Myocardial infarction

Myocardial infarction is a life-threatening condition that occurs when the heart gets too little oxygen. This is because one or more of the coronary vessels of the heart have been blocked so that the blood does not reach the heart muscle. Symptoms can be diverse, but many people experience sudden and persistent chest pain, often with sweating and difficulty breathing. Rapid medical care is required to restore blood supply and reduce damage to the heart muscle.


If you or someone close to you gets chest pain that does not go away after 15 minutes, seek emergency care and wait for an ambulance.


Myocardial infarction is a common indication of coronary artery disease. The World Health Organization estimated in 2004, that 12.2% of worldwide deaths were from ischemic heart disease.


Investigation and treatment have improved and more and more people are aware of risk factors such as smoking, unhealthy diet and lack of physical activity. Today, there are also cardiac starters in many workplaces, shopping malls and other places in the community where people circulate.


Men are more often affected than women and the risk of heart attack increases with age. As a rule, women get sick 5-10 years later than men, thanks in part to the female hormone estrogen, which has a protective effect up until the menopause.


The heart needs a constant supply of oxygen-rich blood to pump the blood into the body. The most common cause of a myocardial infarction is the rupture of an atherosclerotic plaque on an artery supplying heart muscle. Plaques can become unstable, rupture, and additionally promote the formation of a blood clot that blocks the artery; this can occur in minutes. Blockage of an artery can lead to tissue death in tissue being supplied by that artery. Atherosclerotic plaques are often present for decades before they result in symptoms. High blood fat / cholesterol levels and high blood pressure (hypertension) are major risk factors associated with heart attack. Heredity combined with lifestyle factors such as stress, unhealthy eating, too little exercise, smoking or too high alcohol consumption are common, underlying causes.


Common risk factors:


  • age and gender – the risk increases with age, men are affected more often than women
  • high cholesterol
  • hypertension
  • hereditary factors
  • smoking
  • diabetes
  • too little physical activity / abdominal obesity.


In more unusual cases, a myocardial infarction may be due to inflammation or damage to the vessels, other heart disease, severe anemia or very low blood pressure.


Myocardial infarction is generally characterized by sudden chest pain that lasts for more than 15 minutes. The pain can radiate in the left arm, but sometimes even in the right arm or higher up, in the shoulders and neck. Shortness of breath, nausea, sweating, and dizziness are also common.


Not all heart attacks give the same, clear symptoms. Some do not have chest pain but only feel weak, sometimes with difficulty breathing. Diffuse symptoms are especially common among women, the elderly and people with, for example, diabetes or kidney disease. A myocardial infarction can also exist without symptoms, so-called silent myocardial infarction, which usually shows up first by examination with ultrasound and ECG (electrocardiography).


Clear symptoms:


  • severe chest pain in the middle of the chest or pressure over the chest
  • pain radiating to the arms, back, neck, jaw or abdomen
  • cold sweats
  • respiratory distress
  • fatigue, weakness
  • nausea, dizziness and fainting
  • palpitations, high heart rate
  • anxiety 


Half of all heart attacks have several warning symptoms in the form of chest pain, shortness of breath and abnormal fatigue for days, weeks or months. Acute illness can occur in connection with physical or mental exertion, but a heart attack can also come during rest.


Persistent chest pain with respiratory distress and high pulse is not always a sign of heart attack. It may also include other serious illnesses that affect the heart, vessels or lungs such as heart failure, myocarditis, angina or blood clots in the lung.


Sometimes symptoms similar to myocardial infarction may have less dramatic explanations: Muscle aches near the heart can be caused by, among other things, exercise pains or mental stress, for example in a panic attack. It may feel uncomfortable, but is rarely dangerous. Gastrointestinal disorders can also be mistaken for myocardial infarction, such as gastric ulcer with severe heartburn. In case of herniated disk, the muscles in the chest can be affected and cause persistent pain that sometimes radiates to the arms.

Prevention and protection

If you believe that there is the slightest risk that you have suffered a heart attack, you need urgent care – you cannot do anything to stop the process yourself. If you suspect that someone close to you has or is suffering a heart attack, call an ambulance. If the person is unconscious, you should begin cardiac resuscitation and even use a heart starter if there is one nearby.


Many heart attacks give warning signals before acute problems begin. This is due to so-called unstable angina, which is usually experienced as chest discomfort and breathing difficulties, both during exertion and rest. If you experience this type of symptom, seek medical attention immediately.


If you do not feel sick but have high blood pressure or high blood fats, dietary changes and physical activity can make a big difference in lowering blood pressure as well as blood fat and blood sugar levels. This will reduce the risk of heart attack and other diseases.


Ways to reduce the risk of heart attack:


  • normalize cholesterol levels and blood pressure through dietary changes and physical activity (sometimes drugs are also required)
  • stop smoking
  • lose weight if you are overweight (especially in abdominal obesity)
  • avoid stress 
  • avoid alcohol


If you have diseases that increase the risk of heart attack, such as diabetes or kidney failure, you should go for regular medical check-ups.


In the case of acute myocardial infarction, rapid medical intervention is required in an ambulance or emergency room. Heart rate and blood pressure are always measured and the ECG shows whether the heart has been affected by oxygen deficiency or arrhythmia. Ultrasound and blood tests provide information about the heart’s pumping capacity and how much the heart has been damaged.


To localize blood clots and constrictions, coronary x-rays are often required. With the help of blood clot-releasing drugs or a so-called balloon dilation, the blood can flow freely again. Sometimes a major intervention, a so-called bypass operation, is required to ensure the circulation and function of the heart.


When you recover from a heart attack, you are generally prescribed medicines that reduce the risk of being hit again. These may include blood clotting inhibitors (so-called platelet inhibitors), beta-blockers and drugs that widen blood vessels and lower blood fats. Physical exercise and healthy food are also an important part of rehabilitation – you can get help from a physiotherapist, dietician or psychologist.

When to consult a doctor

In case of acute chest pain, pressure over the chest, spasmodic pain or an unpleasant sensation in the chest that lasts for more than 15 minutes, you will need emergency medical care. This also applies if you have chest pain at the same time as shortness of breath, nausea, cold sweats or irregular heartbeats.


If you suspect that you or someone close to you is suffering a heart attack, always seek emergency care and wait for an ambulance.

How Appotek can help

Appotek cannot help you with a heart attack. If you suspect that you or anyone nearby is having a heart attack, call an ambulance.


Vadym Diadiun, Doctor of Medicine, M.D.