Recognising warning signs, acting promptly and protecting the heart afterwards.
What happens during a heart attack?
Myocardial infarction means heart muscle injury with cell death caused by ischaemia, an inadequate oxygen supply. A clot forming on a coronary atherosclerotic plaque is a common mechanism, but other causes exist. Diagnosis requires the clinical picture, ECG findings and appropriate interpretation of cardiac troponin. An elevated troponin alone does not establish a heart attack.
Warning symptoms
Chest pain, pressure or tightness may spread to the arms, jaw, back or upper abdomen. Cold sweating, nausea, breathlessness or sudden weakness can occur. Pain may be less prominent in some people, particularly older adults and those with diabetes. No single feature of discomfort reliably excludes a coronary emergency.
Emergency diagnosis
A 12-lead ECG should be obtained promptly. High-sensitivity troponin, often measured serially using validated pathways, helps establish the diagnosis. ST-elevation and non-ST-elevation presentations require different pathways according to ECG findings, risk and clinical stability. Urgent reperfusion must not be delayed while awaiting troponin when it is already indicated.1
What changed in the 2026 definition?
The Fifth Universal Definition emphasises identifying the underlying cause and using sex-specific troponin reference limits. This helps distinguish myocardial injury from infarction and supports appropriate recognition in women. Imaging may be needed to clarify the mechanism; a blood result must always be interpreted in context.2
Restoring blood flow
When indicated, primary coronary angioplasty restores flow in the artery responsible. Fibrinolysis may be considered in specific ST-elevation situations when timely angioplasty is unavailable and contraindications have been excluded. Antithrombotic treatment, monitoring and management of complications are integral to hospital care.1
Care after the emergency
Echocardiography assesses cardiac function. Secondary prevention includes appropriate lipid-lowering and antithrombotic treatment, smoking cessation, management of risk factors and cardiac rehabilitation. Drug choices and duration depend on bleeding risk, associated conditions and the treatment received; do not stop prescribed antiplatelet medicines without medical advice.3
Life after a heart attack
Many people return to daily activities with an individual recovery plan. Gradual exercise, a balanced diet, adherence to treatment and cardiology follow-up support recovery and reduce recurrence. Anxiety, fear and emotional difficulties also deserve clinical attention.
Understanding the wider picture
Explore coronary artery disease, heart failure and high blood pressure. These guides explain associated conditions and long-term prevention; they do not replace an individual recovery plan.
About Massimo Fioranelli · Cardiology and internal medicine · Clinical practice at Sanatrix, Rome
References
- ESC 2023: acute coronary syndromes.
- Fifth Universal Definition of Myocardial Infarction, 2026.
- ACC/AHA 2025: acute coronary syndromes.
Coronary artery disease · Italian version
Reviewed 23 October 2026. Educational information does not replace individual medical assessment.