Myocardial infarction (MI) is also called a heart attack. A heart attack occurs when an artery leading to the heart becomes totally blocked. A heart attack is a medical emergency. Seek immediate medical attention if you or someone else is having the symptoms listed below.

• Pain, heaviness, tightness, burning—in chest, back, left arm, jaw, neck
• Difficulty breathing
• Dizziness, weakness
• Nausea, vomiting
• Irregular heartbeat

Atherosclerosis, the process of plaque buildup in an artery until it becomes closed, is the most frequent cause of heart attacks. Heart attacks can also result from heart-muscle spasms or hereditary heart problems. The following increase your risk of having a heart attack.

• Smoking
• High-fat diet, excess body weight
• Family history of early MI
• Diabetes
• Oral contraceptives
• Hypertension (high blood pressure)
• Being male, or a female who has gone through menopause
• Cocaine or amphetamine abuse

If you think that you are having a heart attack, call for medical assistance immediately. Treating a heart attack within 90 minutes can save a person's life. In the emergency room, the following three things will happen very quickly to determine if you are having a heart attack.

• You will have an electrocardiogram (EKG).
• A health care provider will ask you about your symptoms and perform a physical examination.
• You will have a blood test to evaluate your cardiac enzyme levels.

Blood must be brought back to the affected area of the heart immediately. Three methods for doing this are drug therapy, angioplasty (using one of several methods to clear the blocked blood vessel, such as inflating a balloon inside it or holding it open with a device called a stent), and surgery.

Your health care provider may prescribe one or several drugs to help bring blood back to the blocked artery, keep your heartbeat regular, lower your blood pressure, control pain, and improve blood flow.

• Streptokinase (SK)—improves widening of the coronary artery; takes 70 minutes to feel the effects; given intravenously
• Tissue plasminogen activator—improves widening of the coronary artery; takes 45 minutes to feel the effects
• Anisoylated plasminogens streptokinase activator complex—more expensive but longer anti-clotting activity than streptokinase�
• Heparin—improves widening of the coronary artery
• Nitroglycerin—improves blood flow, helping to prevent blood clots that block arteries�
• Beta blockers—reduce cardiac rupture, new heart attacks, irregular heart beat; various side effects�
• Angiotensin-converting enzyme (ACE) inhibitors—reduce high blood pressure�
• Pain control—morphine sulfate, intravenous
• Oxygen—by a tube inserted into your nose, as needed
• Aspirin—improves blood flow, helping to prevent blood clots that block arteries; it works best if you chew it; various side effects; frequently prescribed

Alternative therapies are most appropriate to reduce your risk of a first MI, minimize damage from an MI, and reduce the risk of a subsequent MI. It is important that you first get your condition diagnosed and stabilized by a medical professional.

• L-carnitine (9 g per day intravenously for five days, then 6 g per day by mouth for 12 months) within 24 hours of onset of chest pain decreases left ventricular dilation.
• Coenzyme Q10 (120 mg per day) taken for 28 days following a heart attack may reduce degree of damage to the heart and improve heart function
• A diet high in antioxidants (vitamin C, vitamin E, and beta-carotene) and soluble dietary fiber, and low in fat is beneficial.
• Bromelain (400 to 800 mg per day) may help dissolve plaque.

Herbs should not be used in place of immediate medical attention. Herbs can be used as general heart tonics and specifically applied to treating conditions associated with MI, such as atherosclerosis, congestive heart failure, high cholesterol levels, high blood pressure, and high fat levels in the blood.

Homeopathy should never be used instead of immediate medical attention.

Physical medicine may be beneficial for rehabilitation.

Acupuncture is useful for pain and rehabilitation.

Massage is beneficial for rehabilitation and prevention of MI.

You may reduce your risk of heart attack by avoiding known risk factors. Get aerobic exercise (such as walking, biking, or swimming) for at least 20 minutes three times per week. If you haven't exercised much in the past, walking is a great way to start. Reducing stress can also help lower your risk of MI. Learn stress-reduction techniques such as deep breathing and meditation. Gentle exercise such as yoga and tai chi can also help you reduce your stress level. Eat a low-fat diet and stay at the proper weight.

If you have diabetes or high blood pressure, follow your health care provider's instructions to keep it under control. If you are a woman and have gone through menopause, you may want to consider hormone replacement therapy—it can lower your risk of heart disease. Talk to your provider about your options.

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Murray MT. The Healing Power of Herbs: The Enlightened Person's Guide to the Wonders of Medicinal Plants. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:184.

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Singh RB, Niaz MA, Agarwal P, Begom R, Rastogi SS. Effect of antioxidant-rich foods on plasma ascorbic acid, cardiac enzyme, and lipid peroxide levels in patients hospitalized with acute myocardial infarction. J Am Diet Assoc. July 1995;95:775-780.

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