Heart attack: The most important facts at a glance

1. What is a heart attack?
2. What are the consequences of a heart attack?
3. What increases the risk of a heart attack?
4. How can a heart attack be prevented?
5. How are heart attacks, diabetes and obesity related?
6. What are the symptoms of a heart attack?
7. How is a heart attack diagnosed?
8. How is a heart attack treated?

The task of the heart muscle is to pump blood through the body. A heart attack (myocardial infarction) occurs when the blood flow to the heart muscle is completely or partially blocked. This is usually triggered by a blood clot in the coronary arteries, i.e., in the blood vessels that supply the heart with blood. In this context, doctors also speak of acute coronary syndrome. This is an umbrella term for situations in which the blood supply to the heart muscle is suddenly no longer guaranteed.

In addition to heart attacks, this term also includes unstable angina pectoris, in which coronary arteries are narrowed and severely restrict blood flow. All blockages begin with the formation of what are called plaques (deposits) in the coronary arteries. The plaques consist mainly of fat, cholesterol, calcium and connective tissue. Over time, they can become larger and larger and constrict the arteries. Doctors refer to the process of plaque formation as arteriosclerosis.

If plaques in an artery rupture or break open, a blood clot can form. This can block the artery and reduce or stop the blood flow to the heart muscle. As a result, the heart muscle is insufficiently supplied with oxygen and nutrients. This is called ischemia. Without sufficient oxygen, the cells in the heart muscle die, which is characteristic of a heart attack. The body cannot replace the dead tissue.

In Germany, more than 300,000 people suffer a heart attack every year. Most heart attacks occur in men between the ages of 68 and 76, and in women between the ages of 76 and 84.

Every person with a heart attack has his or her own medical history. The consequences and prognosis, i.e., the probable course of the disease, depend on, but are not limited to:

• how quickly the heart attack was treated by a doctor,
• how severe the heart attack was,
• how much tissue in the heart has been damaged,
• which other underlying diseases are present,
• how intensely affected people change their lifestyle after a heart attack.

Common consequences of a heart attack are fatigue, shortness of breath, weakness, but also anxiety, depression, or post-traumatic stress disorder (PTSD).

You can significantly reduce the risk of a heart attack by adopting a healthy lifestyle. The following aspects help to prevent a heart attack:

• Do not smoke: Smoking – including passive smoking – is a significant risk factor for cardiovascular disease. Your doctor’s practice or your pharmacy will help you to stop smoking. Ask for individual advice. Many health insurance companies also offer courses to help you stop smoking or subsidize participation in such courses – just ask.
• Balanced diet: Eat a healthy and balanced diet with plenty of vegetables, pulses, fruit, wholegrain products and “healthy” fats. These are found, for example, in fish, nuts and vegetable oils such as rapeseed, olive or linseed. Take advantage of the colorful variety of foods.
• Pay attention to fat and salt consumption: Reduce your consumption of saturated fatty acids, trans fats, cholesterol, and common salt. To achieve this, cook as much as possible yourself, avoid fast food and convenience products and season with herbs to reduce salt. The German Nutrition Society advises adults to consume a maximum of 6 grams of salt per day. This corresponds to about one teaspoon. Note: Ready-made products also contain salt.
• More exercise: Regular exercise, at least 150 minutes of moderate endurance training per week, can also improve heart health. This includes activities such as walking, running, cycling or swimming. Incorporate more exercise into your daily routine, especially if you sit a lot.
• Reach your normal weight: If you are overweight, try to reduce your body weight. A body mass index (BMI) of 18.5 to 24.9 kg/m² is considered normal weight. Values between 25.0 and 29.9 kg/m² are considered overweight. A BMI of over 30 kg/m² is considered severe overweight (obesity). This applies equally to men and women.
• Reduce your waist circumference: Weight loss measures can also reduce your waist circumference. The standard values for Europe are a waist circumference of less than 80 centimeters for women and of less than 94 centimeters for men.
• Stabilize your blood pressure: High blood pressure (hypertension) also increases the risk of cardiovascular disease. Anyone with high blood pressure should measure it regularly and take appropriate lifestyle measures to counteract it. This includes, for example, a healthy and balanced diet and regular exercise. If this is not enough, medication to control blood pressure (antihypertensives) can help. It is important to take them consistently and according to the doctor’s instructions.
• Bear your blood sugar in mind: If you have diabetes, it is important to keep an eye on your blood sugar levels and take your prescribed medication as directed. Find more information on the individual forms of diabetes in our “Living with Diabetes” portal. Even people with prediabetes have an increased risk of cardiovascular disease. Appropriate lifestyle measures can help to normalize blood sugar levels.
• Alcohol only in moderation: Avoid alcohol or try to reduce your alcohol consumption as much as possible. According to current scientific knowledge, even small amounts of alcohol may be harmful.
• Avoid stress: Chronic stress may also increase the risk of heart attacks. Learn techniques for coping with stress, for example relaxation techniques (yoga, progressive muscle relaxation according to Jacobson) or meditation. Many health insurance companies cover the costs of such courses in full or at least in part.
• Lower blood lipid levels: Have your blood lipid levels determined at your doctor’s practice. A low level of LDL cholesterol is good for heart health. If necessary, take medication as recommended by your doctor to lower and ideally normalize your blood lipid levels.
• Healthy sleep: Sleep long enough, between 7 and 9 hours per night. Too much or too little sleep can be harmful. You can improve the quality of your sleep, for example, by being physically active during the day, always going to bed at similar times and banishing all electronic devices from the bedroom. The bedroom should also be dark and as quiet as possible.

These symptoms sometimes appear suddenly. Nevertheless, up to 50 percent of all affected people show warnings of a heart attack. These are more common in women than in men. They include fatigue, anxiety, sleep disorders, shortness of breath and slight pain in the chest or arms.

The symptoms of a heart attack in women are often less severe. Severe pain that radiates to other areas of the body does not always occur as it does in men. Women are more likely to experience a feeling of pressure or tightness.

Other prominent symptoms of a heart attack in women can include:

• Shortness of breath
• Sweating
• Back pain
• Nausea
• Vomiting
• Pain in the upper abdomen
• Tiredness or even depression

Many people who have these symptoms think of other illnesses, for example of abdominal complaints, but not of a heart attack. This involves the risk of seeking medical help too late.

People with diabetes also often have different symptoms, which can lead to delayed diagnosis and treatment. There may be differences between people with and without diabetes:

• Typical chest pain symptoms may be absent
• Sweating, nausea, dizziness and fear of death are less common in people with diabetes than in people without diabetes
• Shortness of breath is more common in people with diabetes than in people without diabetes

If there are more than one rescuer on site, you can take turns giving chest compressions and send someone out to find an automated external defibrillator, or AED for short. Such devices can often be found in public buildings, at train stations or in busy squares.

Proceed as follows when using an automated external defibrillator (AED):

• Turn on the AED and follow the voice or visual instructions to apply the electrodes and deliver a shock if necessary. Do not worry: Unnecessary shocks are not triggered.
• Only interrupt chest compressions if the AED prompts you to do so.

In order to recognize a heart attack, doctors register typical symptoms during a conversation if the affected person is conscious. They auscultate the heart and lungs, examine the blood for heart attack markers such as troponin (a protein) and heart activity using an electrocardiogram (ECG) and apply various imaging techniques such as ultrasound examinations.

A cardiac catheterization can be used to detect blocked blood vessels and additionally open the blocked blood vessels directly at the same time.

Doctors differentiate between what is called an ST elevation myocardial infarction (STEMI) and a non-ST elevation myocardial infarction (NSTEMI). The STEMI shows pronounced changes in the ECG. One of the larger coronary arteries is completely blocked. In case of an NSTEMI, a coronary artery is usually only partially or temporarily blocked.

During emergency medical treatment, people with a suspected heart attack are given painkillers, oxygen and medication to prevent new blood clots and lower blood pressure if necessary.

In hospital, affected persons are examined and treated in specialized departments, which are called “chest pain units”, wherever possible. Based on the findings of the examinations, the attending physicians decide on the next steps.

The therapies include cardiac catheterization (percutaneous coronary intervention, or PCI for short): A catheter is inserted into the affected artery in order to widen the constriction with a small balloon. Doctors then place a stent (a tubular metal mesh) to keep the affected blood vessel permanently open.

In many cases, thrombolysis can be reasonable. Special medication is administered to dissolve the existing blood clot.

After acute treatment, people who have had a heart attack are given medication to prevent further blood clots, elevated blood pressure and/or increased blood lipid levels, depending on the results of the tests. The exact drug therapy is determined by the attending physician.

A heart attack is often followed by medical rehabilitation, or rehab for short. Important goals are:

• The successful return to everyday life.
• A healthy lifestyle and consistent use of prescribed medication to reduce the likelihood of further heart attacks.