让我们谈谈心脏病发作

You’ve watched a心脏病发作happen in films and on TV enough times to know how they’re scary—but Hollywood’s “reel” life does not always reflect real life. It’s not just a man clutching at his chest in agony before collapsing to the ground. In fact, one in five heart attacks occur without ANY symptoms at all, meaning you could be having a heart attack and not even know it. Fortunately, treatment for heart attack has improved greatly, and your odds of not only surviving but thriving after having one have also increased. Even better? There is a great deal you can do to prevent having one in the first place. We’ve got all the info you need.

Heart Attack

我们的专业面板

We went to some of the nation’s top experts in heart attack to bring you the most up-to-date information possible.

Michael Goyfman M.D., MPH

Director of Clinical Cardiology

Long Island Jewish Forest Hills

Queens，NY

Guy Mintz, M.D.

Director of Cardiovascular Health & Lipidology

桑德拉地图集低音心脏病院

Manhasset, NY

David Friedman, M.D.

Director of Heart Failure Services

Northwell Health的Lij Valley Stream

长岛，纽约

What Is a Heart Attack, Anyway?

心脏病发作很常见。当导致心脏和心脏的动脉被阻止时，它们会发生。他们不能再提供足够的血液，饥饿氧气的核心。如果没有迅速治疗，心脏病发作可能是致命的，因为缺氧杀死心脏组织。（尚未压力，有很多医生可以做到，以确保不会发生。）

The CDC estimates that a heart attack occurs approximately every 40 seconds in the U.S. All told, that’s about 805,000 heart attacks a year. Formally known asmyocardial infarction, heart attack is a form of heart disease, and though they can be fatal, most are not. These days, nine out ten people who have a heart attack survive.
But what’s happening in the body during one? It comes down to blood flow in and out of your heart:

1. Your heart pumps blood to every cell in your body via a system of veins, arteries, and capillaries, collectively known as your blood vessels.

2. This blood provides oxygen and other essential nutrients, without which your body could not function.

3. 您的心脏还需要自己稳定的富含富氧血液供应，它有自己的冠状动脉网络提供。

Types of Heart Attacks

Technically, a heart attack is a single type of event—one that damages the heart muscle—but there are three different ways to cause that damage. The two most common have to do with blockages that lead to the heart, and the third interferes with blood flow in a different way. They are:

• STEMI, or ST-elevation myocardial infarction:这是一个批判性引起的心脏病发作，如果并不总是完整，障碍，通常在称为“罪魁祸首”的单个冠状动脉中。

• NSTEMI, or non-ST-elevation myocardial infarction:This is a heart attack caused by a critical obstruction in one or more coronary vessels. In this kind of heart attack, more vessels are likely to be involved but less heart muscle may be at risk (compared to a STEMI), because people with NSTEMI often have had time to develop what is known as "collateral circulation" that goesaroundblockages to supply the heart muscle in spite of obstructions in the main coronary vessels.

• 冠状动脉痉挛：This is when your arteries spasm and dangerously narrow, causing a partial or complete blockage of the heart’s blood supply, which leads to heart attack. It’s not common, but it does sometimes happen.

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赞助：打开心脏手术的替代解决方案

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What Causes a Heart Attack?

Most heart attacks occur as a result ofcoronary artery disease (CAD). When you have CAD, one or more of your heart’s arteries hardens and narrows as a dangerous, but slowly moving, buildup of fatty deposits calledplaque累积在动脉墙上。

随着时间的推移，这个过程，称为atherosclerosis, progressively restricts the flow of blood to the heart. Initially, this causes angina—the fancy word for chest pain—as the heart’s supply of oxygen gradually diminishes.

斑块堆积主要由胆固醇，钙和脂肪组成，其他物质周围收集。如果斑块的堆积成长为氧气供应被阻止，并且不再满足心脏需求，可能会发生心脏病发作。

More commonly, though, heart attacks happen when one of the plaque buildupssuddenly ruptures, or breaks apart. Your body’s emergency response system kicks in and forms a protective blood clot around the damaged spot. Unfortunately, this clot may result in an even bigger roadblock in your arteries, significantly or sometimes completely shutting down the flow of blood to your heart. The result? You guessed it: a heart attack.

Less commonly, the冠状动脉年代pasms. When this occurs, an artery narrows to a dangerous degree. That partially or completely cuts off your heart’s blood supply, causing chest pain. Spasms are often short-lived, lasting less than 15 minutes, and are not usually life-threatening. However, a severe, prolonged spasm can cause a heart attack if the artery remains narrowed long enough to damage the heart. Or, in some cases, a spasm may rupture a plaque buildup, which in turn triggers a heart attack.

What Are the Risk Factors for a Heart Attack?

But what produces the plaque buildup in the first place? According to the American Heart Association, damage to the inner lining of your arteries may be the trigger. The likely causes of that damage include some familiar suspects, such as:

• 抽烟：它能提高血压,导致斑块布鲁里溃疡ildup, and increases your risk of blood clots.

• High blood pressure (HBP):It stresses your arteries’ delicate tissue, which leads to damage and contributes to the start of plaque buildup.

• High cholesterol:This, too, contributes to plaque buildups. You have two types of cholesterol. The first, called低密度脂蛋白胆固醇(LDL), or "bad" cholesterol, is responsible for those buildups. The second, calledhigh-density lipoprotein(HDL), or "good" cholesterol, helps rid your body of LDL. When you have high cholesterol, you have too much LDL and too little HDL.

• High triglycerides:These are a type of fat found in your bloodstream, and are linked to heart attack risk because they may help harden and stiffen your arteries.

• 肥胖, particularly belly fat:肥胖raises blood pressure and inflammation, both potential triggers of plaque buildup, while an oversized waist indicates excessive visceral fat, which has been linked to high cholesterol.

• High blood sugar:This damages your blood vessels as well as the nerves that control your heart and blood vessels.

While these risk factors can be tied to lifestyle choices that you can modify, some heart attack risks can’t be altered. They include:

• 年龄：As you get older, your arteries begin to stiffen. That, in turn, increases your risk of HBP, and it puts adults 65 and over at much higher risk of heart attack than younger people.

• 遗传学和家族史：If one or both of your parents had a heart attack at an early age (dad before 55, mom before 65), that bumps up your risk. According to Harvard Medical School, your risk of heart attack triples if both parents had one at age 50 or older, and it's seven times higher if their heart attacks occurred before age 50. Also, households often share the same habits and environments, which can include poor diet, lack of exercise, and smoking. Even if you didn’t smoke yourself, growing up around smokers exposes you to secondhand smoke.

一些慢性病也取消了心脏病发作的几率，包括：

• Type 2 diabetes:Elevated blood sugar levels will damage your arteries over time. People with this condition often have other heart attack risk factors such as high blood pressure and obesity.

• 炎症性疾病：These include chronic conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel disease, and lupus, because inflammation common to all these diseases contributes to plaque buildups in your arteries.

• Sleep apnea:This disorder, where your breathing repeatedly stops and starts throughout the night while you are sleeping, raises your blood pressure and puts strain on your heart.

What Are the Symptoms of a Heart Attack?

Heart attacks can have a wide variety of symptoms—and sometimes they have none at all. They can come on suddenly, or they can develop over a period of hours, days, or even weeks. And some symptoms may not seem like they’d be related to heart attack, which makes it all the more important to understand your risk factors and the symptoms to be on the alert for. Still, if you think you might be experiencing any of the symptoms listed below, don’t hesitate—call 911. It just might save your life.

让我们看看一些the ways your body may tell you there’s a problem:

• 胸痛，压力，挤压（也称为心绞痛）：它可能会觉得大象坐在胸前，但它也可能与胃灼热症状更温和和类似的症状。它也可以来。女性比男性不那么可能患有胸痛，但它仍然是两者都是最常见的症状。不要忽视它。但请记住：你可以在没有胸痛的情况下心脏病发作。这发生在所有人的一半近。

• Shortness of breath:This can occur whether or not you have chest pain. It may come on suddenly, even though you haven’t exerted yourself, and worsen over time.

• Pain or discomfort in your upper body:The pain you experience may have originated in your heart, but your nerve pathways leading from your heart may cause you to feel that pain (which is not sharp but rather gives off a sensation of heaviness or numbness) in other parts of your body, including your arms, back, neck, jaw, and stomach.背部和颌骨疼痛更常见于女性, according to the American Heart Association.

• Nausea and vomiting:When a heart attack happens, you might feel queasy. The feeling can be constant or come and go, and while its causes are not fully understood, it’s thought to be triggered by the stimulation of your vagus nerve and/or other nearby nerves which can upset your stomach.

• 疲劳：这不是你典型的'我从漫长的一天疲惫不堪。在正常的例程之后，这感觉过于疲倦或倒闭。它可以突然来。但不总是。在心脏病发作前几天甚至几周，大约有三个人会遇到疲劳。

• Lightheadedness or dizziness:感觉Halozy，就像你可能晕倒一样，可能是从心脏损伤中血压下降的结果，这导致心脏泵效果更低。血流减少也会影响大脑。

• Cold sweats:The sudden, drenching sweats that can accompany a heart attack may be part of your nervous system’s response to your chest pain, or to a sudden spike in blood pressure.

心脏病发作也可以沉默

A silent heart attack can mean one of two things:

1. Your heart attack had no symptoms.

2. Or, the symptoms were so mild or non-specific that they were easy to write off as a strained chest muscle, the flu, or a case of indigestion. Often, they are not diagnosed until you visit your doctor for a routine checkup, or if you see your doctor because of symptoms you likely didn’t realize were heart-related, such as疲劳，胃灼热和呼吸急促.

But make no mistake: Silent heart attacks are just as dangerous as any other type, potentially causing permanent damage. They comprise up to 45% of all heart attacks, according to estimates from the The American Heart Association (AHA), which also reports thatwomen may be more likely than men to have a silent heart attack, which may explain why their symptoms can be misunderstood and often misdiagnosed, even by trained emergency room staff. Patients with diabetes are also more likely to have a silent heart attack.

There are no hard and fast rules that cover what symptoms you will experience. That makes it extra important to discuss any risk factors you may have with your doctor. Know the warning signs—and take even vague symptoms seriously. Remember, don’t waste time trying to diagnose yourself.如果您不确定导致症状的原因，请效果安全。拨打911。

How Do Doctors Diagnose a Heart Attack?

诊断心脏病发作可能需要几次测试。其中一些不需要侵入性程序，而其他人则做。但首先，基础知识。您的医生将审查您的症状，检查您的血压，脉搏和温度，并学习您的健康历史，并识别您可能拥有的任何心脏病风险因素，包括吸烟，糖尿病，饮食缺乏缺乏运动和压力。

典型的测试包括：

• Electrocardiogram (ECG or EKG):您将获得第一个测试，ECG，衡量您的心脏活动，并以电脑显示器或纸张打印输出的波状图案的形式显示它。如果你有心脏病发作 - 或者仍然有一个 - 波浪将表明你的心脏不再是电力，这是伤害的迹象。

• Blood tests:Your doctor will draw blood to help diagnose what’s happening. The test most likely to be used first detects the presence of a protein call troponin. Your heart releases this into your bloodstream only when it has been damaged, and its presence will help confirm that you’ve had a heart attack. The more troponin there is, the larger your heart attack. If your doctor strongly suspects a heart attack, you’ll likely be moved to treatment before the blood test results return.

• Coronary angiography:During this invasive test, done while you are awake, your doctor will perform a cardiac catheterization, threading a very thin and flexible tube called a catheter through one of the blood vessels in your groin until it reaches the blockage in your artery. Once in place, dyes and X-rays allow your doctor to see the blockage and observe blood flow.

What Are the Treatments for a Heart Attack?

Your doctor’s first goal when you have a heart attack: improve the flow of oxygen-rich blood to your heart. The sooner treatment begins, the less damage to your heart and the greater the likelihood you’ll survive.

Treatment will depend in part on the type of heart attack. If you don’t have a total blockage of your artery, meaning that some blood can still flow to your heart, medications may be all that you require. Total blockages, on the other hand, will require more drastic, invasive interventions to get blood flowing to your ticker once again.

Heart Attack Medications

The following types of drugs will be in your doctor’s arsenal:

• 抗血小板药物：This type of medication, which includes aspirin, helps prevent more blood clots from forming.

• Anti-coagulants:Often called blood thinners, these medications are used to slow the development of clots, but they increase the risk of bleeding.

• 硝酸甘油：This medication helps ease your heart’s workload by increasing blood flow and reducing chest pain.

• Beta blockers:These slow your heart rate, reducing your heart’s need for oxygen while easing the pressure in your arteries.

• CLOT破坏者（溶栓）：These drugs target the clot that’s blocking blood flow and causing your heart attack. Treatment with these intravenous drugs typically lasts about an hour during a heart attack.

• Pain relievers:Your doctor may give you a drug like morphine to ease your chest pain (angina).

• ACE inhibitors:This type of drug brings down your blood pressure to ease the stress on your heart.

• 他汀类药物和非他汀类药物：Statins are used to control cholesterol. But statins don’t work well enough for everyone, or they can cause side effects you might not be able to tolerate, such as muscle pain, mental fogginess, and digestive disturbances. If that happens, your doctor likely will prescribe another type of cholesterol-lowering drug, such as a bile acid-binding resin.

You may also receive:

Oxygen therapy:If your blood oxygen levels have dipped below 90% due to your heart attack, you will likely receive supplemental oxygen via a mask placed over your face. Normal oxygen levels range from 95% to 100%.

Surgeries for a Heart Attack

If you have a severe or critical blockage in your artery, you may require a stent or surgery to restore blood flow. These procedures include:

• Coronary angioplasty and stenting:This procedure is frequently performed immediately following a cardiac catheterization. Once the catheter reaches the location of the blockage, the cardiologist inflates a tiny balloon at its end to open the blood vessel and restore blood flow. At the same time, a metal mesh tube called a stent is implanted at this point. It is used to keep your artery open.

• Coronary artery bypass surgery:During this surgery, the surgeon takes part of a healthy blood vessel from another part of your body, such as your lower leg. The surgeon then attaches that blood vessel to points on the blocked artery before and beyond the blockage, allowing the flow of blood to bypass the obstruction. This is usually a planned procedure, but it is sometimes performed during a heart attack or shortly after. It will depend on where your artery blockages occur, and how many blockages there are.

心脏病发作后的生活是什么样的？

Your number-one priority is to improve your heart health and prevent another heart attack from happening. That means making some important lifestyle changes to reduce your risk from having another one. Follow your cardiologist’s recommendation and enroll in a cardiac rehabilitation program—many hospitals offer them.

Cardiac rehab programsinvolve health professionals from many different specialties, including cardiologists, nutritionists, and exercise physiologists. Over 12 weeks, you’ll learn how to live a healthier life through:

• Regular exercise

• Improved nutrition

• Weight management

• Better adherence to your prescription drug plan

• Psychological counseling

• 如有必要，帮助戒烟

• Stress management

No doubt about it: Having a heart attack is extremely scary. Your world will change after you experience one. It has to! You’ll need to recover, yes, but you’ll also likely have to make some big changes to how you live your life. That can feel overwhelming and even increase your risk of depression. That’s why doctors strongly recommend patients begin their new post-HA lives by entering a cardiac rehab program.

心脏康复工作。根据美国心脏协会的说法，完成此类计划的人比那些不采取的人更容易生存的可能性近50％，因为他们了解在管理心脏病的同时保持健康所需的技能和信息。这意味着思想健康和身体。Addressing the stress, anxiety, anddepressionthat often follow a heart attack and make recovery more difficult will be a key part of your treatment plan.

和你的医生谈谈症状看你t for. Do you no longer stick to your regular routine? Have you become more withdrawn than is normal for you? Both may be signs of depression. Talk to your doctor, who can recommend the best cardiac rehab program that is closest to you.

Meet Our Writer

马特麦克米伦

马特麦克米伦has been a freelance health reporter since 2002. In that time he’s written about everything from acupuncture to the Zika virus. He covers breaking medical news and the latest medical studies, profiles celebrities, and crafts easy to digest overviews of medical conditions. His work has appeared, both online and in print, in华盛顿邮政,WebMD Magazine,Diabetes Forecast,AARP, and elsewhere.

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