Heart attack symptoms, treatment and prevention

Every year UK hospitals see as many as 100,000 admissions as a result of heart attacks – that’s the equivalent of one person taken to hospital with a heart attack every five minutes (i). But while most of us realise heart attacks are a serious medical emergency – and in many cases life threatening – how much do we really know about them?
 

What is heart attack?

The medical term for a heart attack is myocardial infarction (MI). In simple terms, it’s when a partial or total blockage suddenly affects the supply of blood to your heart. When your heart doesn’t get the blood it needs, your heart muscle can become damaged and, if your heart stops beating, it can even be fatal. 
 

What causes heart attacks?

The biggest cause of heart attacks is coronary heart disease, which is when you develop a build-up of fat, cholesterol and other substances (collectively called atheroma or plaques) in a coronary artery or one of their smaller branches. This process, which makes your arteries more narrow, is called atherosclerosis, and it triggers heart attacks because it restricts the blood supply to your heart. Another way atherosclerosis causes heart attacks is when a piece of atheroma breaks loose and forms a clot, which can also block the supply of blood to the heart.
 
A less common cause of heart attacks is drug misuse, since certain recreational drugs can make the coronary arteries more narrow. A condition called hypoxia – which is where there’s a sudden lack of oxygen in the blood caused by lung problems or carbon monoxide poisoning – can also damage the heart muscles and trigger an attack.
 
However there is good news. Most people survive heart attacks and recover well (ii). Many of the risk factors for heart attacks can also be managed, which means there’s plenty you can do to avoid having a heart attack in the first place or prevent having another if you’ve already experienced one.
 

What are the heart attack statistics in the UK?

The latest provisional figures from the Office for National Statistics show that during 2021, 20,061 deaths happened in England and Wales where heart attack was the underlying cause (iii). This figure is slightly higher than the previous two years (19,440 in 2020 and 19,386 in 2019), though for a couple of decades before that numbers of hospital admissions for heart attacks had been steadily declining (iv).
 
One possible reason for the more recent rise in heart attack numbers could be that increasingly sophisticated tests are now detecting a greater number of milder heart attacks that may have previously gone unnoticed.
 

Heart attack rates by gender

Heart attacks are also often thought of as something that only affects men. But every year more than 30,000 women in the UK end up in hospital because they had a heart attack, with coronary heart disease killing more than twice as many women as breast cancer (v). Men, however, are almost three times more likely to be affected than women, with the latest figures suggesting 2.46 percent of men of all ages in the UK experience a heart attack compared with 0.87 percent of women (vi).
 
More encouragingly, however, the British Heart Foundation claims there are around 1.4 million people alive in the UK today who have survived a heart attack (i).
 

What increases your risk of heart attack?

While coronary heart disease is the most common cause of heart attacks, there are certain things that can increase your risk of developing it. These include:
 

• High blood pressure (over time this can damage your blood vessels – including your arteries – and make them more narrow, increasing your risk of having a blockage or clot)

• Smoking (chemicals in cigarettes can narrow and damage your arteries, and make them more susceptible to a build-up of atheroma; it can also raise your blood pressure and speed up your heart rate)

• High cholesterol (too much cholesterol in your bloodstream can contribute to the development of atheroma)

• Overweight (the more overweight you are, the harder your heart has to work and the more likely you are to have high blood pressure and high levels of fat in your blood)

• Diabetes (being overweight is also often linked to the development of diabetes, which is a major risk factor for heart disease – experts reckon people with diabetes are up to five times more likely to develop heart disease than those who don’t have diabetes (vii)) 

• Lack of exercise (if you’re not very active you’re more likely to have other risk factors for heart attacks too, including being overweight and having high blood pressure and cholesterol) 

• Alcohol misuse (drinking too much can raise your blood pressure and cholesterol as well as make you gain weight)

• Poor diet (as with lack of exercise and alcohol misuse, eating an unhealthy, high-fat diet is linked with the development of other heart attack risk factors)

• Drug misuse (several recreational drugs can raise your blood pressure, which increases your risk for a heart attack: cocaine, for instance is thought to increase your heart attack risk by almost 24 times during the first hour after you take it (vii))

• Family history (if a close family member has coronary heart disease your risk may be higher too – but while there’s nothing you can do about your genes, being aware of a family history of heart disease does mean you can take extra steps to reduce the risks that can be managed) 

• Ethnicity (people of African, Afro-Caribbean and South Asian ethnicity have a higher-than-average risk of coronary heart disease – again you can’t control your ethnic background, but you can control lots of other risk factors)

• Age (the older you get, the greater your risk is of having a heart attack – for instance, 0.06 percent of men and 0.02 percent of women aged 44 and younger have heart attacks compared with 12.08 percent of men and 5.5 percent of women aged 75 and older (viii))

 

What are the symptoms of a heart attack?

Chest pain is the most common symptom – more specifically this is usually a feeling of heavy pressure, tightness or squeezing across your chest – but you may feel pain elsewhere too, as if the pain is spreading to other parts of your body including your arms (usually the left arm but sometimes both arms), your back, neck, stomach and/or jaw. 
 

How long does a heart attack last?

This pain usually lasts for more than 15 minutes – this is how you can sometimes tell the difference between a heart attack and angina, with angina only usually lasting 15 minutes or less (read on for more details about angina).
 
The chest pain that comes with a heart attack is often severe, though some people only experience mild pain or discomfort, and may even mistake it for indigestion or heartburn. Very occasionally there may be no pain at all (viii).
 

Additional heart attack symptoms

 

• Breathlessness

• Rapid and/or weak pulse

• Coughing/wheezing

• Dizziness/lightheadedness

• Sweating 

• Pale skin

• Nausea and/or vomiting

• Severe anxiety (this may feel similar to a panic attack)

 

Female heart attack symptoms

According to the NHS chest pain is the most common symptom in both men and women, though women are more likely than men to experience other symptoms (ix).
 

What are the symptoms of heart attack in women?

Heart attacks often strike without warning, but the first signs of heart attack in a woman may be chest pain or pressure, sometimes hours, days or even weeks beforehand. Some women, however, can have a heart attack without having any chest pain or discomfort.
 
Other symptoms of heart attack in women include pain in other parts of the body – such as the neck, jaw, shoulder, stomach or upper back – as well as nausea, vomiting and breathlessness. Meanwhile research funded by the British Heart Foundation has found there’s no major difference in the key heart attack symptoms between the sexes (x). The research, however, did discover that heart attack symptoms in men are more likely to include less typical signs such as heartburn, back pain and indigestion-like pain than in women, with women more likely to experience pain in their jaw and nausea than men.
 

What's the difference between a heart attack and angina?

Angina is also caused by problems with blood flow to the heart, but it’s when the blood flow is reduced rather than blocked. It has similar symptoms to those of a heart attack, including chest pain and sometimes also breathlessness and nausea. And while it may not usually be life threatening, having angina can mean you have a higher risk of having a heart attack or stroke.
 

Treatments for angina

If you’ve been diagnosed with angina your doctor will usually prescribe medicine that can improve your symptoms. This medicine, called glyceryl trinitrate, improves the pain of angina quickly, often within five minutes (though you may need three doses spaced five minutes apart to get relief). If, after 15 minutes and taking three doses of glyceryl trinitrate the pain is still there, you may be having a heart attack and should call 999 for an ambulance.
 
In other words, the symptoms of angina can be controlled with medication, but heart attack symptoms can’t.
 

What to do if someone is having a heart attack?

If you suspect someone you’re with may be having a heart attack – that is, if they are experiencing chest pain as described above – call 999 as soon as possible. Help them to sit down while you wait for the ambulance: according to the Red Cross, sitting them on the floor leaning against a chair or a wall can help ease the strain on their heart, plus they’ll be less likely to hurt themselves if they collapse (xi). 
 
Another thing you could do is give them an aspirin tablet to chew slowly, if you have any aspirins available. The correct dose to give is a single 300mg tablet. Then try to reassure them until the ambulance arrives.
 
If you’re having the symptoms of a heart attack yourself, the same thing applies. Call for an ambulance (or ask someone to call for you) then sit and rest while you wait, chewing a single 300mg tablet if one is readily available (don’t get up and look for an aspirin as it may put too much strain on your heart).
 
Most importantly, don’t wait to call 999 because you’re worried about hospitals being too busy. A heart attack can cause serious heart damage if you delay, and the longer you go without medical  help the longer it will take you to recover.
 
Once you’re admitted to hospital with a suspected heart attack, you’ll usually have a test called an electrocardiogram (ECG) within the first 10 minutes. AN ECG can confirm whether or not you’ve had a heart attack, and if you have, which type of heart attack you’ve had using a measurement called the ST segment. 
 

Heart attack types

There are three main types:
 

• STEMI (ST segment elevation myocardial infarction): this is the most serious type of heart attack caused by a total blockage of the coronary artery.

• NSTEMI (non-ST segment elevation myocardial infarction): this is often less serious than a STEMI because the blood supply to the heart may only have been partially rather than totally blocked – though it’s still classed as a medical emergency because without treatment it can progress to a STEMI or serious heart damage.

• Unstable angina: the least serious type of heart attack, this is also classed as a medical emergency. Unstable angina is when the blood supply to the heart is seriously restricted but without any permanent damage to the heart muscle.

 

What are the complications of a heart attack?

Having a heart attack can cause certain complications, some of which may be mild and clear up fairly quickly (though others may need medication to control or even be life threatening):
 

• Arrhythmia: this is the term for an abnormal heartbeat, as in your heart beating too quickly (superventricular tachycardia), too slowly (bradycardia) or too irregularly (atrial fibrillation). Life-threatening arrhythmias include ventricular arrhythmia, which can cause sudden cardiac arrest, and complete heart block, which prevents your heart pumping properly.

• Angina: you could have angina before having a heart attack, or you may develop it after having a heart attack.

• Heart failure: this can happen when a heart attack leaves your heart muscle badly damaged, with treatment including medication and, occasionally, surgery. Symptoms include shortness of breath, fatigue and swelling in the arms and legs. 

• Cardiogenic shock: this is like heart failure but more serious, with treatment including cardiac surgery. Another serious complication of a heart attack is heart rupture, which can happen when the heart is seriously damaged. Fifty percent of people with heart rupture die within five days of the rupture happening (xii).

 

How is a heart attack treated?

If you’re diagnosed as having had a heart attack you’ll receive treatment to stop your coronary heart disease getting worse and to reduce your risk of having one or more further attacks. This may include medication – which you’ll usually have to take for the rest of your life – and/or surgery, depending on the type of heart attack you had.
 
If you had a STEMI heart attack, for instance, you would usually need a surgical procedure to widen your coronary artery called a coronary angioplasty. This is a procedure that places a tiny balloon in your artery to keep it open. If you can’t have a coronary angioplasty – if there are several blockages in different branches of your arteries, for instance – you may have a coronary artery bypass graft, which is when surgeons take a blood vessel from your chest, arm or leg and attach it to your coronary artery to bypass the narrowed or blocked area.
 

Heart attack medicines

 

• Antiplatelet and anticoagulant medicines help prevent blood clots (you may also need medicines to break down blood clots called thrombolytics or fibrinolytics)

• Beta-blockers to protect your heart and prevent the development of abnormal heart rhythms

• Statins to lower your cholesterol

 

How long does it take to recover from a heart attack?

After having a heart attack you’ll usually have to stay in hospital for a while – how long will depend on how severe the attack was and how well you’re recovering. The good news is that many people make a full recovery after having a heart attack, though it’s likely that you’ll recover faster if you attend a cardiac rehabilitation programme when you’re discharged from hospital (visit the British Heart Foundation’s website for more information about cardiac rehabilitation).
 

How to prevent a heart attack

There are lots of lifestyle changes you can make that may help reduce your risk of having a heart attack (or having a further heart attack if you’ve already had one). If you have a heart attack, you’ll usually receive all the information you need from your hospital before you leave, or when you attend cardiac rehab. Some of the things you can do to help keep your heart as healthy as possible include the following:
 

• Eat a healthy diet: try to limit high-fat foods, especially foods that contain saturated fat such as fatty meats, butter, ghee, cream, hard cheese, fried foods, pies and pastries,

• cakes, biscuits and foods that contain coconut or palm oil. Instead choose healthier oils such as olive oil and other plant-based oils, as well as oily fish like salmon, sardines, mackerel and pilchards. Also aim to eat at least five portions of fruit and vegetables every day, plus plenty of other fibre-rich foods such as whole grains.

• Stay active: exercising regularly can help reduce some of the risk factors linked with heart attacks as well as help keep your heart and blood vessels in good condition. Try working towards doing at least 150 minutes of moderate exercise every week and aim to be more active in general, especially if you spend a lot of time sitting during your day. However if you have recently had a heart attack or have heart disease or another medical condition, always check with your GP before starting to do any new exercise, as some activities may not be suitable for you.

• Manage your weight: if you’re overweight it’s a good idea to try to get your weight down to a healthier level, even if you only lose a small amount – read more about losing weight here. 

• Give up smoking: if you’re a smoker you can find more information about quitting in our guide to stop smoking.

• Drink alcohol in moderation: stick to the recommended limits of 14 units of alcohol a week, spreading your drinking over three or more days if you regularly drink that much and avoiding binge drinking, which can quickly raise your blood pressure to a dangerous level (xii). For tips on cutting down, read our guide to alcohol misuse.

• Watch your blood pressure: find ways to keep your blood pressure at a normal level, including reducing the amount of salt you eat (aim to have no more than 6g of salt a day). For more ways to help keep your blood pressure healthy, read our guide.

• Control your cholesterol: read more about how you can maintain a healthy cholesterol level by reading our cholesterol guide.

• Keep an eye on your blood sugar: if you have type 1 or type 2 diabetes, it’s important to keep your blood sugar levels in check. Find out more about what can happen when your blood sugar levels aren’t well controlled, as well as ways to keep them within your target range, by reading some of the guides in our diabetes category.

 

The best supplements for a healthy heart

For many people a healthier lifestyle may also include taking nutritional supplements that help support heart health and indeed health in general. A good-quality multivitamin and mineral supplement is often a good place to start, especially if your diet isn’t always as healthy as it should be. Not sure which multivitamin would suit you best? Take a look at our guide to multivitamins and daily requirements, which outlines some of the types of supplements that are available.
 

Coenzyme Q10

A powerful antioxidant that’s found in every cell in the body, CoQ10 – also known as ubiquinone – is found in particularly high concentrations in the muscles of the heart, though it’s thought that your levels in general decrease as you get older. Studies suggest CoQ10 may help people recovering from a heart attack (xiv), while there’s also evidence it may help reduce high blood pressure (xv). For instance, one study found just over half of participants were able to stop taking their blood pressure medications around four months after starting to take CoQ10 supplements (xvi).

An analysis of 12 clinical studies on CoQ10 and heart health also suggests taking it may reduce systolic blood pressure between 11-17mmHg and diastolic blood pressure between 8-10mmHg (xvii). Scientists writing in the journal Pharmacology & Therapeutics also claim CoQ10 has a potential role for the prevention and treatment of heart problems, and that it limits the progression of atherosclerosis (xviii).
 

Fish oils

The omega-3 fatty acids found in oily fish have been studied extensively for their potential in helping to protect the heart, with one review of randomised clinical trials finding people taking omega-3 fish oil supplements had lower risks of heart attack and other cardiovascular disease events compared with those who were given a placebo (dummy pill) (xix). A meta-analysis of 14 clinical trials has also found that supplementing with omega-3 fatty acids may reduce the risk of heart attack and other major adverse cardiovascular events such as stroke (xx). Fish oils may also be beneficial for heart health as they may raise levels of ‘good’ (HDL) cholesterol (xxi).

If you’re a vegetarian or vegan you can still benefit from an omega-3 supplement, thanks to the availability of products that contain the natural triglyceride (TG) form of omega-3, which is sourced from plant organisms called microalgae rather than fish.
 

Magnesium

Magnesium is a mineral that’s required by the body for muscle relaxation and is believed to be important for the regular functioning of heart muscle. There is, for instance, evidence that the level of magnesium in your blood may be related to your risk of coronary artery disease, with higher levels associated with lower risks (xxii). Taking magnesium supplements on a regular basis may also help to lower high blood pressure (xxiii).
 

Vitamin D

Vitamin D may help support heart health by reducing your risk of having high blood pressure later in life, says a paper that included 35 studies (xxiv). With more than 146,500 participants involved in those studies, the paper found people with higher vitamin D levels had lower blood pressure and were less likely to develop high blood pressure compared with those who had lower vitamin D levels. Researchers writing in the World Journal of Cardiology, meanwhile, believe having low vitamin D levels is significantly linked to heart attacks and recurrent major adverse cardiovascular events (xxv).

Vitamin D deficiency, however, is common in some countries including the UK, which explains why Public Health England advises adults and children aged one year and older to consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter (xxvi).

If your skin is rarely exposed to the sun – if you spend most of your time indoors, for instance, or if your skin is always covered when you’re out and about – you may also want to think about taking vitamin D throughout the year. People with dark skin from African, Afro-Caribbean and South Asian backgrounds should consider taking vitamin D all year round too, PHE advises.

The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan vitamin D3 supplements sourced from lichen are now more widely available.

Most heart attacks are caused by coronary heart disease, which is the UK’s single biggest killer. This guide describes the symptoms to look out for as well as the things that could increase your risk of having a heart attack. It also shows there are lots of things you can do to prevent having a heart attack – even if you’ve already had one, as research suggests 20 percent of people with acute coronary syndrome (which includes heart attacks) have another cardiac event within a year (xxvi). To discover more about heart health, as well as a wide range of general health conditions, visit our pharmacy health library.

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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