Heart attack

Description of Heart attack

A heart attack or a myocardial infarction means death of heart tissue due to lack of blood supply to the heart muscles. This can happen when there is an accumulation of fat or cholesterol narrowing the coronary arteries or when other substances like a blood clot are blocking the blood flow. This can damage or destroy a part of the heart muscle permanently.
Causes and Risk Factors
Causes include:
1. Coronary heart disease: Most heart attacks arise when your coronary arteries narrow with deposition of fatty materials within their walls, i.e., atherosclerosis. If a piece of this fatty material comes off its place it may cause a blood clot. This clot blocks the artery and cuts the blood supply to the heart.
2. Spasm of coronary arteries: If a coronary artery goes into spasm, it cuts off blood supply to the heart. Use of cocaine drug is one such known cause of spasm of coronary arteries.
Risk factors include:
1. Age: Men above the age of 45 and women above the age of 55 are at a higher risk of suffering a heart attack.
2. Tobacco: Chronic smoking can tremendously increase the risk.
3. Hypertension: High blood pressure damages the arteries that can cause heart attack.
4. High cholesterol
5. Diabetes
6. Obesity
7. Family history of heart attack
8. Stress
Signs and Symptoms
Signs and symptoms include:
1. Severe pressure or squeezing sensation in your chest or arms that can spread to the neck, jaw or back.
2. Indigestion, acidity, and abdominal pain
3. Shortness of breath or difficulty in breathing
4. Rapid or irregular heartbeat
5. Excessive cold sweat breaking out
6. Exhaustion
7. Lightheadedness or dizziness
Diabetics typically do not experience pain to a large extent and theirs is often a ‘Silent attack’ which is fatal because prompt action is often not taken. 
This is usually a medical emergency where immediately your heart rate and blood pressure will be monitored. Electrocardiogram will be done immediately to confirm the diagnosis. Assessment of symptom history and past medical history will be done.
Blood tests will be conducted to check for certain enzymes which show heart damage, e.g., Troponin I and creatine phosphokinase-MB (CPK-MB). Other additional tests include chest x-ray, echocardiogram, angiogram or cardiac catheterization, and cardiac CT scan.
Treatment starts immediately as heart attack is a medical emergency.
A. Medical treatment: Drugs should be given immediately to decrease the amount of damage to the heart. Drugs used include:
1. Thrombolytic therapy to dissolve any blood clots
2. Aspirin and other blood thinners to prevent blood clotting that can aggravate another heart attack.
Other drugs include:
1. Antiplatelet agents -- to prevent formation of new clots.
2. Pain relievers
3. Nitroglycerin -- this medication helps the heart muscle to relax and improve blood flow to the heart.
B. Surgical procedures:
1. Coronary angioplasty and stenting where a metal mesh is placed inside the artery to keep it open.
2. Coronary artery bypass graft surgery (CABG) where a vein is used to create a new route for blood to flow to the affected region of the heart.
Complications and When Should You See a Doctor
Damage to your heart can occur if not treated in time frame of 2 to 3 hours, and may lead to.:
1. Abnormal heart rhythm which can also be fatal.
2. Heart failure -- an attack can cause serious damage to the heart tissue that it fails to pump blood efficiently out of the heart.
3. Rupture of the heart -- parts of the heart muscle can rupture causing damage.
4. Heart valve problems -- they can get damaged and can also leak causing severe problems.
Content Details
Last updated on:
30 Apr 2019 | 06:00 PM (IST)
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Frequently Asked Questions about Heart attack

No. Heart attack leads to death of part of heart tissue. Heart failure is often a complication that occurs after a heart attack because the functioning of the heart slowly reduces, leading to poor pumping of blood.
No. Heart attack does not causing foaming at the mouth. Seizures or convulsions cause foaming at the mouth and should be immediately treated.
Yes. Suddenness is the most typical feature of a heart attack. It can occur during any movement like walking, jogging, eating, etc. Immediate rest should be taken and a doctor should be consulted.
No. Heart attack pain typically lasts only few minutes and subsides with rest and medications. If there is a chest pain lasting all day, then it is more likely to be a muscle pain than heart attack.
Yes, but only rarely. Heart attacks can cause sudden sweating, feverish feeling, increased heartbeat, anxiety and even trembling. All this will be accompanied with severe crushing or squeezing pain in the chest.
Yes. A heart attack causes death of part of heart muscle and reduces its functioning. Also, the chances of getting a repeat heart attack are high. Thus, persons with heart attack tend to have shorter life expectancy compared to others.
Yes. Heart attack pain, i.e., angina often subsides by taking immediate rest. This reduces the workload on the heart and thus, the pain subsides. Immediate treatment with medications also reduces heart attack pain.
Yes. Any movement adds extra pressure on the heart, increasing its work load of pumping blood. During a heart attack, the heart is already losing tissue due to reduced blood supply. Thus, any movement should be avoided and patient should lie down.
A heart attack can occur due to two causes -- blockage of the coronary arteries that supply the heart tissue by a clot or due to a spasm that shuts the flow. This leads to slow death of the area that received blood from that artery and is termed as a heart attack.
Heart attack is treated by giving oxygen, pain killers like nitroglycerin and blood thinner medicines like aspirin or clopidogrel. Placing a stent or a bypass surgery are very vital part of treating a heart attack to rapidly restore blood flow to the heart.
Chronic acidity, also known as gastroesophageal reflux disease (GERD), can sometimes cause a crushing pain in the middle of the chest -- a symptom that mimics a heart attack. However, this is called heartburn and has nothing to do with the heart per se. GERD is not associated with heart attack.
The main kinds of medications given for heart attack are those that prevent blood clotting (such as aspirin) and those that dilate the blood vessels. Most of these drugs are safe to take during pregnancy and are not harmful to the unborn baby; however, some should be avoided in the beginning or towards the end of pregnancy.
The current evidence indicates that milk and dairy products like yoghurt and (fresh) cheese do not cause heart attack/stroke. On the contrary, some studies even report that they might, although only slightly, be beneficial for the heart and its blood vessels.
Some genes have been identified that make a person more prone to getting a heart attack. However, a heart attack is not inherently a genetic disorder and can occur in anyone, if the risk factors are present.
The current evidence shows that eating what is called ‘saturated fats’ is linked to the development of heart diseases. As ghee and butter have more than 60% saturated fats, they do increase the risk of heart attack. ‘(Poly)unsaturated fats’, as those found in fish and other sources, are considered to be relatively healthier.
A person who has heard a shockingly bad news can have a heart attack if he or she has an underlying heart condition. In some cases, a person, even with a healthy heart, can have associated nervous system disorder. The nervous system plays an important role in regulating the heart function. Such nervous system disorder, on rare occasions, may lead to a sudden cardiac arrest, even when the heart was healthy.
Heavy red meat consumption is not good for heart health and increases the risk of diseases associated with the heart. In contrast, fish and poultry reduce the risk. A non-vegetarian diet also tends to have more fiber, which, in general, is beneficial for heart health.
There are some reports that say that a few women can experience abnormal symptoms of heart attack -- pain in the stomach, cramps, nausea, vomiting, and/or diarrhea during or after a heart attack. This can occur together with sweating, breathlessness, and lightheadedness.
A ‘major’ heart attack is when a large artery supplying blood to the heart is blocked, causing damage to/death of a large area of the heart muscle. A ‘minor’ heart attack is when a smaller artery is blocked. ‘Major’ and ‘massive’ can be interchangeably used.
A heart attack can lead to what is known as sudden cardiac arrest, i.e., when the heart suddenly stops working, leading to death if CPR is not immediately available. Unfortunately, many people with heart attack, even if it’s their first, do die due to sudden cardiac arrest.
Although the pain during a heart attack is mainly in the chest (center or left-sided), it can often also be felt in the shoulders. Other areas include the jaw, the neck, and the left arm.
Although conclusive evidence is not available yet, L-carnitine decreases angina, which is the chest pain when the heart muscle is not getting enough oxygen. L-carnitine also has other pro-heart benefits. However, it has not been found to reduce the risk of subsequent heart attacks.
A heart attack is a condition caused by blocking of blood supply to a part of the heart, which dies due to lack of oxygen, whereas cardiac arrest means that the heart suddenly stops working. A heart attack can increase the risk of a sudden cardiac arrest.
The temperature of the water after a meal does not influence the heart. This is because water is brought to the normal body temperature within minutes of reaching the stomach. This is true of anything cold that is consumed.
Heart attack, also known as ‘myocardial infarction’, is basically the death of the heart muscle due to lack of oxygen delivered to the heart by arteries. Therefore, although there may be many causes for the arteries to be blocked, the underlying mechanism is the arterial blockage, which may be complete or partial. The blocked arteries are almost always the main arteries of the heart (coronary arteries), but they may rarely be small blood vessels.
The type of heart attack that carries a great risk of death or post-attack disability is known as ST-elevation myocardial infarction (STEMI). Being aware of the symptoms of heart attack and seeking immediate medical help (both for yourself or a friend/family member), especially to a hospital via an ambulance, can markedly increase the chances of a good outcome of such heart attacks.
A stroke and a heart attack have often the same precipitating conditions, such as high cholesterol levels, high blood pressure, the coexistence of diabetes, smoking, etc. Thus, both stroke and heart attack increase the risk of each other. It is possible to have a heart attack after a stroke if the risk is not reduced by diet, exercise, and medications.
Heart attacks generally occur suddenly. For example, if a ‘coronary plaque’ (a collection of cells and lipids in the wall of an artery of the heart) is suddenly broken and clogs the artery, it can cause a sudden heart attack or a stroke.
A heart attack can, directly or indirectly, increase the risk of getting other heart diseases such as arrhythmia (abnormal heart rhythm), heart failure (ineffective work in pumping blood), rupture (a hole) in or aneurysm (thinning and ballooning) of the part of the heart that was affected, etc. It also increases the risk of stroke.
Calling emergency services or taking a person to the nearest emergency center is the main thing you should do. In addition, have the person sit down and try to calm them down; if they have a medication for chest pain, have them take it immediately. Do not leave the person alone until the symptoms go away or help arrives.
Yes, overweight people are more prone to disorders related to the heart in general, including heart attacks. The risk of heart attack can be as much as three times higher in people, especially women, with obesity than in those with normal weight. Also, reduction in weight seems to reduce this risk in the long term.
Extreme exercise has been recently found to be somewhat damaging to the heart. That’s because it puts a lot of stress on the heart to perform well, leading to certain anatomical changes, making it prone to heart diseases. That said, low to moderate exercise is certainly beneficial to your heart and overall health. Consult your doctor/physical trainer to know the right workout for you.
Certain medications are taken over-the-counter (OTC), especially the pain killers such as ibuprofen and diclofenac -- increase the risk of heart attack, as well as other vascular diseases. There is a whole list of medications that are harmful to the heart. It is therefore advised to avoid self-medication and to consult your doctor before taking any medicine.
Heart attack is not a contagious disease. It is caused by blocking of blood supply to a part of the heart, which dies due to lack of oxygen.
Reversing of heart attack can occur only in the hospital if the patient reaches the hospital within 60 min of the start of chest pain and the blocked artery is opened soon enough. Other than that, the muscles death that occurs in a heart attack is irreversible, and medications given are to ensure that no further complications occur. Of them, aspirin is the only one that is available over-the-counter (OTC).
After a heart attack, the patient generally needs three kinds of drugs: Aspirin -- to prevent blood clots; beta-blockers and angiotensin-converting enzyme (ACE) inhibitors -- to protect the heart; and a statin, to keep the blood cholesterol levels in control, all of which prevent complications. Some or all of these are usually administered lifelong. Other medications may be required depending on factors such as patient age and other conditions if present.
A typical pain of heart attack starts slowly with a feeling of discomfort or pain in the chest. Then the pain increases, along with a feeling of uncomfortable crushing sensation. The discomfort/pain may be constant or may go and come back every few minutes. The pain may also radiate to the neck, jaw, and left arm.
Deficiency of vitamin C for a long time may lead to hardening of arteries because of fat deposition in them. This could thus increase the chance of heart disease. Getting vitamin C from diet and/or supplements can help prevent this.
During a heart attack, the pain is felt mainly in the chest (at the center or left-sided); however, it can often also be felt on the shoulders, the jaw, the neck, and the left arm.
It seems there is some minor relation between panic attacks, also known as panic disorders, and heart attacks and other related diseases, also known as cardiovascular disorders. Patients with panic disorders sometimes have abnormal blood pressure or fat regulation, which can indirectly increase the risk of heart diseases.
The diagnosis of heart attack is primarily established with the help of the following: 1) Recognition of symptoms 2) Certain blood tests, such as heart enzymes 3) Devices which evaluate the heart such as an electrocardiograph and echocardiography 4) Angiography-- invasive, CT or MRI.
If you have a deficiency (i.e., lower than normal levels) of vitamin D, your risk of getting a heart attack increases. This is partly because vitamin D helps in regulating blood pressure and blood sugar.
It does not seem like heart attacks are more or less common in people with hemophilia. Although studies have found directly conflicting data, the percentage of people with hemophilia admitted to the hospital because of heart attacks (and related conditions) were found to be similar to those without hemophilia.
Light to moderate intake of red wine has protective benefits to the heart. Certain components of red wine act as antioxidants, and by different mechanisms operating at the cellular level, also improves fat metabolism and blood clotting process. The benefits decrease with an increased intake of red wine. Consult your doctor to know more about the right quantity and risk/benefit of red wine.
Cardiac rehabilitation is an important multifactorial approach customized for a patient of heart attack. It involves exercises, a planned treatment plan, and even psychological counseling. Cardiac rehabilitation significantly improves not only cardiac health but also overall health, and decreases the risk of a second heart attack.
Kidney disease and heart disease share common risk factors like increased blood pressure and diabetes mellitus. So, a person with kidney failure may already have an imbalance that can lead to heart conditions such as heart attack. Kidney failure may also further increase the blood pressure, which increases work on the heart.
X-rays are useful after a heart attack in some cases as they may show some changes in the heart or blood vessels that can help identify the cause or give an idea of the prognosis of the patient. However, this is certainly not the best imaging modality for these patients.
There are many factors that increase the risk of a heart attack: Abnormal lipid levels, smoking, obesity (especially fat around the stomach), diet (consumption of high levels of carbs and fat), some psychological factors such as stress, high blood pressure, presence of diabetes, use of certain drugs, excessive alcohol consumption, or a history of heart attack/disease in the family.
Heart attack becomes somewhat more common after the age of 55 in both men and women, and the risk increases with the increase in age, more for women than for men. That said, a heart attack can occur even as early as 30 to 35 years of age.
For coronary vessel stenting, there is no maximum number. In one setting, as many as five coronary vessels can be operated on. However, the ideal is to use bypass surgery if multiple vessels are blocked.
If you are alone and have a heart attack, sit down and call the emergency services or try to get to a nearby hospital if the former is not available. This should be the first thing to do. If you have an aspirin, take it. If you have nitroglycerin, a medicine for angina, take that too.
Certain medications are taken over-the-counter, especially the pain killers such as ibuprofen and diclofenac -- which are very commonly taken -- increase the risk of heart attack, as well as other heart conditions. Illegal drugs such as cocaine, heroin, and amphetamine and a few older-generation drugs for heartburn can also cause a heart attack. Always consult your doctor before taking any medications.
Although research has shown that heart attacks in the early morning tend to be more serious, there is no conclusive evidence yet regarding the reason for the same. It may be linked to hormone levels, blood pressure changes and/or increased workload on the heart immediately on waking up.
Blood coming out of the mouth is not a symptom of heart attack. Blood can come out of the mouth because of bleeding from the mouth itself, or ruptured blood vessels in the throat/food pipe, or other problems of the wind pipe/lung. However, if the patient is on blood thinners before/during heart attack and there is a wound in the mouth, there can be bleeding, but that is not due to the heart attack per se.
Frequent and serious gambling, or ‘pathological gambling’, can lead to constantly high amounts of stress. Also, these individuals are more likely to indulge in smoking and excessive consumption of alcohol, unhealthy food, and even recreational drugs. Due to this, the risk of heart diseases, including heart attack, increases.
There are many factors other than high cholesterol that can increase the risk of a heart attack like high homocysteine levels, high triglyceride levels, diabetes mellitus, severe anemia, other lipid metabolism disorders, etc.
Smoking weed, partly because of the smoking and partly because of weed itself, can increase heart rate, blood pressure, or other heart disorders. Weed smoking may also slightly increase the risk of heart attack and stroke.
Gastroesophageal reflux disease (GERD) or ‘heartburn’ can sometimes cause sudden intense chest pain similar to that of the heart attack. It can be hard to distinguish between the two. Typically, heartburn will be after food and the symptoms will reduce on belching and there may be a sour acidic taste in the mouth because of acid reflux (especially when lying down), whereas the pain of heart attack may be associated with sweating, dizziness, and/or shortness of breath. However, it is better to seek immediate medical attention if not sure.
The risk of heart attack can be significantly lowered by doing the following things: Complete cessation of smoking, weight control, increased physical activity especially aerobic exercise, moderation of alcohol, reducing sodium intake, keeping blood pressure in control, keep cholesterol levels in control (diet and statins), and diabetes if present should also be strictly controlled.
Although strong evidence is still lacking, whole body vibration exercises may decrease the stiffness of arteries (one of the main factors involved in a heart attack). They also improve an older adult’s general health. However, whether it can be performed after a heart attack depends on the physician’s approval.
A heart attack has typical symptoms like chest pain, a feeling of tightness, etc. A heart attack causes disorders in the normal electrical impulses in the heart, which is detected by the electrocardiogram or ECG (or EKG). Echocardiography is another device; it helps visualize the motion of heart walls and has a good accuracy in detecting which part of the heart had a heart attack.
Yes, certain bacterial infections, such as those causing pneumonia or similar infections of the respiratory tract (namely, Streptococcus pneumoniae or Hemophilus influenzae) can cause heart attack, especially in the older adults. Also, some bacteria that cause dental infections can also damage the blood vessels, including those of the heart.
Cardiac resynchronization therapy defibrillator (CRT-D) is used in patients with certain heart conditions that help with the regularization of the heart beat and also improve the function of the heart. CRT-D and other such devices definitely prolong a person’s life; however, how long a person can live cannot be judged by this alone.
There are many diseases that increase the risk of getting a heart attack like type 2 diabetes, fat metabolism abnormalities, high blood pressure, depression, anxiety, chronic stress, some disease of the blood vessels and the heart, etc. Sometimes drugs such as cocaine and amphetamines can also cause heart attacks.
There is not enough data linking phobia or heights, or acrophobia, to heart attack and other related conditions, so it does not seem that acrophobia alone affects the risk of heart attack. However, acrophobia is associated with panic disorders, so if you are suffering from other panic/anxiety disorders, there may be a slightly increased indirect risk of factors that may cause heart conditions.
Optimal calcium levels in the blood are essential for good health of the heart and the blood vessels. Low or high calcium levels can mildly increase the risk of heart diseases. However, a high intake of calcium supplements also seems to increase the risk of heart disease. Taking calcium from natural food sources seems to be the ideal way.
Yes. ‘Acute coronary syndrome’ is a term that includes heart attack, as well as other similar conditions (such as ‘unstable angina’) where the blood supply to the heart is suddenly blocked, leading to lack of oxygen delivery to the heart muscle.
A person’s risk of having a heart attack increases after having a coronary artery bypass surgery, but this is mainly due to not following the care team’s recommendations strictly. Walking will not cause a heart attack, but certain exercises should certainly be avoided. Consult your doctor to know more on the physical activity recommendations after a bypass surgery.
Myocardial ischemia is when the blood supply to a part of the heart muscle is considerably reduced or blocked, leading to a lack of oxygen for that part. However, this can be reversed and there is no lasting damage. If ischemia lasts long enough, it leads to death of the muscle, called as myocardial infarction, from which the muscle cannot recover and eventually gets converted to scar tissue.
Chest pain that comes and goes can be either due to a heart condition (angina or heart attack) or a stomach condition (acidity or ulcer). If it comes and goes due to a change in position, it is probably muscular.
For a healthy heart, the diet should consist of a lot of vegetables, fruits, lean meat such fish, eggs, nuts and legumes, and whole grains. Too many carbs and fats should be avoided.
Increased blood pressure, known as ‘hypertension’, and elevated cholesterol are two of the common factors that increase a person’s risk to have a heart attack. Normalizing blood pressure and cholesterol levels reduce the lifetime risk of a heart attack.
A 90% blockage in your left main artery (LMA) requires a procedure to remove the blockage (stenting) or bypassing the blockage. In addition, if you have other risk factors for heart diseases such as smoking, overweight, etc., you need to modify your lifestyle (e.g., diet, exercise, and stop smoking) and take some medications to prevent such blockages from happening again, which will prevent heart attacks as well.
There is some evidence that flu, caused by an infection of influenza virus, can trigger a heart disease, including heart attack. While it is debatable that the virus can itself start a chain of events that leads to a heart attack or it could be ‘the last straw’ over a range of already present risk factors that eventually causes the heart attack. However, at present, the evidence is limited.
A heart attack occurs when the muscles of a part of a heart are dying because of lack of oxygen, usually due to a blocked blood vessel. If the patient reaches the hospital in 60 to 90 minutes and the blocked artery is reopened, the total death of that muscle part can be stopped. Apart from this, there is no definitive cure for heart attack.
The length of stay in the hospital after a heart attack is on an average 3 to 4 days, but it can vary a lot from patient to patient. Younger men and those with no complication can get discharged faster, whereas older patients and/or those with many other diseases or complications may be required to stay longer.
Yes, sweating is an important symptom of heart attack, although it may not occur in all patients. A person with pressure-like chest pain with sweating should immediately be taken to the hospital for further management.
Horror movies affect different people differently. There are those who are sensitive to it. If such people also have an underlying panic/anxiety disorder(s) or other risk factors for heart attack, it may lead to heart attack or sudden cardiac arrest. However, the evidence, at present, remains anecdotal.
A heart attack is a condition in which the heart muscles (usually only a specific area, and not the whole heart) die due to lack of oxygen. A defibrillator is a device that shocks the heart when it has stopped working or during an arrhythmia. Heart attacks can lead to arrhythmia or sudden cardiac arrest -- which is sudden stopping of the heart, and a defibrillator can certainly be used there to save someone’s life.
Usually, a heart attack is triggered by physical activity or stress. However, some types of heart attack precursors (known as unstable angina or variant angina) can occur during rest or even during sleep, which may even progress to a heart attack.
Constant pain in the left side of the chest can indicate many diseases, including those of the heart, the lung, and sometimes the stomach. Chest pain can have different characteristics, which may point to different diseases. The typical pain of heart attack is a severe, crushing pain in the center or to the left side of the chest, which may go to the neck or the left arm.
There are some female-specific disorders (gynecological and obstetric conditions) that increase the risk of heart diseases in a woman. One of the common ones is polycystic ovary syndrome or PCOD, which is a condition affecting ovaries and causes hormonal imbalances in the body. In addition, the type of oral contraceptive used can also mildly affect certain heart diseases.
Yes, loud environmental noise, including noise from the street and traffic, can cause detrimental changes in the heart and blood vessels that can lead to heart attack. It does this by disturbing your sleep and inducing a stressful state -- even during sleep -- thereby harming your health.
Heart attacks are caused by blocking of the artery (which can, in some cases, be due to blood clots), and after the attack, there is a tendency of the blood to form clots. In both the situations, aspirin helps by preventing clot formation. However, the role of aspirin during most heart attacks is limited.
Yes, a heart attack is a serious condition that should not be ignored. It can lead to various other complications of the heart and the blood vessels. If left untreated, it can even lead to sudden death. Treatment should be sought immediately.
Certain chemicals and medicines have been found to be linked to heart attack. E.g., perfluorooctanoic acid (PFOA) and other perfluoroalkyl chemicals (PFCs) that are found in many household products; some medicines for heartburn (like cisapride and tegaserod), etc.
The early symptoms of a heart attack include the following: Chest discomfort or pain (can be felt as pressure), shortness of breath, pain or discomfort in arms, neck, shoulder, jaw, back, etc., and other nonspecific symptoms such as sweating, nausea, and dizziness.
Nicotine in any form -- smoked, chewed, or snuffed -- is harmful to the heart. It makes the blood vessels stiff, increases heart rate, and blood pressure. It also results in changes in the blood that increases the risk of heart attack. It can also affect fat metabolism and insulin levels, both of which can further contribute to heart attack.
The heart pumps oxygen-rich blood to the rest of the body. It does this by taking the deoxygenated blood, sending it to the lung to be filled with oxygen from the air we breathe, and then sending it to the entire body.
If you have a heart disease or a history of heart attack, you may get it while traveling if you do not stick to your treatment plan.
Exercise after a heart attack should be done with the assistance of trained medical professionals. Usually, you will start by walking slowly, then increase both pace and duration. Gradually, simple aerobic exercises will be added. It may take a few months to recover to the optimal physical condition.
Although the exact reason(s) remain unclear, one theory is that diabetic neuropathy leads to damage of the nerves through which the pain of the heart attack is felt.
Consumption of alcohol in moderation is ok. Excessive drinking causes imbalances in the fat, metabolism increase calorie intake, and raises blood pressure -- all of which can lead to heart attack.