context: Most heart attacks are the result of coronary heart disease, a condition that clogs coronary arteries with fatty, calcified plaques. In the early 1980s, researchers confirmed that the immediate cause of nearly all heart attacks is not the obstructive plaque itself. Instead, it's the sudden formation of a blood clot on top of plaque that ruptures and subsequently cuts off blood flow in an already narrowed blood vessel. The step-by-step process that leads to heart attack is not fully understood. Major risk factors, though, are well-known, and some can be controlled. Of these, the main ones are high blood pressure, high cholesterol, obesity, smoking, diabetes and a sedentary lifestyle. Stress may also raise the risk, and exertion and excitement can act as triggers for an attack. Another important risk factor is family history. A family history of heart disease can increase the risk in both men and women at earlier ages. Men over the age of 50 with a family history of heart disease are predisposed to heart attack. High levels of estrogen are thought to protect premenopausal women fairly well, but the risk of heart attack increases significantly after menopause. We are learning more about the risk factors specific for women, such as preeclampsia and gestational diabetes. Autoimmune diseases and inflammatory diseases, that are more prevalent in women, also increase the risk. A cardiologist, or heart specialist, relies on various tests to diagnose a heart attack. These tests can also identify sites of blockage as well as tissue damage. Assessing for heart damage using an ECG, which also is able to monitor the heart's electrical activity, together with blood tests provides data for an initial assessment of the patient's condition. Images of the heart and coronary arteries done with angiograms and radioisotope scans locate specific areas of damage and blockage. Ultrasound tests called echocardiograms evaluate the heart's function and can evaluate whether or not the heart muscle has been damaged, as well as visualize the function of the valves. With such data, the doctor can decide on proper treatment as well as anticipate potential complications. A heart attack is a medical emergency. It must be quickly addressed by conventional medicine. At this point, alternative medicine cannot compete with standard drug therapy and surgical treatments. Alternative medicine may at other times, though, make valuable contributions to heart attack prevention and recovery. Heart attack victims undergo emergency procedures to restore blood flow to the heart and become stabilized. Then, they are usually hospitalized in special coronary care units ( CCU) for at least 36 hours. Standard drug therapy may include: Vasodilators such as nitroglycerine to expand blood vessels Beta-adrenergic blocker drugs to calm the heart Aspirin to reduce clotting activity Other types of blood thinners to prevent clots from forming and for breaking up those that are already there. Intensive therapy with a statin medicine. A painkiller such as morphine In some cases, clot-dissolving drugs like t PA or tenecteplase ( TNKase) are also given. These drugs are most effective if given within a few hours of the beginning of a heart attack. And are the first choice if emergency angioplasty is not available. Sometimes it is used if there is a delay in angioplasty. Emergency angioplasty, and possibly surgery, might be performed to remove a clot, reopen a clogged artery, or bypass blocked arteries. Once past the critical phase of a heart attack, patients continue to receive: Beta blockers to slow the heart Nitrates to increase heart blood flow Blood thinners to prevent further blood clotting Statins to lower the LDL cholesterol In the hospital, electrocardiogram machines are used to monitor the heart and watch for rhythm abnormalities. If the heart starts beating too fast or too slow, various medications may be given. Some patients may be fitted with pacemakers. If a patient experiences a dangerous arrhythmia known as ventricular fibrillation, electric shock may be used to restore the normal rhythm. Patients who show signs of congestive heart failure receive a variety of medications to decrease strain on the heart and encourage the heart to beat more forcefully. People recovering from a heart attack are urged to get back on their feet as quickly as possible. Doing so reduces the chances of blood clots forming in the deep veins of the legs. These clots could travel through the circulatory system and lodge in the lung, creating a blockage. Gentle exercise is recommended, but nothing that requires significant exertion. Beginning exercise soon after suffering from a heart attack can help in improving the heart function and overall well being. A cardiac rehabilitation program with monitored exercise and lifestyle modification is a critical piece to recovery. Long-term recovery from heart attack requires psychological and lifestyle adjustments. Habits that need to go include Smoking Heavy drinking Eating high-fat foods. Being inactive and sedentary. As a preventive measure, most heart attack survivors take a daily aspirin tablet to thin the blood. Other drugs may also be prescribed, depending on the patient. Some patients need invasive procedures to improve blood flow to the heart over the long term. The two most common procedures are: Angioplasty -- a catheter technique that widens clogged arteries by breaking up plaques. Stents are often placed to hold the artery open. Coronary bypass surgery, which diverts blood flow around clogged arteries Regular aerobic exercise greatly improve the chances of preventing or recovering from a heart attack. Check with your doctor before starting any kid of exercise program. If you already have a heart condition, your doctor will likely schedule a stress test before beginning an exercise program. The test can help to determine how much exertion is safe. Heart attack survivors are advised to exercise with other people rather than alone during the first months of recovery. Many community health and recreation centers offer physician-supervised cardiovascular rehabilitation programs. Reducing stress may be one of the risk factors that you can control to help prevent a heart attack and aid recovery. Many techniques promote relaxation -- among them, meditation, biofeedback, and yoga. Relaxation has also been shown to provide relief from pain, which may be encountered during the recovery period. People with a positive attitude about recovery tend to do much better. You may find that a particular mind/body technique helps you to focus on positive thoughts. You may also find, as many others have, that sharing thoughts and emotions with a support group is extremely beneficial. Depression is also associated with heart disease. Discuss any signs of depression with your doctor. Untreated depression can interfere with your recovery. The basic goals of a heart-healthy diet are to keep salt, sugar, and saturated fat to a minimum to control cholesterol, blood pressure, and weight. Eating magnesium-rich foods such as nuts, beans, bran, fish, and dark green vegetables may help prevent a heart attack. Magnesium protects the heart directly and indirectly, by stabilizing heart rate, reducing coronary artery spasm, and combating such conditions as atherosclerosis and high blood pressure. Much evidence suggests that unstable chemical compounds known as free radicals make the body more vulnerable to heart attack by striking the heart and coronary arteries and promoting atherosclerosis. Free radicals can be neutralized by antioxidants like vitamins A, C, and E. Fruits, vegetables, and grains supply many of the antioxidant vitamins. Vitamin supplements are not typically recommended, as they have been shown not to be beneficial, but getting vitamin and nutrients in a balanced diet is critical. Omega-3 fatty acids have also received a lot of attention for being heart healthy by lessening inflammation in the body. Omega-3s can be found in olive oil, canola oil, walnuts, and flax seed. However, omega-3 fatty acids are probably best known for being in certain types of fish like salmon, tuna, herring, and mackerel. A landmark 2006 study showed that a modest intake of fish can reduce the risk of dying from a heart attack by a whopping 36%. Eating root vegetables such as carrots may also help prevent heart attack. These vegetables lower cholesterol over the long term and reduce blood-clotting activity. Remember: Having a heart attack does not make you an invalid. You can best heal your heart by remaining active. Do not take birth-control pills if you have had a heart attack; they are linked to increased blood-clotting activity. Consider getting a pet. Pet owners recover more quickly from heart attacks -- probably because of reduced stress levels -- and tend to live longer than people without pets. Just be sure to choose a pet that fits your lifestyle. Stay in touch with friends and family. Research shows that people with poor social support are more vulnerable to heart disease. Also, seek ways to control feelings of anger and hostility; these emotions may add to heart attack risk. Assess your heart attack risk profile and make appropriate changes to diet and lifestyle early. Talk with your doctor about taking an aspirin daily. Studies have shown that a regimen of taking a low-dose aspirin each day can significantly reduce the risk of a heart attack. Your doctor may prescribe other drugs as well. Recent studies have shown that a new medication, evolocumab ( Repatha), can help prevent heart attacks and strokes in people who have been diagnosed with cardiovascular disease. You or someone you are with has signs of a heart attack. Your angina (chest pain) no longer responds to medication; this may indicate that a heart attack is under way. Your angina attacks become more frequent, prolonged, and severe or occurs at rest; as angina worsens, the risk of heart attack increases. You are taking aspirin to prevent heart attack and your stool appears black and tarry. This may indicate gastrointestinal bleeding and could be a sign that aspirin has thinned your blood too much, a problem that can and should be corrected.