Heart Attack vs. Heart Failure: Which do YOU have??

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The vast majority of people do not really understand the difference between a HEART ATTACK and the entity known as HEART FAILURE. The confusion is entirely understandable. It’s a bit complicated. So, what exactly is the difference?

A heart attack happens when the blood supply to the heart muscle itself is compromised. That blood supply comes from the ‘coronary’ arteries and if one or more gets blocked sufficiently, the heart muscle doesn’t get oxygen and portions of the muscle can die off if blood supply is not restored in time (like within a few minutes). Thus, the term ‘having a coronary’ is the same as having a heart attack.

Coronary disease (credit: Mayo Foundation)

When a muscle doesn’t get enough blood, there is pain. Everyone knows about the pain of a heart attack: severe chest pain, sometimes with radiation into the arms (left arm more than right) or neck.  ANGINA is the name for the same heart muscle pain that happens before the muscle dies. This can go on for months before an actual heart attack. When the muscle dies from lack of blood, it is called an INFARCTION, or more specifically, a MYOCARDIAL INFARCTION. When that happens, all you can do is try to heal and rehabilitate.

The causes of coronary heart disease are well known: smoking, diabetes, elevated cholesterol and triglyceride levels, other genetic factors and many less common causes.

HEART FAILURE is more about the strength of the heart, not the blood supply. Heart failure happens when the heart muscle becomes weak and cannot pump blood with enough force to keep everything humming along. Instead of pain, heart failure causes symptoms of weakness and fatigue, swelling of the legs, and swelling in the lungs which leads to difficulty breathing with exertion or when lying down flat. The symptoms can worsen over months to years until other vital organs are not getting enough blood. This leads ultimately to organ failure and death.

 

Heart Failure (Credit: American Heart Association)

What causes HEART FAILURE? The most common cause is when enough of the heart muscle has died from one or more infarctions during heart attacks that there isn’t enough strong heart muscle to pump adequately. About 70% of heart failure in developed countries comes from prior myocardial infarctions.

Other causes include high blood pressure, toxins such as alcohol or cocaine, viral infections that affect the heart muscle itself, and certain hormonal diseases. This is different from bacterial infections that affect heart valves in a condition called endocarditis.

An important difference between heart attacks and heart failure is that heart attacks can be reversed if treated soon enough. If you are having symptoms of a heart attack, i.e. crushing chest pain with radiation down one or both arms, the sooner you arrive at an Emergency Department and receive anti-clotting drugs, the better your chances of not killing off any heart muscle that could lead to heart failure.

Heart failure, on the other hand, once it is established, seems to be relentless, worsening gradually to the point where the only treatment is a heart transplant.

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