Heart Attack

A heart attack, or myocardial infarction, occurs when blood flow to a part of the heart muscle is blocked, causing damage or death of heart tissue. This blockage is typically due to a blood clot that forms in one of the coronary arteries, which supply oxygen-rich blood to the heart. Without prompt treatment, the affected portion of the heart muscle begins to die, which can lead to serious complications, including heart failure, arrhythmias, and even death.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG) | MRCP (UK) | MMed (Internal Med) (SG) | FAMS (Cardiology, SG)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of a Heart Attack

The following symptoms may indicate someone is experiencing a heart attack and require immediate medical attention.

Chest pain or discomfort

Often described as pressure, squeezing, fullness, or pain in the centre of the chest. It may last for several minutes or come and go.
Upper body discomfort

Pain or discomfort may spread beyond the chest to the shoulders, arms, back, neck, jaw, or upper stomach.
Shortness of breath

This can occur with or before chest discomfort and may happen even while at rest or with minimal physical activity.
Cold sweat

Sudden sweating, often with cold, clammy skin, may indicate reduced blood flow to the heart.
Nausea or vomiting

Some people experience stomach discomfort, nausea, or vomiting, which can sometimes be mistaken for indigestion.
Light-headedness or dizziness

A feeling of faintness or dizziness may occur due to reduced blood flow to the brain.
Fatigue

Unusual or extreme tiredness, sometimes persisting for days before a heart attack, may be an early warning sign, particularly in women.

Causes and Risk Factors

A heart attack occurs when the coronary arteries become narrowed or blocked, typically due to a combination of factors that develop over time.

Atherosclerosis

Fatty deposits (plaque) accumulate inside artery walls, causing narrowing and reduced flexibility. This restricts blood flow and increases the risk of blockages.

Blood clots

If a plaque deposit ruptures, it can trigger the formation of a clot at the site. A large clot can completely block the artery, stopping blood flow to part of the heart.

Coronary artery spasm

A sudden tightening of a coronary artery temporarily reduces or blocks blood flow. This may occur even in arteries without significant plaque build-up.

Genetics

A family history of heart disease increases the likelihood of developing cardiovascular problems, especially if close relatives had heart disease at an early age.

Tobacco exposure

Smoking and long-term exposure to second-hand smoke damage artery walls, promoting plaque build-up and increasing clot formation.

High blood pressure

Increased force against artery walls causes them to harden and narrow, making it more difficult for blood to flow efficiently.

High cholesterol

Excess LDL (bad) cholesterol contributes to plaque formation, which further narrows arteries and increases the risk of heart attacks.

Diabetes

Elevated blood sugar levels damage blood vessels over time, accelerating atherosclerosis and increasing the risk of heart attack.

Obesity

Carrying excess weight is linked to inflammation, high cholesterol, high blood pressure, and increased strain on the heart.

Chronic stress

Prolonged stress may contribute to high blood pressure, unhealthy coping behaviours, and inflammation, all of which affect heart health.

Physical inactivity

A sedentary lifestyle is linked to obesity, poor circulation, and an increased risk of heart disease. Regular movement supports cardiovascular health and reduces other risk factors.

Diagnostic Methods

Electrocardiogram (ECG)

This test records the electrical activity of the heart and can detect abnormalities in heart rhythm or damage to the heart muscle. An ECG is typically one of the first tests performed when heart attack symptoms are present, as it can quickly identify characteristic changes, such as ST-segment elevation, that indicate ongoing heart damage.
Blood tests

Certain proteins, known as cardiac enzymes, are released into the bloodstream when the heart muscle is damaged. Tests for cardiac troponin and other biomarkers help confirm a heart attack diagnosis. Multiple blood samples may be taken over several hours to track changes in enzyme levels, providing information about the timing and extent of heart damage.
Coronary angiography

This procedure involves injecting a special dye into the coronary arteries and taking X-rays to visualise blood flow. Coronary angiography can identify the location and severity of blockages in the coronary arteries. The test is often performed during cardiac catheterisation, where a thin, flexible tube is guided through a blood vessel to the heart.
Echocardiogram

This ultrasound test creates images of the heart in motion, showing the size and shape of the heart, pumping capacity, and any tissue damage. An echocardiogram can reveal areas of the heart that aren’t contracting normally due to damage or poor blood flow, as well as complications such as heart valve problems.
Cardiac CT or MRI

These imaging tests provide detailed pictures of the heart and coronary arteries. They can show the extent of damage from a heart attack and help identify areas of reduced blood flow. These tests are particularly useful for assessing heart function and detecting structural abnormalities that may have contributed to the heart attack.
Stress tests

These evaluate the heart’s performance during physical activity. While not typically used during an acute heart attack, stress tests may be conducted after recovery to assess the heart’s function and help guide treatment decisions. Various types include exercise stress tests, nuclear stress tests, and stress echocardiograms.

Treatment Options

The treatment approach for heart attacks focuses on restoring blood flow quickly to minimise heart muscle damage and prevent complications.

Non-Surgical Treatment

Medications: Aspirin helps prevent blood clotting and is often given immediately when a heart attack is suspected. Other medications include antiplatelet agents to prevent blood clotting, beta-blockers to reduce heart rate and blood pressure, statins to lower cholesterol levels, and ACE inhibitors to aid in heart recovery. Pain relief medication may also be administered to alleviate chest discomfort.
Thrombolytic therapy: These clot-dissolving medications help restore blood flow by breaking down blood clots in blocked coronary arteries. They are most effective when given within the first few hours of a heart attack, reducing heart muscle damage. Thrombolytics work by activating plasmin, an enzyme that breaks down fibrin, the structural protein in blood clots.

Surgical Treatment

Percutaneous Coronary Intervention (PCI): A catheter with a balloon is inserted into the blocked coronary artery, where the balloon is inflated to compress the plaque against the artery wall. A stent, a small mesh tube, is often placed to keep the artery open. Primary PCI is the preferred treatment for ST-elevation myocardial infarction (STEMI) when available and performed within recommended time frames.
Coronary Artery Bypass Grafting (CABG): This surgery redirects blood flow around blocked coronary arteries using blood vessels from other parts of the body. CABG is often recommended for patients with multiple blockages, left main coronary artery disease, or when PCI is not suitable. The procedure requires general anaesthesia and a more extended recovery period than PCI.

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Prevention and Management

Heart attack prevention focuses on managing risk factors through lifestyle changes and, when necessary, medication. Regular physical activity strengthens the heart and improves circulation. A heart-healthy diet low in saturated fat, trans fat, and sodium supports cholesterol and blood pressure control. Maintaining a healthy weight reduces strain on the heart, while avoiding tobacco, managing stress, and limiting alcohol further lowers risk. For those with conditions that increase heart attack risk, taking prescribed medications consistently and attending regular check-ups help monitor and adjust treatment as needed. After a heart attack, following a cardiac rehabilitation programme, adhering to prescribed medications, and making recommended lifestyle changes support recovery and reduce the risk of future events.

Frequently Asked Questions (FAQ)

How does stress affect heart attack risk?

Chronic stress can raise blood pressure, increase heart rate, and damage blood vessels over time. In people with heart disease, sudden stress may trigger a heart attack by causing arteries to constrict or disrupting plaques. Stress management techniques, such as deep breathing, meditation, and regular exercise, can help lower the risk.

Can women experience different heart attack symptoms than men?

Yes, women may have symptoms beyond chest pain, such as shortness of breath, nausea, vomiting, back or jaw pain, and unusual fatigue. These differences can sometimes lead to misdiagnosis or delayed treatment, highlighting the need for greater awareness.

Can a heart attack be mistaken for heartburn?

Yes, as both can cause chest discomfort. However, heart attack pain often spreads to the arm, jaw, or back and may come with shortness of breath, sweating, or nausea. Heartburn pain usually worsens after eating and improves with antacids. If symptoms are unclear, seek emergency medical care to avoid delaying potentially life-saving treatment.

Dr. Kua Jieli

Senior Consultant
Cardiologist (Intervention)

MBBS (SG)|MRCP (UK)|MMed (Internal Med) (SG)|FAMS (Cardiology, SG)

A Senior Consultant Cardiologist specialising in interventional cardiology and serves as the Medical Director at Carrington Cardiology, located at Mount Elizabeth Medical Centre in Singapore.

Dr. Kua obtained his MBBS from the National University of Singapore. He furthered his medical education by earning an MRCP in the UK and an MMed in Internal Medicine from NUS. He completed advanced training in interventional cardiology at Hammersmith Hospital in London.
Dr. Kua’s international training at Hammersmith Hospital provided him with extensive experience in complex coronary interventions and exposure to advanced cardiovascular research. He served as an International Cardiology Fellow and Honorary Consultant during his tenure there.

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