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How Does a Heart Attack Occur?
A heart attack is usually the result of a process that develops silently over many years: atherosclerosis (hardening of the arteries). Cholesterol, fat, calcium and inflammatory cells accumulate inside the coronary artery walls, forming plaques.
During a heart attack, the process unfolds as follows:
- An atherosclerotic plaque in the artery wall suddenly ruptures or cracks, triggered by factors such as high blood pressure or sudden stress.
- The body sends platelets to the area to repair the rupture.
- The accumulating platelets form a blood clot (thrombus), which can completely block the already narrowed artery within minutes.
- Heart muscle cells in the affected area lose their oxygen supply and begin to die. This is felt as severe chest pain.
Symptoms at a Glance
The most typical symptom is pressure or tightness in the center of the chest lasting longer than 20 minutes. Pain may spread to the left arm, jaw and back, accompanied by cold sweats, breathlessness and nausea. However, in women, people with diabetes and older adults, symptoms may differ; some patients present with fatigue and breathlessness without chest pain.
First Aid During a Heart Attack
If a heart attack is suspected, take these steps in order: (1) Call 112 immediately. Do not travel to hospital in a private vehicle. (2) Sit or lie still. (3) If you are not allergic to aspirin, chew 300 mg of aspirin. (4) Use sublingual nitroglycerin if it was previously prescribed for you. Stay calm until the emergency team arrives.
For detailed first-aid steps, actions to avoid, and guidance on CPR when someone has a heart attack, please see our heart attack symptoms page.
Diagnostic Methods
- ECG (Electrocardiography): The heart’s electrical activity helps identify the type of heart attack, STEMI or NSTEMI. An ECG must be performed within the first 10 minutes.
- Blood Tests (Troponin): Blood levels of markers released when heart muscle is damaged are measured. High-sensitivity tests can establish a diagnosis within the first 1–3 hours.
- Echocardiography: Reveals areas of the heart with impaired contraction.
- Coronary Angiography: The gold standard for definitive diagnosis and treatment. The site of the blockage is identified immediately, and a stent can be placed during the same procedure if necessary.
Treatment Options
Treatment aims to reopen the blocked artery as quickly as possible and restore blood flow (revascularization). The choice depends on the location and number of blockages and the patient’s general condition.
Angioplasty and Stenting
A catheter is introduced through the groin or wrist. A wire is passed to the blocked segment, a balloon opens the narrowing, and a stent, or metal mesh tube, is inserted to keep the artery open. Drug-eluting stents minimize the risk of restenosis.
Coronary Artery Bypass Grafting (CABG)
Bypass may be needed when a blockage is too calcified for stenting, several vessels are diseased, or the left main coronary artery is involved. Blood vessels taken from the body are used to create a route around the blockage.
Stent or Bypass: How Is the Decision Made?
The decision is made through a joint cardiology and cardiovascular surgery Heart Team assessment. General principles include:
- A stent is preferred: For short narrowings in one or two arteries with suitable anatomy, and in STEMI cases requiring emergency revascularization.
- Bypass is preferred: For three-vessel disease, left main coronary narrowing, multivessel disease in patients with diabetes, or complex anatomy. Long-term results are better in these settings.
More on Choosing a Treatment
Our dedicated page addresses the 25 most frequently asked questions about choosing a stent or bypass, medication, recovery and daily life.
View All Questions and Answers →Frequently Asked Questions
Life After a Heart Attack and Prevention
A heart attack is not the end, but the start of a new way of life. To prevent a second heart attack:
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To Book an Appointment
Prof. Dr. Selim İsbir — Yeditepe University Koşuyolu Hospital
