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At any suspicion of a heart attack — persistent chest pain, pressure, radiation, cold sweat, shortness of breath — call the emergency number 112 immediately. Never drive to hospital yourself and do not wait.
In a heart attack (myocardial infarction) a coronary artery is suddenly blocked, so that part of the heart muscle is no longer supplied with oxygen. The coronary arteries are the fine vessels that supply the heart muscle itself with blood. If one of them becomes blocked, the muscle tissue behind it begins to die within minutes — and the longer the blockage lasts, the more of it dies. That is exactly why the guiding principle is: "Time is muscle."
The trigger is almost always a tear in a calcified deposit (plaque) on the inner vessel wall. At this rupture site a blood clot (thrombus) forms in a flash and blocks the vessel completely or partially. The heart attack is thus the dramatic culmination of vascular calcification that has usually progressed unnoticed over years — coronary heart disease.
Why is time so decisive? Heart muscle tissue cannot regenerate. Whatever dies in the first few hours remains permanently as a scar and weakens the heart's pumping power. If the vessel is reopened early, however, a large part of the muscle can be saved. The life-saving chain is therefore: recognise the symptoms, call 112 immediately, reopen the vessel in the cardiac catheterisation lab — and afterwards prevent a second attack with the right treatment. Each of these steps determines your later resilience and quality of life.
Three terms are often confused, even though they differ in urgency. They do belong together, but describe different stages and situations of the same underlying problem — the narrowing of the coronary arteries.
| Term | What lies behind it | Urgency |
|---|---|---|
| Coronary heart disease (CHD) | Chronic calcification and narrowing of the coronary arteries — the underlying condition | Treat long-term, plannable |
| Stable angina pectoris | Chest tightness only on exertion that quickly disappears again at rest | Have it clarified by a doctor |
| Unstable angina pectoris | Newly occurring, increasing, or chest tightness also occurring at rest | Emergency — 112 |
| Heart attack (myocardial infarction) | Complete or near-complete blockage of the vessel, heart muscle dies | Emergency — 112 |
The most important practical difference is the duration and the trigger of the symptoms. Stable angina pectoris reliably announces itself on exertion — for example when climbing stairs — and subsides again within a few minutes at rest or after a nitro spray. It is a serious warning sign, but not an acute emergency. In a heart attack, by contrast, the pain lasts longer than about 15 to 20 minutes, often occurs at rest and does not improve with rest or a nitro spray. Unstable angina and heart attack are grouped together as acute coronary syndrome — both belong in hospital immediately, because in the first minute you cannot yet tell for certain which one is present.
The classic picture, often known from films, is the strong pressure or pain behind the breastbone radiating into the left arm. This picture is correct — but it is only part of the truth. Especially in women, older people and people with diabetes, an attack often runs an atypical course, that is without the textbook chest pain. It is precisely these untypical cases that are dangerously often recognised too late.
Typical symptoms that point to a heart attack:
In women, it is often not the classic chest pain but more non-specific symptoms that dominate: pronounced nausea and vomiting, pain in the upper abdomen, in the back between the shoulder blades or in the jaw, together with shortness of breath, unusual tiredness and a feeling of weakness. Because these signs are easily misinterpreted as an upset stomach, tension or exhaustion, women wait longer on average before calling the emergency services — and lose valuable time in the process. The message is therefore simple: an attack can be present even without typical chest pain.
The actual cause of a heart attack is almost always atherosclerosis — the calcification and narrowing of the coronary arteries over many years. On this basis a deposit tears, a clot forms, the vessel closes. Which factors accelerate this process is well studied — and many of them can be influenced.¹
Important to understand: most of these factors act over years and insidiously. You feel neither the rising blood pressure nor the high cholesterol — yet both damage the vessels. That is exactly why prevention is so effective: anyone who does not smoke, has their blood pressure and cholesterol treated and exercises regularly considerably lowers their risk of an attack. These factors count double after a heart attack you have survived, because then the goal is to prevent a second one.
If a heart attack is suspected, a well-rehearsed procedure runs in hospital — and already in the ambulance. The aim is to clarify in the shortest possible time whether an attack is present and whether a vessel must be reopened immediately.¹,²
The ECG and troponin yield two major types of attack: the STEMI, in which a vessel is completely blocked and the vessel must be reopened as quickly as possible, and the NSTEMI, in which the blockage is usually incomplete and the catheter examination takes place quickly but somewhat less hastily depending on risk. For you as a patient this changes nothing about the most important thing: both forms are an emergency, and both begin with a call to 112.
The most important treatment in a heart attack is to reopen the blocked vessel as quickly as possible. Because only when blood flow returns does the heart muscle stop dying. The standard procedure for this is the cardiac catheter with insertion of a stent — specialists call it a percutaneous coronary intervention (PCI).¹
The procedure today is highly rehearsed, and for you as a patient usually surprisingly gentle, because it is carried out through only a small access point:
Why the time pressure? As little time as possible should pass between the onset of symptoms and the reopening of the vessel — ideally under two hours in the case of a complete blockage. The earlier the vessel is open, the more heart muscle is preserved and the better the later pumping performance. That is the whole point behind "time is muscle" — and the reason why every wasted minute between symptom onset and the emergency call counts.
After the acute treatment, the second, equally important part begins: secondary prevention. Its aim is to prevent another attack, keep the stent open and relieve the heart. For this there is a fixed combination of medications that almost every patient takes permanently after an attack. These tablets are no sign of weakness — they are the most effective protection against the next event, and their benefit is clearly proven in large studies.¹,³
You can picture the standard therapy as a team of active substances, each acting at a different point. Here are the load-bearing building blocks in plain terms:
Which active substances and dosages are exactly right for you depends on the pumping power of your heart, your blood pressure, your kidney function and how well you tolerate them. Side effects are no reason to quietly stop — often a small adjustment already helps. More on this: interactions between medications.
After a heart attack, every tablet counts. brite reminds you reliably and documents everything — ready for your next check-up.
A heart attack is a turning point — but for the vast majority of people no reason to give up an active life. On the contrary: with the right follow-up care, many patients return to their usual resilience. Two building blocks are decisive here: cardiac rehabilitation and consistently changing the risk factors.²,³
The follow-up rehabilitation (rehab) usually begins shortly after the acute treatment. Under professional supervision the heart is gradually put under load again, you get to know your individual load limit and receive guidance on exercise, nutrition and handling the medications. Rehab demonstrably lowers the risk of further events and gives many patients back the confidence to ask something of their heart again.
For everyday life afterwards, these points count above all:
The mind also needs attention: after an attack, anxiety, low mood and uncertainty are common and completely normal. They can be treated — raise them openly during rehab or with your doctor. Atrial fibrillation or heart failure can develop after an attack and are monitored during the check-ups.
Record in brite how your blood pressure, pulse and weight develop — the ideal basis for every check-up with your GP and cardiologist.
The most important section of this article: a heart attack is always an emergency, in which minutes decide the extent of the damage. Memorise the following signs — for yourself and for people around you.
You should be aware of two common, dangerous errors of thinking. First: "It'll get better soon" — in an attack, salvageable heart muscle is lost with every minute of waiting. Second: "I don't want to raise a false alarm" — the emergency services exist for precisely this situation, and a false suspicion is always better than a neglected attack. When in doubt, the rule without exception is: 112.
After an attack, secondary prevention determines the future — often with five or more medications at the same time. Their protection only works if they are taken reliably and the values are kept in view. That is exactly where brite supports you.
