Heart Attack Vs Heart Failure

Overview

Heart attack also known as myocardial infarction occurs when the flow of blood that brings oxygen to a part of your heart muscle suddenly becomes blocked. This blockage can occur in one or more of your heart’s arteries. Heart failure also known as congestive heart failure does not mean the heart has stopped working it simply means the heart is not able to pump sufficient blood to meet the demands of the body. This leads to the buildup of blood in other organs, especially in the lungs, legs and feet. Heart attack is one of the medical conditions that can lead to heart failure.  

Understanding heart attack

Common causes of a heart attack

The leading cause of heart attacks is Coronary heart disease (CHD). CHD is a medical condition characterised by the narrowing and blockage of the major blood vessels supplying the heart (coronary arteries) due to the accumulation of cholesterol deposits known as plaques. One of the plaques ruptures prior to a heart attack, causing a blood clot to form at the site of the rupture. The clot may obstruct blood flow to the heart, resulting in a heart attack.

Signs and symptoms 

Sometimes, a mild heart attack is called a “silent heart attack” as it produces no symptoms. ¹ Some common symptoms of symptoms:

• Chest pain (squeezing, heaviness, tightness, pressure in chest)- The chest pain is frequently severe, but some people only have minor pain, similar to indigestion
• Pain in other parts of the body - it can feel like the pain is spreading from your chest to your arms (usually the left arm), jaw, neck, back, and stomach
• Feeling dizzy or lightheaded
• Sweating
• Shortness of breath
• Nausea, or vomiting
• Anxiety 
• Wheezing or coughing

While all genders experience chest pain as the most common symptom, individuals assigned female at birth are more likely to experience other symptoms such as shortness of breath, feeling or being sick, and back or jaw pain.

Who is at risk?

Various factors like lifestyle, genetics, other diseases etc. can increase the risk of a heart attack. 

Other diseases that increase the risk of a heart attack

• High blood pressure
• High blood cholesterol
• Diabetes mellitus 
• Obesity 

Lifestyle choices that increase the risk of heart attack

• Saturated fats, trans fats, and cholesterol-rich diet
• Limited physical activity 
• Excess alcohol consumption 
• Tobacco use

Genetics, age, gender, and sex as a risk factor 

• High blood pressure, heart disease, and other related conditions are all likely influenced by genetic factors. However, people with a family history of heart disease are more likely to share common environments and other risk factors
• When heredity is combined with unhealthy lifestyle choices like smoking and consuming an unhealthy diet, the risk of heart disease becomes even more heightened 
• Heart disease can strike at any age, but the risk increases with age. Anyone can be affected by heart disease or stroke, but certain groups are more likely to have conditions that increase their risk of cardiovascular disease

How to diagnose? 

The first test that is performed within 10 minutes of being admitted to the hospital for a suspected case of heart attack is an electrocardiogram (ECG). The heart generates tiny electrical impulses and ECG helps to measure this. An ECG is necessary because it helps the medical practitioner confirm if the individual had a heart attack, and the type of heart attack and aids in determining the most effective treatment.¹

Other tests that can also be performed to assess heart health and check for any complications include: ¹

• Blood test: analyze the level of proteins and fats in the bloodstream which could damage the heart muscles 
• Chest X-ray or Coronary angiography: Performed to check for narrowing of coronary arteries. A tiny catheter is inserted into the artery of the leg or arm and threaded up into the coronary arteries. A contrast material is then injected from the end of the catheter into coronary arteries, and X-rays are taken to observe heart disease.
• Echocardiogram (EKG):  is an ultrasound-based test that creates images of the heart's structure and function.  It uses sound waves to produce real-time images of the heart's chambers, valves, and blood flow

Treatments

The medical practitioner decides the most suitable treatment plan for each patient based on the severity of the attack. The treatment includes:

• Administration of drugs to dissolve blood clots, relieve pain and reduce blood pressure
• Undergoing surgery to aid in the restoration of blood flow to the heart

As long as the person having a heart attack is not allergic to aspirin, it could be beneficial may help to chew and then swallow a tablet of aspirin while waiting for an ambulance. Aspirin thins the blood and increases blood flow to the heart. In worse cases, heart transplantation may be required.¹

Understanding heart failure

Common causes of heart failure

Heart failure can develop suddenly (acute) or over time as the heart gets weaker (chronic) affecting one or both sides of your heart. It can occur at any age but is most common in older people. Left-sided and right-sided heart failure may have different causes but most often heart failure is caused by another medical condition that damages your heart like coronary heart disease, high blood pressure, cardiomyopathy etc.

The following conditions can lead to heart failure:

• Coronary heart disease is a condition in which the arteries that supply blood to the heart become clogged with fatty substances (atherosclerosis), resulting in angina or a heart attack
• High blood pressure can put additional strain on the heart, eventually leading to heart failure
• Conditions that affect the heart muscle like cardiomyopathy
• Arrhythmias of the heart, such as atrial fibrillation or other problems with the heart valves
• Congenital heart disease refers to birth defects that interfere with the normal functioning of the heart
• Obesity, anaemia, excessive alcohol consumption, an overactive thyroid, or high pulmonary pressure (pulmonary hypertension) can all lead to heart failure

Signs and symptoms

Symptoms can develop quickly in the case of acute heart failure or gradually over weeks or months in the case of chronic heart failure and it also depends on the type of heart failure.

People with left-sided heart failure may experience the following symptoms:

• Trouble breathing
• Cough
• Fatigue (extreme tiredness even after rest)
• General weakness
• The bluish colour of fingers and lips
• Sleepiness and trouble concentrating
• Inability to sleep lying flat

People with right-sided heart failure may experience the following symptoms:

• Nausea and loss of appetite
• Pain in your abdomen (the area around your stomach)
• Swelling of the ankles, feet, legs, abdomen, and the veins in your neck
• Needing to pee often
• Weight gain

Who is at risk?

Several factors contribute to increasing a person’s risk of getting a heart attack. 

Other diseases that increase the risk of a heart attack

• Heart or blood vessel disease, severe lung disease, or infections like HIV or SARS-CoV-2 increase your risk
• Obesity, high blood pressure, diabetes, sleep apnea, chronic kidney disease, anaemia, thyroid disease, or iron overload
• Cancer treatments like radiation and chemotherapy can damage the heart 
• Heart failure can also be caused by atrial fibrillation (irregular heart rhythm)

Lifestyle choices that increase the risk of a heart attack

• Poor diet
• Smoking
• Using cocaine or other illegal drugs
• Excessive alcohol consumption
• Lack of physical activity

Genetics, age, biological gender, and ethnicity influence the risk of getting heart attacks

• Ageing population
• Black and African-American 
• Family history

How to diagnose?

There are multiple tests to diagnose heart failure:

• Blood tests: To check the levels of molecules like brain natriuretic peptide (BNP) as these rise during heart failure.
• ECG: It is used to record the electrical activity of your heart to check for problems
• EKG: It is an ultrasound-based test that creates images of the heart's structure and function
• Breathing test: You may be asked to blow into a tube to check whether a lung problem is contributing to your breathlessness
• Chest X-ray: To check the size of the heart as well as for fluid build-up in the lungs

Treatments

Heart failure is primarily a chronic condition and cannot be completely cured, but there are  treatments available to alleviate symptoms:

• Lifestyle changes: adopt a balanced diet, increase physical activity, quit smoking, avoid alcohol, manage stress
• Medications to remove excess sodium and fluids from the body (diuretics and aldosterone antagonists), to relax blood vessels (ACE inhibitors and angiotensin receptor blockers (ARBs), to slow the heart rate (beta blockers) etc
• Devices to control heart rhythm like pacemakers, cardiac resynchronisation therapy devices, implantable cardioverter defibrillators etc
• Surgery to repair congenital heart defects and in worse cases, a heart transplantation may be required 

How to tell if you are experiencing a heart attack or heart failure?

A heart attack is an acute event that can come without a warning while heart failure is a condition that usually develops slowly and is often eventually fatal. Despite their distinct natures, they both share many similar causes and symptoms, making it difficult to differentiate between a heart attack and heart failure. Consult your GP if you experience any of the above-mentioned symptoms. If you experience sudden or severe symptoms, dial the ambulance or go to your nearest ER as soon as possible.

Which is more common between the two? 

Heart and circulatory diseases account for one-quarter of all deaths in the UK, accounting for more than 160,000 deaths per year - an average of 460 deaths per day, or one every three minutes. The most common type of heart disease is coronary heart disease. It is the leading cause of heart attacks and the leading cause of death in both individuals assigned male at birth and in individuals assigned female at birth worldwide in 2019. Heart attacks cause up to 100,000 hospital admissions in the United Kingdom each year, or one every five minutes. Over 900,000 people in the United Kingdom experience heart failure.

When to seek medical attention?

If you doubt that you or someone you know are showing symptoms of heart attack or heart failure visit the nearest GP or ER and in case of severe onset of symptoms please call the ambulance immediately. 

Summary

A heart attack occurs when blood flow to a portion of the heart is cut off partially or completely, where as a heart failure occurs when the heart is unable to pump enough blood effectively to all parts of the body. Heart attack and heart failure share many of the risk factors and underlying medical conditions. An individual can reduce their risk by eating a healthy diet, exercising regularly, and managing underlying health conditions. If you experience any of the symptoms of heart failure or heart attack contact your GP or visit the nearest ER.