Myocardial Infarction: Don’t Let Your Heart Stage a Walkout!

Imagine your heart deciding it’s had enough and starts clocking out; that’s essentially what a myocardial infarction (MI) is — in layman's terms, a heart attack. It’s your heart’s way of saying: "I’m not getting enough blood!" Thankfully, you don’t have to wait for things to go south. Recognising the signs and understanding the risks can help you avoid a crisis. Myocardial infarction or heart attack cases in India have surged dramatically, rising from 2.26 million in 1990 to 4.77 million in 2020. While advancements in medical knowledge and emergency response systems have significantly improved survival rates, early detection and timely action remain crucial.

Many heart attacks start with mild discomfort — chest pain that comes and goes, fatigue, or even indigestion-like symptoms. Others strike suddenly, with intense pain, breathlessness, and dizziness. Recognising these early warnings and acting fast can make all the difference.

This blog dives into the key signs to watch for, what increases the risk, and what immediate steps can be taken to improve survival chances.

What is myocardial infarction?

Myocardial infarction occurs when blood flow to a part of the heart muscle is blocked, leading to tissue damage or death. This obstruction is usually caused by a blood clot (thrombus) that forms in a coronary artery after the rupture of an atherosclerotic plaque  — a fatty deposit that builds up on artery walls over time. Without timely treatment, the affected heart muscle begins to deteriorate due to a lack of oxygen. The severity of a heart attack depends on the location of the blockage and how quickly medical intervention begins.

Myocardial infarction symptoms

• Chest pain or discomfort – Often described as pressure, squeezing, or fullness, sometimes radiating to the arms, neck, jaw, or back

• Shortness of breath – Can occur with or without chest pain

• Cold sweating – Sudden, unexplained sweating

• Nausea and dizziness – May be mistaken for indigestion or general weakness.

• Unusual fatigue – A sense of extreme tiredness, more common in women.

• Abdominal pain – Some women experience pain in the stomach area rather than the chest.

• Heart palpitations – Though rare, heart palpitations are a sign of a heart attack. 

• Anxiety – Women commonly feel more crippling anxiety while having a heart attack. 

• Silent heart attacks – More common in people with diabetes, occurring with minimal or no noticeable symptoms.

What triggers a heart attack?

Myocardial infarction can have several underlying causes, with coronary artery disease being the most common. Other, less frequent causes can also lead to a heart attack. These include:

• Coronary artery disease (CAD) – The primary cause, where arteries narrow due to atherosclerosis (buildup of fatty deposits, cholesterol, and plaque)

• Blood clots – Form when plaque ruptures, blocking blood flow to the heart muscle

• Coronary artery spasms – Sudden tightening of arteries, restricting blood flow

• Takotsubo cardiomyopathy – Also known as stress-induced cardiomyopathy, triggered by extreme physical or emotional stress

• Coronary microvascular disease – Affects the small blood vessels of the heart, reducing oxygen supply

• Spontaneous coronary artery dissection (SCAD) – A rare condition where a tear occurs in the coronary artery wall.

Stages of myocardial infarction

Myocardial infarction progresses in stages, beginning with reduced blood flow and worsening over time if left untreated:

• Ischemia – In the initial stage, reduced blood supply deprives heart cells of oxygen, but they remain alive.

• Injury – If ischemia continues, cells experience reversible damage, meaning timely treatment can still prevent permanent harm.

• Infarction – Prolonged oxygen deprivation leads to irreversible cell death, resulting in permanent damage to the heart muscle.

The healing process occurs in three phases:

1. Acute inflammatory phase (Day 0–3) – The body's immune response removes dead cells.

2. Proliferative phase (Day 3–14) – New tissue forms as the heart begins repairing itself.

3. Maturation phase (Day 14 onward) – Scar tissue replaces damaged areas, affecting future heart function.

Since scar tissue lacks the flexibility and strength of healthy heart muscle, the extent of damage influences long-term heart performance.

Are you at risk?

Myocardial infarction risk factors fall into two categories: modifiable and non-modifiable. Understanding these can help in prevention and early intervention.

Non-modifiable risk factors

• Age – Risk increases after 45 years in men and 55 years in women.

• Gender – Men generally have a higher risk than women.

• Family history – A history of heart disease in close relatives increases risk.

• Ethnicity – Certain ethnic groups may have a higher predisposition.

Modifiable risk factors

• Smoking – One of the biggest preventable causes

• High blood pressure – Strains the heart and damages arteries

• Cholesterol levels – High LDL (bad cholesterol) and low HDL (good cholesterol) raise the risk

• Obesity – Especially when fat is concentrated around the abdomen

• Diabetes – Uncontrolled blood sugar levels contribute to arterial damage.

• Sedentary lifestyle – Lack of exercise weakens heart health.

• Excessive alcohol consumption – Can lead to high blood pressure and irregular heart rhythms

• Stress, poor diet, and lack of sleep – Indirectly increase risk by contributing to other factors

• Medical conditions – Autoimmune disorders, sleep apnoea, and chronic kidney disease add to the risk.

Many of these risk factors often act together, significantly increasing the chances of a heart attack.

Spot it, treat it

Diagnosing a myocardial infarction typically involves a combination of reviewing symptoms, physical examination, and the use of investigative tools to assess heart function and damage. Healthcare professionals look for signs of restricted blood flow and may use various assessments to confirm the extent of the issue.

Once identified, treatment focuses on restoring blood flow to the heart and preventing further damage. This may include immediate interventions to stabilise the condition, followed by long-term management aimed at reducing risk factors and supporting heart health. Early response is key to minimising complications and improving outcomes.

How to prevent myocardial infarction?

Preventing myocardial infarction involves both lifestyle changes and medical management. Key strategies include:

• Heart-healthy diet – Increase intake of fruits, vegetables, whole grains, and lean proteins, while reducing saturated fats, sodium, and processed foods.

• Regular physical activity – Aim for at least 150 minutes of moderate exercise per week, such as brisk walking, cycling, or swimming.

• Avoiding tobacco and limiting alcohol – Quitting smoking and reducing alcohol intake significantly lower heart risks.

• Managing underlying conditions – Keep hypertension, diabetes, and high cholesterol in check through medications, lifestyle changes, and routine check-ups.

• Stress reduction – Practise meditation, yoga, or counselling to manage stress effectively.

• Regular health screenings – Early detection through routine medical check-ups helps prevent complications.

By adopting these preventive measures, one can significantly reduce the risk of a heart attack and improve overall heart health.

Just healthy hearts

Myocardial infarction remains a leading cause of mortality worldwide, but awareness of its causes, symptoms, and prevention strategies can greatly improve outcomes. Early intervention is critical — the sooner treatment begins, the higher the chances of survival and recovery. Advances in research continue to improve treatment options from innovative medications to state-of-the-art interventional procedures.

Everyone should recognise the warning signs of a heart attack and adopt a heart-healthy lifestyle. Prevention is always better than treatment, and small lifestyle changes today can help prevent serious cardiac events in the future.

Frequently Asked Questions

1. What are the four stages of myocardial infarction? 

Myocardial infarction progresses through four stages. The pre-infarction stage marks the beginning of ischemia, where reduced blood flow triggers early symptoms like chest discomfort and shortness of breath. If untreated, it advances to the acute stage, where actual tissue damage occurs due to prolonged oxygen deprivation, leading to irreversible heart muscle injury. The healing stage, typically between 3 to 7 days, involves the body's repair process, with scar tissue beginning to form. Finally, in the post-infarction stage, which takes several weeks, scar tissue fully develops, affecting the heart’s long-term function and overall recovery.

2. What are the four signs of myocardial infarction (MI)? 

The four key signs of myocardial infarction include angina, which is chest pain or pressure that may radiate to the arms, neck, or jaw; dyspnea, or shortness of breath; cold sweats and nausea; and unusual fatigue and dizziness. Symptoms may be less predictable in women, often presenting as extreme tiredness, indigestion-like discomfort, or mild chest pain rather than the classic severe chest pressure.

3. What are 3 common complications of myocardial infarction? 

Three potential complications of myocardial infarction include arrhythmias, which are potentially fatal irregular heart rhythms; heart failure, where the heart is unable to pump sufficient blood due to damage from the infarction; and cardiogenic shock, a severe condition where blood flow to vital organs is critically reduced. These complications can significantly impact recovery and may require urgent medical intervention.