Acute coronary syndrome and heart attacks

Acute coronary syndrome (ACS) is when the arteries that carry blood, oxygen, and nutrients get blocked. Heart attacks are a form of ACS. They occur when your heart doesn’t get enough blood supply. A heart attack is also known as a myocardial infarction.

The three types of heart attacks are:

  • ST segment elevation myocardial infarction (STEMI)
  • non-ST segment elevation myocardial infarction (NSTEMI)
  • coronary spasm, or unstable angina

“ST segment” refers to the pattern that appears on an electrocardiogram, which is a display of your heartbeat. Only a STEMI will show elevated segments. Both STEMI and NSTEMI heart attacks can cause enough damage to be considered major heart attacks.

Read on to learn more about each type of heart attack, as well as information on prevention, treatment, and recovery.

Read more: Acute coronary syndrome »

STEMI: The classic or major heart attack

When most people think of a heart attack, they often think of a STEMI. A STEMI occurs when a coronary artery becomes completely blocked and a large portion of the muscle stops receiving blood. It’s a serious heart attack that can cause significant damage.

Symptoms and signs of a STEMI

A STEMI has the classic symptom of pain in the center of the chest. This chest discomfort may be described as a pressure or tightness rather than a sharp pain. Some people who experience STEMIs also describe feeling pain in one or both arms or their back, neck, or jaw.

Other symptoms that may accompany chest pain include:

  • nausea
  • shortness of breath
  • anxiety
  • lightheadedness
  • breaking out in a cold sweat

Call for medical help immediately if you have symptoms of a heart attack. Most people who have a heart attack wait two or more hours for help. This delay can result in lasting heart damage or death.

Read more: Warning signs of a heart attack »

NSTEMI heart attacks

Unlike in a STEMI, the affected coronary artery is only partially blocked in a NSTEMI. A NSTEMI won’t show any change in the ST segment on the electrocardiogram.

A coronary angiography will show the degree to which the artery is blocked. A blood test will also show elevated troponin protein levels. While there may be less heart damage, an NSTEMI is still a serious condition.

CAS, silent heart attack, or heart attack without blockage

The coronary artery spasm is also known as a coronary spasm, unstable angina, or silent heart attack. The symptoms, which can be the same as a STEMI heart attack, may be mistaken for muscle pain, indigestion, and more. It occurs when one of the heart’s arteries tightens so much that blood flow stops or becomes drastically reduced. Only imaging and blood test results can tell your doctor if you’ve had a silent heart attack.

There is no permanent damage during a coronary artery spasm. While silent heart attacks aren’t as serious, they do increase your risk of another heart attack or one that may be more serious.

Treatments for all types of heart attacks

Immediate treatment

If your doctor suspects a heart attack, you may be treated immediately with:

  • aspirin to prevent blood clotting
  • nitroglycerin to relieve chest pain and improve blood flow
  • oxygen therapy

After your doctor confirms the heart attack, they will prescribe medications. They may recommend surgery, if needed.

Medications for heart attacks

Less severe heart attacks may be treated with medication. Your doctor will prescribe you medications based on your condition, risk factors, and overall health. These drugs may include:

Prices of heart attack medications

Surgical treatment for major heart attacks

Grafting: A blocked artery may also be treated with coronary artery bypass grafting, sometimes referred to as bypass surgery. In this procedure, a blood vessel is taken from elsewhere in the body and attached, or grafted, onto the blocked artery. With this, blood flow can be rerouted around the blockage.

Stent: A stent is a tiny, flexible, mesh tube that is placed at the site of the blockage. This opens up your blocked artery for normal blood flow. The plaque is pressed against the wall of the artery and the stent allows blood to pass through it.

Read more: Alternative treatments for heart attacks »

Heart attack recovery and outlook

Your recovery from a heart attack will depend on its severity and how it was treated. It can take anywhere from one week to several weeks before you can return to all your regular activities, especially anything involving heavy lifting.

Treating a heart attack promptly and effectively minimizes the damage. Your chances of a better outcome also improve if you do cardiac rehabilitation. Cardiac rehabilitation is a multiweek program of exercise routines, nutrition counseling, and learning about heart medications and lifestyle changes.

Follow-up appointments

Follow-up appointments with your doctor are typically done one, three, and six months after the heart attack. Then you’ll have them annually if you’re recovering well. It’s crucial to take your medications as prescribed and to follow all of your doctor’s instructions.

Feelings of anxiety or depression may also increase after a heart attack. Tell your doctor if you feel these emotions or if they interfere with your day-to-day activity. Your doctor can recommend steps to decrease anxiety.

Learn more: Recovery after a heart attack »

What increases your risk of a heart attack?

The risk factors for STEMI and NSTEMI are the same:

  • high levels of LDL (“bad”) cholesterol
  • high blood pressure
  • obesity
  • sedentary lifestyle
  • smoking
  • advanced age
  • diabetes

There are also risks associated with gender. For example, until age 55 or so, men are at a higher risk of heart attack. After menopause, though, women tend to have similar risks as men. Also, men tend to have problems in the heart’s larger arteries, while women often experience blockage in the smaller arteries of the heart.

Coronary artery spasm risk factors

The factors above also put you at risk of coronary spasm. But having other conditions can increase your risk of coronary artery spasms as well. These conditions include:

  • migraines
  • excess thyroid hormone
  • chronic allergy conditions
  • smoking
  • excessive alcohol consumption
  • low magnesium levels
  • taking drugs for chemotherapy

Heart attack prevention tips

You can lower your risk by following these key lifestyle behaviors.

Prevention tips

  • Spend at least 150 minutes (2.5 hours) per week doing moderate-intensity exercise, such as brisk walking or swimming.
  • Follow a heart-healthy diet that focuses on fruits, vegetables, whole grains, lean proteins (such as fish), beans, lentils, nuts, and olive oil.
  • Avoid red meat, processed foods, and beverages with added sugars.
  • Stop smoking.
  • Take your medications consistently.
  • Get 7 to 9 hours of sleep each night.
  • Reduce stress.
  • Get regular checkups and blood work done.

Keep reading: What to do after surviving a heart attack »