Types of Heart Attack: What you need to know

Heart attacks pose a serious health risk and can be life-threatening. They occur when a blockage in the coronary arteries disrupts blood flow to the heart, which can cause permanent damage.

Types of Coronary Artery Diseases which leads to Heart Attack

  • ST segment elevation myocardial infarction (STEMI)
  • non-ST segment elevation myocardial infarction (NSTEMI)
  • coronary artery spasm

What is a Heart Attack?

The coronary arteries carry blood to the heart, allowing it to function. A heart attack, also known as a myocardial infarction, occurs when a blockage develops in the coronary arteries and restricts the flow of blood to the heart.

Blockages occur when fat, cholesterol, and other substances build up, forming deposits called plaques in blood vessels. These plaques can become damaged over time and may release platelets.

Platelets can cause the blood to clot. They may collect around a plaque, eventually blocking blood flow.

By restricting blood flow, these blockages can damage the heart muscle. The severity of damage will depend on the size of the blockage. When blood is not reaching a significant segment of the heart, the damage will be more extensive.

A cardiac arrest is often mislabelled as a heart attack. However, a cardiac arrest occurs when the heart abruptly stops working.

Types

STEMI

A STEMI heart attack is severe and requires immediate attention.

These attacks occur when the coronary artery is fully blocked, preventing blood from reaching a large area of the heart. This causes progressive damage to the heart muscle, which can eventually stop it from functioning.

NSTEMI

NSTEMI heart attacks occur when the coronary artery is partially blocked and blood flow is severely restricted. While they are less dangerous than STEMI heart attacks, they can cause permanent damage.

Coronary artery spasm

These spasms are also called silent heart attacks or unstable angina. They occur when the arteries connected to the heart contract, preventing or restricting blood flow to the heart.

Symptoms do not cause permanent damage, and they are less severe than those of other types of coronary artery disease.

It is possible to mistake a coronary artery spasm for a minor condition, such as indigestion. However, having a coronary artery spasm can increase the risk of having a more severe heart attack.

Treatment

Regardless of the cause, all heart attacks require immediate medical attention. The treatment used will depend on the type of coronary artery disease.

In most cases, medical professionals will administer immediate treatment before determining the type or severity of the attack. This treatment may involve:

  • aspirin to reduce further blood clotting
  • oxygen therapy
  • nitroglycerin to support blood flow
  • efforts to reduce chest pain

Once a doctor has determined the type of heart attack, more treatment is needed to stimulate blood flow. When the underlying coronary artery disease is less severe, this can be done using medication, such as:

  • Clot busters, also known as thrombolytic medicines, which help to dissolve the blood clots causing blockages
  • Blood thinners, also known as anticoagulants, which prevent further clotting.
  • Blood pressure medications, such as ACE inhibitors, which help to maintain healthy blood flow and reduce pressure.
  • Statins, which can lower low-density lipoprotein cholesterol.
  • Beta-blockers, which can reduce the heart’s workload and chest pain.

Recovery

Recovery can vary significantly, depending on the type of heart attack, its severity, and how it was treated.

A person can often return to normal activities within a week. However, when the underlying coronary artery disease was more severe, it may take months to recover from a heart attack.

Following any kind of heart attack, a doctor will often recommend cardiac rehabilitation, which can teach a person to maintain a healthful lifestyle and minimise the risk of another attack. Changes to levels of physical activity and diet may be suggested.

Risk factors

Some people may be more vulnerable to heart attacks. Common risk factors include:

  • high blood pressure
  • obesity or being overweight
  • a poor diet, particularly one high in trans or saturated fats
  • low levels of physical activity
  • smoking tobacco
  • older age
  • diabetes or high blood sugar levels
  • a family history of heart disease

Prevention

A person can lower their risk of having a heart attack by:

  • exercising for at least 150 minutes per week
  • reducing stress
  • not smoking
  • eating a diet rich in vegetables, fruits, whole grains, legumes, nuts, and oily fish
  • maintaining a healthy weight

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Coronary CTA Should Be the Initial Test in Most Patients With Stable Chest Pain: PRO

The evaluation of adults with stable chest pain concerning for possible coronary artery disease (CAD) is one of the most commonplace and costly evaluations in all of medicine. Given the number of available, well-studied, and prognostically useful noninvasive tests for CAD, there remains much debate over optimal evaluation pathways to improve clinical and cost outcomes in patients with chest pain. Current US stable ischemic heart disease guidelines favor noninvasive functional testing for myocardial ischemia in most patients, reserving anatomic testing using coronary computed tomography angiography (CTA) for patients without established CAD who have already undergone functional testing (inconclusive results or ongoing symptoms) or are unable to undergo functional testing.1However, coronary CTA has undergone remarkable technological advancements in safety and image quality that, when paired with results from recent comparative effectiveness trials, has led many to conclude that it should be more broadly performed and serve as the first test in many patients with stable chest pain.2 For example, in 2016, the National Institute for Health and Care Excellence (NICE), the evidence-based organization that guides healthcare in the United Kingdom, updated its chest pain guideline and made coronary CTA the first test for all patients without established CAD who present with typical or atypical angina or with non-anginal chest pain plus an abnormal resting electrocardiogram (ECG).3Stress imaging studies were recommended in patients with known CAD, and exercise stress ECG testing was not recommended for the diagnosis of CAD due to its low accuracy and high rates of subsequent testing. It was estimated that broad adoption of this strategy would save the UK National Health Service £16 million annually.

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