rich blood to the heart becomes restricted.

People with angina can experience similar symptoms to a heart attack, but they usually happen during exercise and pass within a few minutes.

However, occasionally, people with angina can have a heart attack. It's important to recognise the difference between the symptoms of angina and those of a heart attack.

The best way to do this is to remember that the symptoms of angina can be controlled with medication, unlike the symptoms of a heart attack.

If you have angina, you may have been prescribed medication that improves your symptoms within five minutes. If the first dose doesn't work, a second dose can be taken after five minutes, and a third dose after a further five minutes.

If the pain persists, despite taking three doses of glyceryl trinitrate over 15 minutes, call 999 and ask for an ambulance.

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Causes

Heart attacks are caused by the blood supply to the heart being suddenly interrupted. Without this supply, heart muscles may be damaged and begin to die.

Without treatment, the heart muscles will experience irreversible damage.

If a large portion of the heart is damaged in this way, the heart stops beating (known as a cardiac arrest), resulting in death.

Coronary heart disease

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.

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 block the supply of blood to the heart, triggering a heart attack.

Your risk of developing CHD is increased by:

Read about the causes of CHD.

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

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Diagnosis

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 impulses. 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 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 from the ECG known as the ST segment. It corresponds to the area of damage inflicted on the heart.

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 may be only partially, rather than completely, blocked.

As a result, a smaller section of the heart may be damaged. However, an NSTEMI is still regarded as a serious medical emergency. Without treatment, it can progress to serious heart damage or STEMI.

Unstable angina

Unstable angina is the least serious type of ACS. However, like NSTEMI, it is still regarded as a medical emergency as it can also progress to serious heart damage or STEMI.

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).

The most common protein measurement is called cardiac troponin. Your troponin 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 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. This helps your cardiologist decide the best treatment for you.

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Treatment

The treatment options for a heart attack depend on whether you've had an ST segment elevation myocardial infarction (STEMI), or another type of heart attack.

A STEMI is the most serious form of heart attack and requires emergency assessment and treatment. It's important you're treated quickly to minimise damage to your heart.

If you have symptoms of a heart attack and an electrocardiogram (ECG) shows you have a STEMI, you'll be assessed for treatment to unblock the coronary arteries.

The treatment used will depend on when your symptoms started and how soon you can access treatment.

  • If your symptoms started within the past 12 hours – you'll usually be offered primary percutaneous coronary intervention (PCI).
  • If your symptoms started within the past 12 hours but you can't access PCI quickly – you'll be offered medication to break down blood clots.
  • If your symptoms started more than 12 hours ago – you may be offered a different procedure, especially if symptoms have improved. The best course of treatment will be decided after an angiogram and may include medication, PCI or bypass surgery.

Primary percutaneous coronary intervention (PCI)

Primary PCI is the term for emergency treatment of STEMI, using a procedure to widen the coronary artery (coronary angioplasty).

Coronary angiography is performed first to assess your suitability for PCI.

You may also be given blood-thinning medication to prevent further clots from developing, such as:

  • aspirin
  • heparin
  • clopidogrel
  • prasugrel
  • ticagrelor
  • bivalirudin

Some of these medications may be continued for some time after PCI.

Coronary angioplasty

Coronary angioplasty is a potentially complex type of procedure that requires specialist staff and equipment, and not all hospitals have the facilities.

This means you'll need to be taken urgently, by ambulance, to one of the specialist centres (Heart Attack Centres) that now serve most of the UK's regions.

During coronary angioplasty, a tiny tube known as a balloon catheter, with a sausage-shaped balloon at the end, is put into a large artery in your groin or arm. The catheter is passed through your blood vessels and up to your heart, over a fine guidewire, using X-rays to guide it, before being moved into the narrowed section of your coronary artery.

Once in position, the balloon is inflated inside the narrowed part of the coronary artery to open it wide. A stent (flexible metal mesh) is usually inserted into the artery to help keep it open afterwards.

Medication to break down blood clots

Medications used to break down blood clots, known as thrombolytics or fibrinolytics, are usually given by injection.

Thrombolytics, or fibrinolytics, target and destroy a substance called fibrin. Fibrin is a tough protein that makes up blood clots by acting like a sort of fibre mesh that hardens around the blood.

Some examples of these types of medications include:

  • reteplase
  • alteplase
  • streptokinase

You may also be given an additional medication called a glycoprotein IIb/IIIa inhibitor if it is thought you have an increased risk of experiencing another heart attack at some point in the near future.

Glycoprotein IIb/IIIa inhibitors don't break up blood clots, but they prevent blood clots from getting bigger. They're an effective method of stopping your symptoms getting worse.

Coronary artery bypass graft

A coronary angioplasty may not be technically possible sometimes if the anatomy of your arteries is different from normal. This may be the case if there are too many narrow sections in your arteries or if there are lots of branches coming off your arteries that are also blocked.

In such circumstances, an alternative surgical operation, known as a coronary artery bypass graft (CABG), may be considered. A CABG involves taking a blood vessel from another part of your body, usually your chest or leg, to use as a graft.

The graft bypasses any hardened or narrowed arteries in the heart. A surgeon will attach the new blood vessel to the aorta and the other to the coronary artery beyond the narrowed area or blockage.

Treating NSTEMI or unstable angina

If the results of your ECG show you have a "less serious" type of heart attack (known as a non-ST segment elevation myocardial infarction (NSTEMI) or unstable angina), then blood-thinning medication, including aspirin and other medications, is usually recommended.

In some cases, further treatment with coronary angioplasty or coronary artery bypass graft may be recommended in cases of NSTEMI or unstable angina, after initial treatment with these medications.

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Recovery

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

During your recovery period, you'll 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 usually takes 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're in hospital. You should also be invited back for another session taking place within 10 days of leaving 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'll 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

They can also answer any questions you have about finance, welfare rights, housing and social care.

Exercise

Once you return home, it's 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 activity levels.

Your rehabilitation programme should contain a range of different exercises, depending on your age and ability. Most of the exercises will 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're 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 won't 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 dysfunction 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.

Driving

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

Many people can now return to driving one week after a heart attack, as long you don't have any other condition or complication that would disqualify you from driving.

However, in more severe cases you may need to stop driving for four weeks. Your doctor or rehabilitation team should advise how long you must wait before driving after your heart attack.

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

Your licence will be temporarily suspended, for a minimum of six weeks, until you've adequately recovered.

Your licence will be reissued if you can pass a basic health and fitness test, and don't have any other condition that would disqualify you from driving.

Depression

Having a heart attack can be frightening and traumatic, and it's 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's important to seek advice, because serious types of depression often don't 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's recommended that 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's 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.

Smoking

If you smoke, it's strongly recommended that you quit as soon as possible.

Stop Smoking Wales can help you with this.

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, don't exceed the recommended limits:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

Fourteen units is equivalent to six pints of average strength beer or 10 small glasses of low strength wine.

Regularly exceeding the recommended alcohol limits raises your blood pressure and cholesterol level, 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.

Read more about treatment for alcohol misuse.

Weight management

If you're overweight or obese, it's 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've 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's 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:

  • 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 to 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:

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 medicines, they can cause unpredictable effects.

Check with your GP or pharmacist before taking anything in combination with ACE inhibitors.

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

You are more likely to be given additional anti-platelet medication, such as clopidogrel, prasugrel or ticagrelor, especially if you've had stent treatment. These can also be used if you're 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's usually recommended that you take aspirin indefinitely. If you experience troublesome side effects due to aspirin, you should contact your GP for advice. Don't 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 to relax the heart's muscles so the heart beats slower and the blood pressure drops, both of which will reduce the strain on your heart.

It's 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.

Check with your GP or pharmacist before taking other medicines, including over-the-counter 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's usually recommended that you take statins indefinitely.

Getting help

Everyone who experiences a heart attack will face different problems and challenges, and any guidance or advice you receive will be tailored to your needs.

There are many local and national cardiac support groups where you can meet people who have been through a similar experience.

The British Heart Foundation has a helpline that offers confidential information about your recovery and advice about how to keep your heart healthy.

The helpline can be reached on 0300 330 3311 and is open from 9am to 5pm, Monday to Friday.

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Complications

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

Some people experience a "minor" heart attack (although it can still be 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 potential 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:

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:

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 24-48 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 bradycardias 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 your heart muscle is 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 treating heart failure.

Cardiogenic shock

Cardiogenic shock is similar to heart failure, but more serious. It develops when the heart muscle has been damaged so extensively it can no longer pump 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
  • difficulty breathing

A type of medication called vasopressors (or inotropes) 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 an extremely serious but relatively uncommon complication of heart attacks where the heart's muscles, walls or valves rupture (split apart).

It can occur if the heart is significantly damaged during a heart attack and usually happens 1 to 5 days afterwards.

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 isn't good, and it's estimated that half of all people die within five days of the rupture occurring.

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Prevention

Making lifestyle changes is the most effective way to prevent having a heart attack (or having another heart attack).

There are three main steps you can take to help prevent a heart attack (as well as stroke):

  • eat a healthy, balanced diet
  • avoid smoking
  • try to keep your blood pressure at a healthy level

Diet

Eating an unhealthy diet high in fat will make your atherosclerosis (hardening of the arteries) worse and increase your risk of heart attack.

Continuing to eat high-fat foods will cause more fatty plaques to build up in your arteries. This is because fatty foods contain cholesterol.

There are two main types of cholesterol:

  • low-density lipoprotein (LDL) – this is mostly made up of fat plus a small amount of protein; this type of cholesterol can block your arteries, so it is often referred to as "bad cholesterol"
  • high-density lipoprotein (HDL) – this is mostly made up of protein plus a small amount of fat; this type of cholesterol can reduce deposits in your arteries, so is often referred to as "good cholesterol"

There are also two types of fat – saturated and unsaturated. Avoid foods containing high levels of saturated fat, as they increase levels of bad cholesterol in your blood.

Foods high in saturated fat include:

  • meat pies
  • sausages and fatty cuts of meat
  • butter
  • ghee (a type of butter often used in Indian cooking)
  • lard
  • cream
  • hard cheese
  • cakes and biscuits
  • foods that contain coconut or palm oil

Eating a small amount of unsaturated fat will increase the level of good cholesterol and help reduce any blockage in your arteries. Foods high in unsaturated fat include:

  • oily fish
  • avocados
  • nuts and seeds
  • sunflower, rapeseed and olive oil

Read more about healthy eating.

Smoking

Smoking is a major risk factor for heart attacks, because it causes atherosclerosis and raises blood pressure.

If you want to give up smoking a good first step is to contact Stop Smoking Wales on 0800 085 2219. Stop Smoking Wales hold details of local support services.  These services offer the most effective support for people who want to give up smoking. Studies show you are four times more likely to give up smoking successfully if you do it with the help of the NHS.

For more information about giving up smoking, see stop smoking.

High blood pressure

Persistent high blood pressure can put your arteries and heart under extra strain, increasing your risk of a heart attack.

High blood pressure can often be reduced by a healthy diet, moderating your intake of alcohol, maintaining a healthy weight and taking regular exercise.

Diet

The dietary advice above also applies if you have high blood pressure. In addition, cut down on the amount of salt in your food and eat plenty of fruit and vegetables.

Salt raises your blood pressure. The more salt you eat, the higher your blood pressure. You should aim to eat less than 6g (0.2oz) of salt a day, which is about a teaspoonful.

Eating a low-fat diet that includes lots of fibre – such as wholegrain rice, bread and pasta – and plenty of fruit and vegetables, has been proven to help lower blood pressure. Fruit and vegetables are full of vitamins, minerals and fibre, and help keep your body in good condition.

You should aim to eat five 80g portions of fruit and vegetables every day.

Read more about getting your 5 A Day.

Alcohol

Regularly drinking alcohol above the recommended limits can raise your blood pressure.

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

Read more about how many units are in your favourite tipple and tips on cutting down.

Alcohol is also high in calories, so you will gain weight if you drink regularly. Being overweight will also increase your blood pressure.

Weight

Being overweight forces your heart to work harder to pump blood around your body, which can raise your blood pressure. Find out if you need to lose weight with the BMI healthy weight calculator.

If you do need to shed some weight, it is worth remembering that losing just a few pounds will make a big difference to your blood pressure and overall health.

Exercise

Being active and taking regular exercise will lower your blood pressure by keeping your heart and blood vessels in good condition. Regular exercise can also help you lose weight, which will help lower your blood pressure.

Low-impact activities such as walking, swimming and cycling are recommended. More strenuous activities, such as playing football and squash, may not be recommended. Check with the doctor in charge of your care.

Read more on how to prevent high blood pressure.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 14/12/2016 10:12:30