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What is a heart attack?

A heart attack occurs when a specific area of the heart is deprived of oxygen and suffers damage due to a sudden interruption in blood flow. There are many possible causes for this interruption in blood flow, but the most common cause is the sudden blockage of a coronary artery by a blood clot.

What are the symptoms of a heart attack?

Heart attack symptoms vary from person to person. Some people experience symptoms as a very severe level of discomfort, while others have serious clinical signs. In some individuals, no symptoms are seen at all; it is discovered purely by chance much later that the patient had a heart attack in the past. For many people, symptoms that come and go, starting hours, days, or weeks in advance, can be precursors to a heart attack. Sometimes, there are no warning signs at all. The most common heart attack symptoms include:

A feeling of discomfort, pain, pressure, burning, or tightness in the center or left side of the chest. These are usually not felt at a single point but over a wider area. In addition to the chest—or even without chest involvement—these complaints may be felt in the shoulder, arm, back, neck, jaw, or upper abdomen.
Cold sweats, dizziness, or a feeling of fainting.
Indigestion, nausea, or vomiting.
Severe weakness, fatigue, or shortness of breath.
Fast, slow, or irregular heartbeat.
Anxiety and a sense of impending doom.

What are the causes of a heart attack?

The heart receives the oxygen it needs not from the blood within its chambers, but through its own specialized vessels. However, in some individuals, fat progressively accumulates in the walls of these vessels over many years. These vulnerable areas, known as plaques, can suddenly rupture in some people. The body’s mechanisms immediately intervene, recognizing this rupture as a “wound” and attempting to repair it by sealing it with a clot. However, either because the clot is too large or due to chronic narrowing at the site of the rupture, it may accidentally completely block the vessel. Nineteen out of every 20 heart attacks occur due to this mechanism. Since the heart tissue beyond the blockage suddenly receives no oxygen, the tissues in that area begin to die and permanent damage develops unless the vessel is reopened urgently. If tissues die, the electrical balance is disrupted, and serious rhythm disturbances can emerge. Furthermore, the heart’s pumping power decreases, leading to heart failure. All of these can be fatal. In summary, the sudden blockage of a heart vessel by a clot is by far the most common cause.
Sudden and severe spasm (contraction) of the heart vessels
An embolism (clot) traveling to the heart vessels from elsewhere
Congenital abnormalities in the structure of the heart vessels
Spontaneous tearing (dissection) of the heart vessels

What are the factors that increase the risk of a heart attack (risk factors)?

Advanced age (Heart attacks can occur at any age, but they become more frequent as people get older.)
Family history of heart attack (Genetic predisposition)
Hypertension (High blood pressure)
High cholesterol
Diabetes (Sugar disease)
Obesity
Sedentary lifestyle
Unhealthy dietary habits
Intense stress
Smoking addiction
Substance abuse (Cocaine, amphetamines, etc.)
Other rare causes

How do you respond to someone having a heart attack?

Call 112 (or your local emergency number) immediately.
Administer Aspirin (250-300 mg). Chewing the medication allows it to enter the bloodstream faster through the sublingual vessels. Aspirin reduces the risk of death from a heart attack due to its antiplatelet (blood-thinning) effect.
If the patient is unconscious and you suspect they are having a heart attack, check their breathing and pulse. If the patient is not breathing or you cannot feel a pulse, begin cardiopulmonary resuscitation (CPR). If you have not been trained in CPR, even without giving rescue breaths, performing chest compressions at a rate of 100-120 times per minute (twice per second) can be beneficial.

How is a heart attack diagnosed?

For a patient who presents to the emergency department with complaints suggestive of a heart attack, the first test performed is an ECG (electrocardiography). The damaged area that fails to maintain its electrical balance usually manifests itself on the ECG. However, sometimes these issues are not reflected in the ECG. In other words, a normal ECG does not mean that a heart attack is not occurring. In such cases, blood tests are performed. Certain substances (troponin) leak out of the damaged cells, enter the bloodstream, and are detected in the blood analysis. For most patients, a diagnosis is established at this stage. Sometimes, a certain amount of time must pass for these substances to reach detectable levels in the blood. Therefore, even if the initial blood test is normal, it is repeated a few hours later. Throughout this process, an ECHO (echocardiography; heart ultrasound) is also performed if possible. The loss of movement in the heart tissue supplied by the blocked vessel can sometimes be detected on the ECHO.

If we wait for the blood test results during a heart attack, won’t we be too late to start treatment?

Let’s explain the logic behind the answer to this frequently asked question as follows: Suppose 100 people arrive at the emergency department with a significant complaint like chest pain. In reality, 20 of them are having a heart attack; 80 are not. Most of these 80 individuals do not actually have a major problem (for example, it could be muscle pain); however, some may have another life-threatening condition (stomach perforation, aortic dissection, pulmonary embolism, etc.). In other words, not every instance of chest pain is a heart attack. Thanks to the diagnostic approach mentioned above, we avoid mistakenly, unnecessarily, and perhaps harmfully performing an emergency angiography or starting the wrong treatment for the 80 people who have a problem other than a heart attack that causes similar complaints; furthermore, we ensure those other conditions are not overlooked. Remember, during this waiting period, the patient is still being monitored in the hospital—a safe environment where emergency intervention can be performed. In fact, among the 20 people having a heart attack, 15 are diagnosed immediately with the first ECG. To ensure that the remaining 5 people, who do not yet show ECG findings but are actually having a heart attack, are not mistakenly sent home with a “you are fine” message, blood is drawn immediately. In this first blood test, a heart attack is identified in 4 of those 5 people within a short time. Thus, the second blood test is performed so that the final 1 person—whose ECG, ECHO, and first blood test are normal but who is still actually having a heart attack—is not missed. In summary, the key point of this approach is that the issue is not just whether a heart attack is present, but that different emergencies causing the same complaint must also be considered in the differential diagnosis. This is because the treatment for each disease is very different, and the fundamental principle of avoiding incorrect treatment is a systematic approach.

How is a heart attack treated?

Treatment for a heart attack involves reopening the vessel as quickly as possible to restore blood flow and, therefore, deliver oxygen to the heart tissue before permanent damage occurs. For this reason, emergency angiography and a stent procedure are required. During angiography, the vessel blocked by a clot is identified; usually, a balloon is inflated to break up the clot, followed by the placement of a stent. A stent is a thin, wire-mesh tube that acts as a scaffold to keep the vessel open. Today, this is the primary treatment for a heart attack. However, a stent cannot always be placed or may not be successful. In such cases, emergency bypass surgery may be necessary. The longer the delay in a heart attack, the greater the damage. In locations without emergency angiography and stent facilities, powerful intravenous clot-dissolving medications (fibrinolytic drugs) are administered to try to open the vessel and prevent heart damage until the patient can be transferred. Ultimately, this buys the patient time for the primary treatment, which is the stent. In the final medical therapy, two blood-thinning (antiplatelet) drugs are used in combination to prevent the placed stent from developing a clot. One of these is low-dose Aspirin, and the other is a medication with the active ingredient clopidogrel, ticagrelor, or prasugrel. Cholesterol-lowering medications (statins) are also started to reduce fat accumulation in the heart vessels and decrease the risk of new narrowing. If heart failure, hypertension, and rhythm disturbances are present, their specific medications are added as well.

Can a heart attack happen again?

Yes, that is a possibility. One in five people who have a heart attack will have another one within five years. However, looking at it the other way around, many people never have another heart attack. Making lifestyle changes and taking medications as prescribed are crucial for reducing this risk.

Does the heart regenerate after a heart attack?

Unfortunately, no. If treatment is delayed after a heart attack and heart cells have been damaged, new heart muscle cells cannot replace the dead ones. Instead, connective tissue cells repair the area. However, unlike heart muscle cells, connective tissue cells cannot contract and therefore cannot contribute to pumping blood. As a result, the remaining healthy part of the heart must work harder to maintain its pumping function. If the damaged tissue is extensive, this becomes increasingly difficult, and eventually, heart failure develops. Starting treatment early is the most critical step in preventing this.

I was someone who exercised regularly and ate a healthy diet; why did I have a heart attack?

A heart attack does not occur due to a single cause. Many factors, including your genetic predisposition, chronic stress, and high blood pressure, all play a role. It is true that exercising and eating a healthy diet reduce the risk of a heart attack, but that does not mean the risk will be “zero.” Think of it this way: If you hadn’t been careful to lead a healthy lifestyle, you would likely have had a heart attack not now, but many years ago. In other words, by paying attention to these factors, you have postponed a heart attack for years.

What should I be careful about after a heart attack?

If you experience a complaint similar to the chest pain or symptoms you had during your heart attack, rest for a few minutes or take your sublingual (under-the-tongue) medication. If your chest pain does not subside despite resting or taking sublingual medication, go to the nearest emergency department or call 112.
Quit smoking; do not settle for just reducing it.
Do not consume alcohol; at the very least, reduce it (It was previously thought that small amounts of alcohol, especially wine, could be beneficial for the heart. However, according to new scientific data, it is likely best to avoid alcohol altogether. This is the recommendation of the latest European Society of Cardiology “Guidelines on Cardiovascular Disease Prevention”).
Do not gain weight; if you are overweight, lose weight through a healthy diet and exercise program.
Keep your cholesterol levels under control (by watching what you eat and using medication).
If you have diabetes (sugar disease) and hypertension, keep them under control.
Exercise regularly; at the very least, avoid using elevators, driving everywhere, and sitting continuously.
Use your heart medications (especially blood thinners) regularly.
Pay attention to what you eat (Details are mentioned below).

What should a patient who has had a heart attack eat?

Keep in mind that the Mediterranean-style diet recommended by international guidelines is actually applicable to everyone, whether they have cardiovascular problems or not. The difference for a patient who has had a heart attack is the need to follow these rules more strictly (See References).

Focus on a diet rich in vegetables and fruits. Ensure they are fresh and in season.
Consume more nuts such as walnuts, hazelnuts, and almonds (unsalted and raw), fish, legumes (dried beans, kidney beans, chickpeas, lentils), and high-fiber foods.
Do not eat too much bread. However, it is not correct to eat no bread at all. Prefer whole-wheat bread over white bread.
Reduce sweets and sugary drinks (cola, soda, fruit juices, etc.); if possible, remove them from your life. Request water or mineral water with your meals.
Stay away from processed meats (sausages, sucuk, salami, etc.). In fact, stay away from everything processed.
Use less salt; do not exceed 5 grams per day.
Avoid fast-food products and snacks like chips and biscuits.
Prefer low-fat or non-fat dairy products.
Do not use trans fats such as margarine. Cook your meals with healthier oils like olive oil or sunflower oil.
Do not consume too much animal fat (saturated fats) like butter. Actually, this subject has become somewhat controversial with new data. That is, consuming none at all is likely not correct. For example, you can consume butter at breakfast. There is also no harm in eating eggs.
You can eat up to 500 grams of lean red meat per week. However, we do not recommend eating offal (organ meats).
You can drink herbal teas, black tea, and coffee up to twice a day; however, more may cause palpitations.
Although a plant-based diet is generally considered healthier, do not fall into the misconception that every plant-based food is beneficial and every animal-based food is harmful. For example, remember that white flour and refined sugar, which are known to be harmful, are plant-based; while fish, known to be beneficial, is an animal-based food.
We also recommend reading our article titled “Can herbal treatment open blocked arteries?“

Heart Attack