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Heart Attack

Myocardial Infarction

Quick Facts

More than a million Americans have heart attacks each year. It happens every 40 seconds to someone in the U.S., according to the CDC.

Heart attacks happen to both men and women and those assigned male and female at birth. Although they are more likely as you get old, there are many risk factors—including high blood pressure, high levels of LDL (“bad”) cholesterol, diabetes, and whether you smoke—that you can change.

Types of heart attacks: When someone has a heart attack, you may hear some of these terms used:

STEMI (ST-elevation myocardial infarction): A heart attack where a coronary artery is completely blocked

NSTEMI (Non-ST-elevation myocardial infarction): A heart attack where a coronary artery is narrowed enough to greatly reduce blood flow but is not totally blocked

MINOCA (myocardial infarction with nonobstructive coronary arteries): A heart attack in which no blockages are seen in the main coronary arteries.

What Is a Heart Attack?

A heart attack is a life-threatening medical emergency that requires immediate treatment.

A heart attack, also known as a myocardial infarction, happens when the flow of blood that brings oxygen to a part of your heart muscle suddenly becomes blocked. Your heart can’t get enough oxygen. If blood flow is not restored quickly, the heart muscle will begin to die.

Heart attacks are very common. According to the Centers for Disease Control and Prevention, more than 800,000 people in the United States have a heart attack each year.

A heart attack is not the same as cardiac arrest, which happens when your heart suddenly and unexpectedly stops beating. A heart attack can cause sudden cardiac arrest.

Most heart attacks are caused by coronary artery disease. Your age, lifestyle habits, and other medical conditions can raise your risk of a heart attack. Symptoms of a heart attack include chest and upper body pain, shortness of breath, dizziness, sweatiness, and nausea. Women often experience different symptoms of a heart attack.

If you think you or someone else may be having a heart attack, call 9-1-1 right away. Acting fast can save your life. The longer the heart goes without enough oxygen, the more damage is done to the heart muscle.

Many people survive and live active, full lives after a heart attack. Getting help and treatment quickly can limit the damage to your heart.

What are other medical terms for a heart attack?

Myocardial infarction (MI): When an area of the heart muscle is damaged or dies after blood supply is blocked. MI is the classic medical term for a heart attack.

Acute coronary syndrome (ACS): When the blood supplied to the heart muscle is suddenly blocked.

STEMI: STEMI is a common name for ST-elevation myocardial infarction. It’s caused by a complete blockage in a coronary artery.

NSTEMI: A non-ST-elevation myocardial infarction is when an artery is partially blocked and blood flow is greatly reduced.

Coronary thrombosis: When a clot forms in one of the arteries that supply blood to the heart muscle. This slows or blocks blood flow to part of the heart muscle and can cause a heart attack. It’s also called coronary occlusion.

Symptoms

Not all heart attacks begin with the sudden and crushing chest pain that comes when the blood flow to heart gets blocked. Heart attack symptoms can start slowly and can be mild or more serious and sudden. Symptoms also may come and go over several hours. The symptoms of a heart attack can be different from person to person and different between men and women. If you’ve already had a heart attack, your symptoms may not be the same for another one.

Silent heart attacks

Heart attacks can happen without any symptoms or with very mild symptoms. These are called silent heart attacks. Silent heart attacks are more common in older adults and in people who have high blood sugar or diabetes.

What are the symptoms of a heart attack?

If you are having a heart attack, you may experience one or more of the symptoms below.

Chest pain, heaviness, or discomfort in the center or left side of the chest (this is the most common symptom)

Pain or discomfort in one or both arms, your back, shoulders, neck, jaw, or above your belly button

Shortness of breath when resting or doing a little bit of physical activity (this is more common in older adults)

Sweating a lot for no reason

Feeling unusually tired for no reason, sometimes for days (this is more common in women)

Nausea (feeling sick to the stomach) and vomiting

Heartburn or indigestion

Light-headedness or sudden dizziness

Rapid or irregular heartbeat

It is also possible to have mild symptoms or even no symptoms at all and still have a heart attack.

When to call 9-1-1

Any time you think you might be having a heart attack, don’t ignore it. Call 9-1-1 for emergency medical care, even if you are not sure that you’re having a heart attack.

Acting fast can limit damage to your heart and save your life. The 9-1-1 operator or emergency medical services (EMS) personnel can give you advice that can help prevent damage to your heart.

An ambulance is the best and safest way to get to the hospital. Do not drive to the hospital or let someone else drive you. EMS personnel can check how you are doing and start tests and lifesaving medicines right away. People who arrive by ambulance often get faster treatment at the hospital.

Every minute matters. Never delay calling 9-1-1, taking aspirin or doing anything else you think might help.

Knowing the difference between stable angina (chest pain in people who have coronary artery disease) and a heart attack is important.

The pain from angina usually happens after physical activity and goes away in a few minutes when you rest or take medicine to treat it.

The pain from a heart attack is more serious than the pain from angina. Heart attack pain doesn’t go away when you rest or take medicine.

If you don’t know whether your chest pain is angina or a heart attack, call 9-1-1.

Diagnosis

Calling 9-1-1 for an ambulance and getting to the emergency room quickly if you suspect a heart attack is critical. Once at the hospital, you will likely get tests to see whether you are having a heart attack or whether you have already had one.

An electrocardiogram (EKG) is the most common initial test and may be given within minutes of your arrival at the hospital. An EKG will check whether you may be having a heart attack.

Based on the results of the EKG, your doctor may then order more tests, ask you about your medical history, and do a physical exam.

Tests to diagnose a heart attack include:

Electrocardiogram (ECG or EKG). This first test done to diagnose a heart attack records electrical signals as they travel through the heart. Sticky patches (electrodes) are attached to the chest and sometimes the arms and legs. Signals are recorded as waves displayed on a monitor or printed on paper. An electrocardiogram (ECG) can show if you are having or have had a heart attack.

Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins (cardiac markers).

Chest X-ray. A chest X-ray shows the condition and size of the heart and lungs.

Echocardiogram. Sound waves (ultrasound) create images of the moving heart. This test can show how blood moves through the heart and heart valves. An echocardiogram can help identify whether an area of your heart has been damaged.

Coronary catheterization (angiogram). A long, thin tube (catheter) is inserted into an artery, usually in the leg, and guided to the heart. Dye flows through the catheter to help the arteries show up more clearly on images made during the test.

Cardiac computed tomography (CT) or Magnetic resonance imaging (MRI). These tests create images of the heart and chest. Cardiac CT scans use X-rays. Cardiac MRI uses a magnetic field and radio waves to create images of your heart. For both tests, you usually lie on a table that slides inside a long tubelike machine. Each test can be used to diagnose heart problems. They can help show the severity of heart damage.

Causes and Risk Factors

What causes a heart attack?

The most common cause of a heart attack is coronary artery disease, which is the most common type of heart disease. This is when your coronary arteries cannot carry enough oxygen-rich blood to your heart muscle. Most of the time, coronary artery disease happens when a waxy substance called plaque builds up inside your arteries, causing the arteries to narrow. The buildup of this plaque is called atherosclerosis. This can happen over many years, and it can block blood flow to parts of your heart muscle. Plaques that narrow arteries slowly over time cause angina.

Eventually, an area of plaque can break open inside your artery. This causes a blood clots to form on the plaque’s surface. If the clot becomes large enough, it can block blood flow to your heart. If the blockage isn’t treated quickly, a part of your heart muscle begins to die.

Other causes of a heart attack

Coronary artery disease causes most heart attacks. In coronary artery disease, one or more of the heart (coronary) arteries are blocked. This is usually due to cholesterol-containing deposits called plaques. Plaques can narrow the arteries, reducing blood flow to the heart.

If a plaque breaks open, it can cause a blood clot in the heart.

A heart attack may be caused by a complete or partial blockage of a heart (coronary) artery. One way to classify heart attacks is whether an electrocardiogram (ECG or EKG) shows some specific changes (ST elevation) that require emergency invasive treatment. Your health care provider may use electrocardiogram (ECG) results to describe these types of heart attacks.

Not all heart attacks are caused by blockages from atherosclerosis. When other heart and blood vessel conditions cause a heart attack, it is called myocardial infarction in the absence of obstructive coronary artery disease (MINOCA). MINOCA is more common in women, younger people, and racial and ethnic minorities, including Black, Hispanic/Latino, and Asian people.

Conditions that can cause MINOCA have different effects on the heart.

Small plaques in your arteries may not block your blood vessels, but they can break open or their outer layer can wear away. This can cause blood clots to form on these plaques. The blood clots can then block blood flow through your coronary arteries. The formation of small plaques is more common in women, people who smoke, and people who have other blood vessel conditions.

A sudden and serious spasm (tightening) of your coronary artery can block blood flow through your artery, even if there isn’t a buildup of plaque. Smoking is a risk factor for a coronary spasm. If you smoke, you may be more likely to have a spasm triggered by extreme cold or very stressful situations. Drugs like cocaine may also cause coronary spasm.

A coronary artery embolism occurs when a blood clot travels through your bloodstream and gets stuck in your coronary artery. This can block blood flow through your artery. This is more common in people who have atrial fibrillation or conditions that raise the risk of blood clots, such as thrombocytopenia or pregnancy.

Spontaneous coronary artery dissection (SCAD) occurs when a tear forms inside your coronary artery. A blood clot can then form at the tear, or the torn tissue itself can block your artery. SCAD can be caused by stress, extreme physical activity, and pregnancy. This condition is more common in women who are under 50 years old or pregnant and in people who have Marfan syndrome.

Other conditions may cause symptoms similar to a heart attack. Your doctor will look at all of your test results to rule them out.

What raises the risk of a heart attack?

Certain risk factors make it more likely that you will develop coronary artery disease and have a heart attack.

Risk factors you can control

Lifestyle habits, such as:

An unhealthy diet, including eating too many foods high in saturated fat or sodium

Lack of regular physical activity

Smoking

Other medical conditions, such as:

High blood cholesterol

High blood pressure or preeclampsia (high blood pressure during pregnancy)

High blood sugar or diabetes

High blood triglycerides

Overweight and obesity

If you have three or more of these conditions that raise your risk for heart disease, it is called metabolic syndrome. This greatly increases your risk of a heart attack.

Risk factors you can’t control

Age: The risk of heart disease increases for men after age 45 and for women after age 55 (or after menopause).

Family history of early heart disease: You have a higher risk if your father or a brother was diagnosed with coronary artery disease before 55 years of age or if your mother or a sister was diagnosed with coronary artery disease before 65 years of age.

Infections from bacteria and viruses

Can you prevent a heart attack?

You can lower your risk of a heart attack by changing behaviors that can raise your risks or treating any known coronary artery disease. Healthy lifestyle changes, including heart-healthy eating, staying active, quitting smoking, managing stress, and maintaining a healthy weight, can help prevent heart disease. Even if you already have coronary artery disease, these changes can lower your risk of a heart attack.

It is also important for you to get treatment for other health conditions that raise your risk of a heart attack. Talk to your doctor about whether taking aspirin can help you prevent blood clots that can lead to a heart attack.

Complications

Heart attack complications are often due to heart muscle damage. Potential complications of a heart attack include:

Irregular or atypical heart rhythms (arrhythmias). Heart attack damage can affect how electrical signals move through the heart, causing heartbeat changes. Some may be serious and can be deadly.

Cardiogenic shock. This rare condition occurs when the heart is suddenly and abruptly unable to pump blood.

Heart failure. A lot of damage to the heart muscle tissue can make the heart unable to pump blood. Heart failure can be temporary or long-lasting (chronic).

Inflammation of the saclike tissue surrounding the heart (pericarditis). Sometimes a heart attack triggers a faulty immune system response. This condition may be called Dressler syndrome, postmyocardial infarction syndrome or postcardiac injury syndrome.

Cardiac arrest. Without warning, the heart stops. A sudden change in the heart's signaling causes sudden cardiac arrest. A heart attack increases the risk of this life-threatening condition. It can lead to death (sudden cardiac death) without immediate treatment.

Treatment

Your doctor or emergency medical personnel may start treatment even before they confirm that you are having a heart attack. Early treatment to remove the blood clot or plaque can prevent or limit damage to your heart, help your heart work better, and save your life.

Emergency treatment

Medicines

Medications to treat a heart attack might include:

Aspirin. Aspirin reduces blood clotting. It helps keep blood moving through a narrowed artery. If you called 911 or your local emergency number, you may be told to chew aspirin. Emergency medical providers may give you aspirin immediately.

Clot busters (thrombolytics or fibrinolytics). These drugs help break up any blood clots that are blocking blood flow to the heart. The earlier a thrombolytic drug is given after a heart attack, the less the heart is damaged and the greater the chance of survival.

Other blood-thinning medicines. A medicine called heparin may be given by an intravenous (IV) injection. Heparin makes the blood less sticky and less likely to form clots.

Nitroglycerin. This medication widens the blood vessels. It helps improve blood flow to the heart. Nitroglycerin is used to treat sudden chest pain (angina). It's given as a pill under the tongue, as a pill to swallow or as an injection.

Morphine. This medicine is given to relieve chest pain that doesn't go away with nitroglycerin.

Beta blockers. These medications slow the heartbeat and decrease blood pressure. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. They are given to most people who are having a heart attack.

Blood pressure medicines called angiotensin-converting enzyme (ACE) inhibitors. These drugs lower blood pressure and reduce stress on the heart.

Statins. These drugs help lower unhealthy cholesterol levels. Too much bad (low-density lipoprotein, or LDL) cholesterol can clog arteries.

Aspirin or other medicines can prevent more blood clots from forming. In some people, aspirin may cause bleeding in the stomach.

Nitroglycerin, or nitrates, can make it easier for your heart to pump blood and to improve blood flow through your coronary arteries. Nitroglycerin also treats chest pain. You may also be given other medicines for chest pain. Side effects of this medicine include nausea, vomiting, weakness, a slow heartbeat, and low blood pressure.

Thrombolytic medicines, also called clot busters, can help dissolve blood clots that are blocking your coronary arteries. These medicines may cause bleeding problems. You may be given these if you were unable to reach a hospital that can do a percutaneous coronary intervention (see below) quickly enough.

Oxygen therapy

Oxygen therapy is a treatment that delivers oxygen gas for you to breathe. You can receive oxygen therapy from tubes resting in your nose, a face mask, or a tube placed in your trachea (windpipe). You may need oxygen therapy if you have a condition that causes your blood oxygen levels to be too low.

Oxygen therapy can be given for a short or long period of time in the hospital, another medical setting, or at home. Oxygen poses a fire risk, so you should never smoke or use flammable materials when using oxygen. You may experience side effects from this treatment, such as a dry or bloody nose, tiredness, and morning headaches. Oxygen therapy is generally safe.

Procedures

You may need one of the following procedures at the hospital or later to help restore blood flow to your heart. These procedures are often done as soon as your healthcare team confirms that you are having a heart attack.

Percutaneous coronary intervention

Percutaneous coronary intervention (PCI), also called coronary angioplasty, is a nonsurgical procedure that improves blood flow to your heart. Doctors use PCI to open blood vessels to the heart that are narrowed or blocked by buildup of plaque. PCI requires cardiac catheterization.

A cardiologist, the doctor who specializes in the heart, performs PCI in a hospital cardiac catheterization laboratory. Live X-rays help your doctor guide a catheter through your blood vessels into your heart, where special contrast dye is injected to highlight any blockage. To open a blocked artery, your doctor will insert another catheter over a guidewire and inflate a balloon at the tip of that catheter. Your doctor may also put a small mesh tube called a stent in your artery to help keep the artery open.

You may develop a bruise and soreness where the catheters were inserted. It also is common to have discomfort or bleeding where the catheters were inserted. You will recover in a special unit of the hospital for a few hours or overnight. You will get instructions on how much activity you can do and what medicines to take. You will need a ride home because of the medicines and anesthesia you received. Your doctor will check your progress during a follow-up visit. If a stent is implanted, you will have to take certain anticlotting medicines exactly as prescribed, usually for at least 6 to 12 months.

Serious complications during a PCI procedure or as you are recovering after one are rare, but they can happen. This might include:

Bleeding

Blood vessel damage

Treatable allergic reaction to the contrast dye

Need for emergency coronary artery bypass grafting during the procedure

Arrhythmias, or irregular heartbeats

Damaged arteries

Kidney damage

Heart attack

Stroke

Blood clots

Sometimes chest pain can occur during PCI because the balloon briefly blocks blood supply to the heart. Restenosis, when tissue regrows where the artery was treated, may occur in the months after PCI. This may cause the artery to become narrow or blocked again. The risk of complications from this procedure is higher if you are older, have chronic kidney disease, are experiencing heart failure at the time of the procedure, or have extensive heart disease and more than one blockage in your coronary arteries.

Surgical and other procedures

If you've had a heart attack, a surgery or procedure may be done to open a blocked artery. Surgeries and procedures to treat a heart attack include:

Coronary angioplasty and stenting. This procedure is done to open clogged heart arteries. It may also be called percutaneous coronary intervention (PCI). If you've had a heart attack, this procedure is often done during a procedure to find blockages (cardiac catheterization).

During angioplasty, a heart doctor (cardiologist) guides a thin, flexible tube (catheter) to the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow.

A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents are coated with a medication that helps keep the arteries open.

Coronary artery bypass grafting (CABG). This is open-heart surgery. A surgeon takes a healthy blood vessel from another part of the body to create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. It may be done as an emergency surgery at the time of a heart attack. Sometimes it's done a few days later, after the heart has recovered a bit.

Recovery

Most people survive heart attacks and live active, full lives. If you get help quickly, your treatment can limit damage to your heart muscle. Less heart damage and healthy lifestyle changes improve your chances of a better quality of life after a heart attack.

Cardiac rehabilitation

You may need cardiac rehabilitation to help you recover from a heart attack and to help prevent another heart attack.

Cardiac rehabilitation is a medically supervised program for people recovering from heart problems. Cardiac rehabilitation involves adopting heart-healthy lifestyle changes to lower your risk for more heart and blood vessel diseases. To help you adopt lifestyle changes, these programs include exercise training, education about heart-healthy living, and counseling to reduce stress and help you return to an active life.

Cardiac rehabilitation is provided in an outpatient clinic or in a hospital rehab center. Your team will design a program to meet your needs. During cardiac rehabilitation, you will learn to exercise safely and increase your physical activity. The length of time that you spend in cardiac rehabilitation depends on your condition. Medicare and most insurance plans cover a standard cardiac rehabilitation program that includes 36 supervised sessions over 12 weeks.

Cardiac rehabilitation can benefit you by:

Improving your health and quality of life

Reducing the need for medicines to treat heart or chest pain

Decreasing the chance you will need to go back to a hospital or emergency room for a heart problem

Preventing future heart problems

The heart-healthy lifestyle changes in cardiac rehabilitation have few risks. In very rare cases,, physical activity during the rehabilitation program can cause serious problems, such as injuries to your muscles and bones, or possible life-threatening heart rhythm problems.

Returning to normal activities

You may be able to return to your normal activities within a few weeks if you don’t have chest pain, discomfort, or other problems. Many people can start walking right away. Talk with your doctor about a safe schedule for returning to your normal routine, including sexual activity.

Depending on your state laws, you may be able to start driving within a week. You shouldn’t start driving if you still have symptoms of a heart attack.

Take steps to prevent another heart attack

Once you’ve had a heart attack, you have a higher risk of another one. Your doctor may prescribe medicines or talk to you about steps you can take, including heart-healthy lifestyle changes.

Medicines

ACE inhibitors lower your blood pressure and make it easier for your heart to pump blood. Side effects may include pain in your stomach area and swelling in your face and neck.

Anticlotting medicines, such as aspirin and clopidogrel, stop platelet from clumping together to form blood clots.

Anticoagulants, or blood thinners, help prevent blood clots from forming in your blood vessels. These medicines also keep existing clots from getting larger. Both anticlotting medicines and anticoagulants can cause bleeding problems.

Beta blockers make it easier for your heart to pump blood. These medicines are also used to treat irregular heartbeats and chest pain and discomfort. Side effects include an irregular heartbeat and worsening heart failure.

Statins control or lower your blood cholesterol. Serious side effects include muscle pain and muscle damage.

Take all your medicines as instructed by your doctor. Don’t change the amount of your medicine or skip a dose unless your doctor tells you to. If you find it hard to get your medicines or complete your cardiac rehabilitation program, talk to your doctor.

Make heart-healthy lifestyle changes

Learn more about heart-healthy living:

Heart-healthy eating

Aiming for a healthy weight

Managing stress

Physical activity

Quitting smoking

The symptoms of a second heart attack may not be the same as those of your first heart attack. Don’t take a chance if you’re not sure. Always call 9-1-1 right away if you or someone else has heart attack symptoms.

What kind of health problems can a heart attack cause?

A heart attack can cause serious heart problems, including the ones listed below.

Cardiac arrest

Cardiogenic shock

Heart failure

Heart inflammation

Irregular heartbeat

Sticking to your treatment plan can help prevent other problems.

Take care of your mental health

After a heart attack, you may worry about having another heart attack. You may also feel depressed and have trouble adjusting to your new lifestyle changes.

Talk about how you feel with your healthcare team. They may recommend talking to a professional counselor or joining a patient support group.

Let your loved ones know how you feel and what they can do to help you. Support from family and friends can help lower your stress and anxiety.

If you’re depressed, you may need medicines or other treatments that can improve your quality of life.

Heart Attacks in Women

The causes, risk factors, and symptoms of a heart attack can be different in women compared with men.

Causes and risk factors

Risk factors such as age, lifestyle habits, and other health conditions affect men and women differently.

Women may get heart attacks at older ages than men do.

Smoking, high blood pressure, high blood cholesterol, high blood sugar, obesity, and stress raise the risk of a heart attack more in women than in men.

Women are more likely than men to have heart attacks that are not caused by coronary artery disease. This can make it more difficult for healthcare providers to diagnose heart attacks in women.

Women have more health problems after having a heart attack than men do.

Symptoms of a heart attack in women

Both women and men who have a heart attack often have chest pain. However, in addition to chest pain, women are more likely to have these symptoms:

Pain in the shoulder, back, or arm

Shortness of breath

Unusual tiredness and weakness

Upset stomach

Anxiety

These symptoms can happen together with chest pain or without any chest pain.

Many women may not recognize that these are symptoms of a heart attack. Women may not get emergency treatment right away if they downplay their symptoms and delay going to the hospital, or if the usual initial screening tests performed at the hospital may not detect an early or atypical heart attack. Because of this, women have a higher risk of serious health problems after a heart attack.

It is important to call 9-1-1 if you have these symptoms. Early treatment can limit damage to your heart and can save your life.

Pregnancy and heart attacks

Heart attacks are not common among pregnant women, but they are possible both during and soon after delivery. Normal changes to your body during pregnancy can raise your risk of a heart attack. Your age, lifestyle habits, and other health conditions, such as bleeding disorders, obesity, preeclampsia(high blood pressure during pregnancy), and diabetes, can also raise your risk.

If you already have coronary artery disease, being pregnant can raise your risk of a heart attack. Coronary artery disease is a major cause of heart attacks during pregnancy. Ask your doctor whether it is safe for you to get pregnant and what steps you need to take to keep your heart healthy during your pregnancy.

Heart attacks caused by spontaneous coronary artery dissection (SCAD), a coronary artery embolus, or a coronary artery spasm are more common in pregnant women than in people who are not pregnant.

If you have symptoms of a heart attack during your pregnancy, or at any time, call 9-1-1 right away. Your healthcare team will take steps to protect your baby during these tests. Your healthcare team will also make sure that any treatment you take for a heart attack is safe to use during pregnancy.

Self care

To improve heart health, take the following steps:

Exercise. Regular exercise helps improve heart health. As a general goal, aim for at least 30 minutes of moderate or vigorous physical activity five or more days a week. If you've had a heart attack or heart surgery, you may have activity restrictions. Ask your health care provider what's best for you.

Eat a heart-healthy diet. Avoid or limit foods with a lot of saturated fat, trans fats, salt and sugar. Choose whole grains, fruits, vegetables, and lean proteins, such as fish and beans.

Maintain a healthy weight. Too much weight strains the heart. Being overweight increases the risk of high cholesterol, high blood pressure and diabetes.

Don't smoke. Quitting smoking is the most important thing you can do to improve heart health. Also, avoid being around secondhand smoke. If you need to quit, ask your provider for help.

Limit alcohol. If you choose to drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women and up to two drinks a day for men.

Get regular health checkups. Some of the major risk factors for a heart attack — high blood cholesterol, high blood pressure and diabetes — don't cause early symptoms.

Manage blood pressure, cholesterol and blood sugar. Ask your provider how often you need to have your blood pressure, blood sugar and cholesterol levels checked.

Control stress. Find ways to help reduce emotional stress. Getting more exercise, practicing mindfulness and connecting with others in support groups are some ways to ease stress.

Prevention

It's never too late to take steps to prevent a heart attack — even if you've already had one. Here are ways to prevent a heart attack.

Follow a healthy lifestyle. Don't smoke. Maintain a healthy weight with a heart-healthy diet. Get regular exercise and manage stress.

Manage other health conditions. Certain conditions, such as high blood pressure and diabetes, can increase the risk of heart attacks. Ask your health care provider how often you need checkups.

Take medications as directed. Your health care provider may prescribe drugs to protect and improve your heart health.

It's also a good idea to learn CPR properly so you can help someone who's having a heart attack. Consider taking an accredited first-aid training course, including CPR and how to use an automated external defibrillator (AED).

Preparing for your appointment

A heart attack usually is diagnosed in an emergency setting. However, if you're concerned about your risk of a heart attack, talk to your care provider. A cardiovascular risk assessment can be done to determine your level of risk.

You may be referred to a doctor trained in heart diseases (cardiologist).

Here's some information to help you prepare for your appointment.

What you can do

When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. You might need to avoid food or drink for a while before a cholesterol test, for example.

Make a list of:

Your symptoms, including any that seem unrelated to heart disease, and when they began

Family history of heart problems, including heart disease, stroke, high blood pressure, diabetes or early heart attacks

Important personal information, including recent major stresses or recent life changes

All medications, vitamins and other supplements you take, including doses

Questions to ask your provider

Take a friend or relative along, if possible, to help you remember the information you're given.

Some questions to ask your provider about heart attack prevention include:

What tests do I need to determine my current heart health?

What foods should I eat or avoid?

What's an appropriate level of physical activity?

How often should I be screened for heart disease?

I have other health conditions. How can I best manage these conditions together?

Are there brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your health care provider is likely to ask you questions, including:

How severe are your symptoms?

Are they constant or do they come and go?

What, if anything, seems to improve your symptoms?

If you have chest pain, does it improve with rest?

What, if anything, worsens your symptoms?

If you have chest pain, does strenuous activity make it worse?

Have you been diagnosed with high blood pressure, diabetes or high cholesterol?

What you can do in the meantime

It's never too early to make healthy lifestyle changes, such as quitting smoking, eating healthy foods and becoming more active. These are important steps in preventing heart attacks and improving overall health.

Call your local emergency number (911 in the US)

For any of the following:

You have any of the following signs of a heart attack:

Squeezing, pressure, or pain in your chest

You may also have any of the following:

Discomfort or pain in your back, neck, jaw, stomach, or arm

Shortness of breath

Nausea or vomiting

Lightheadedness or a sudden cold sweat

When should I seek immediate care?

You are tired and cannot think clearly.

Your heart is beating faster than usual.

You are bleeding from your gums or nose.

You see blood in your urine or bowel movements.

You urinate less than usual or not at all.

You have new or increased swelling in your feet or ankles.

When should I call my doctor or cardiologist?

You have trouble taking your heart medicine.

You have questions or concerns about your condition or care.

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