7 DIFFERENCES BETWEEN A HEART ATTACK AND HEART FAILURE

When conversation turns to heart problems, two phrases you may hear a lot are ‘heart attack’ and ‘heart failure’.

They sound similar, but they’re not the same. Let’s look at the difference between them, what causes each condition, and how they’re treated.

The difference between heart attack and heart failure

1. What each means

• Heart attack: Blood flow to a section of the heart muscle is blocked, usually by a clot in a coronary artery. Permanent muscle damage can happen within 20–40 minutes. The more tissue that dies, the harder it is for the heart to pump blood, increasing the risk of life-threatening complications.
• Heart failure: This is a long-term, chronic condition in which the heart cannot pump blood well enough to meet the body’s needs. It still beats, but may be too weak (reduced pumping strength) or too stiff (reduced filling ability) to work at full capacity.

2. How quickly they occur

• Heart attacks or myocardial infarctions often begin suddenly, at times without warning, although some people may see concerning signs hours or days earlier.

The blockage of blood flow can last from minutes to several hours, depending on how quickly the patient receives treatment.

• Heart failure usually develops gradually over months or years. It is generally a lifelong condition.

3. Main cause

• Heart attack: A blockage in a coronary artery, brought on by atherosclerosis or plaque buildup. Plaque is made of cholesterol, calcium, fat particles, and dead cells. If the plaque layer ruptures of breaks, it triggers the body’s natural wound-healing system, and a clot forms. A clot that’s too large can completely stop the flow of oxygen-rich blood to the part of the heart supplied by that artery, leading to a heart attack.
• Heart failure: Many things can damage the heart over time: a past heart attack, long-standing high blood pressure, weak or leaky heart valves, infections, or certain medicines. Heart failure is often the end result of multiple underlying heart problems.

4. Signs and symptoms

• Signs of a heart attack: Chest pain or pressure, crushing pain that spreads to the arm, jaw, neck, or back, shortness of breath, sweating, nausea, or sudden fainting. Women may have less chest pain and more shortness of breath, nausea, or unusual tiredness.
• Signs of heart failure: Shortness of breath during activity or when lying flat, waking at night breathless, swelling in legs or belly, feeling tired all the time, a cough that does not go away, and fast weight gain from fluid buildup. These often come on slowly.

5. How doctors test for each

• If a heart attack is suspected: Doctors typically perform an electrocardiogram (ECG) to look for changes in heart rhythm or electrical activity, blood tests for cardiac enzymes such as troponin (which rise when heart muscle is damaged), and often urgent imaging or coronary angiography to locate and confirm a blocked artery.
• If heart failure is suspected: Doctors may start with a physical exam to check for swelling, fluid buildup, or abnormal heart sounds, followed by blood tests such as BNP or NT-proBNP (proteins that increase when the heart is under stress). An echocardiogram (ultrasound of the heart) is commonly used to assess heart structure and measure how well it pumps.

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6. Emergency care

• Heart attack: Emergency treatment focuses on restoring blood flow to the heart as quickly as possible to limit permanent damage. Depending on the situation, you may receive clot-dissolving medications called thrombolytics, or undergo an urgent procedure called angioplasty.

Angioplasty involves guiding a small balloon into the blocked artery and inflating it to restore blood flow. A stent is often placed in afterwards to keep the artery open.

• Heart failure: You will need emergency care if the chronic condition suddenly worsens: you’re severely short of breath, have very low blood pressure, lips or skin turn blue, become confused, or faint. Treatment in the hospital may include oxygen therapy, intravenous diuretics to flush out excess fluid from the lungs, medications, and continuous monitoring of vital signs.

In some cases, patients may need non-invasive ventilation or other advanced therapies to stabilize their condition.

7. Treatment

• After a heart attack: Blood thinners and antiplatelet drugs like aspirin help prevent blood clots. Beta blockers slow heart rate and lower blood pressure, reducing strain on the heart. Statins lower cholesterol and help stabilize artery plaque to prevent future blockages. ACE inhibitors or ARBs relax blood vessels and help the heart pump more effectively

Some patients may need angioplasty with stent placement. More severe cases may require coronary artery bypass surgery to reroute blood flow around blocked arteries.

• For heart failure: Treatment aims to ease and control symptoms, slow progression, and prevent future flare-ups. Diuretics help remove extra fluid from body tissues, ACE inhibitors or ARBs relax blood vessels, and beta blockers lower strain on the heart. In some cases, SGLT2 inhibitors (originally used for diabetes) improve heart function and reduce hospitalizations.

Lifestyle changes such as limiting salt, maintaining a healthy weight, exercising, and quitting smoking are key. Some people may also need devices like an implantable defibrillator or pacemaker, and in severe cases, surgery or heart transplant.

Frequently Asked Questions about the difference between heart attack and heart failure

1. Can a heart attack cause heart failure?
   Yes. A large heart attack can permanently damage heart muscle, reducing its ability to pump blood effectively. This damage can lead to heart failure, sometimes right away, but often developing gradually over weeks, months, or even years.
2. Is heart failure the same as the heart stopping?
   No. Heart failure means the heart continues to beat, but doesn’t pump as well as it should. Cardiac arrest means the heart stops beating altogether, leading to death within 8-10 minutes if emergency care is not given at once.
3. What tests confirm a heart attack?
   Doctors use an ECG, blood tests to measure enzymes such as troponin, and often imaging or angiography to find a blocked artery.
4. Can heart failure be treated at home?
   Yes, with the help of a doctor’s care plan. Home care includes taking medicines exactly as prescribed, eating a low-salt diet, weighing yourself daily to spot fluid buildup, and getting regular check-ups.

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