A-Z

Heart attack

Ideas about the causes of a heart attack

Certain medical conditions are associated with an increased risk of having a heart attack. These are high blood pressure, certain forms of heart disease, raised levels of cholesterol in the blood, a family history of heart disease and diabetes. Other factors known to increase the likelihood of having a heart attack are smoking, eating the wrong things, being overweight, not taking enough exercise and ethnicity*.

There is some evidence that for some people, having high levels of stress could be a factor, often because it leads to unhealthy eating, smoking and drinking more alcohol and not being active enough. Men are more likely to have a heart attack than women. People who have had angina for many months or years may also go on to have a heart attack.

 

Neil described his lifestyle before his heart attack as ‘burning the candle on both ends’.

Neil described his lifestyle before his heart attack as ‘burning the candle on both ends’.

Age at interview: 65
Sex: Male
Age at diagnosis: 62
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How was your lifestyle before you had the heart attack?
 
Oh I burnt the candle at both ends for years.
 
What do you mean? [laugh]
 
Did too much, late nights. I was a heavy smoker at this stage as well.
 
How heavy?
 
Oh up to 60 a day. I was in a pressured job. I was a company director which carries a lot of responsibility and there were problems every single day of one form or another. But that’s what I was paid to do but it was stressful.
 
Were you overweight also or?
 
No I wasn’t overweight, no.
 
How about your diet?
 
Well as far, I believe my diet was ok.
 
So it was the stress and the smoking that you
 
The stress, the smoking yeah. I probably drank too much as well. I think it all caught up on me and of course it is hereditary. My father died of a heart attack and he had strokes as well. So yeah I was, I think I was doing all the wrong things. I’m a bit better now.
 

 

However, heart attacks may occur in people who believe that they have none of these risk factors.

Certainly some people we talked to could not think what had caused their heart attack, and had previously thought that they had every reason to expect that they would not have one. Others mentioned specific factors that might have contributed to theirs. Some people, who felt they could not point to a cause, said this made them all the more anxious that they might have another one.

 

He had none of the risk factors for a heart attack but had a heart attack at the age of 49.

He had none of the risk factors for a heart attack but had a heart attack at the age of 49.

Age at interview: 61
Sex: Male
Age at diagnosis: 49
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We never really suspected there was anything wrong until the actual heart attack happened and in fact it was one of the things that I didn't ever think would happen to me with my background. I've never smoked, not been overweight. I was a physical education teacher and had always thought that it's something that happens to other people

I don't have a strong family history of heart disease. My mother had a couple of heart attacks but then she had rheumatic fever shortly after the end of the second world war and that had weakened her heart. So that really doesn't count in terms of inherited problems with heart diseases and I have a sister who has had problems, but she's quite a bit older than me. So again, that tends to weaken the family trait a little bit. I was quite a surprise to them all. A heart attack at 49 with a background like mine, surprised everybody. Surprised me a bit.

I think I'm unusual in that it came out of the blue and I didn't really have any pre-disposing risk factors in there. I've never, ever smoked. I have never drunk to excess. I was fit, I wasn't overweight. So all those usual things weren't present in my case. So I'm unusual in that respect.

 

He had a strong family history of heart disease.

He had a strong family history of heart disease.

Age at interview: 62
Sex: Male
Age at diagnosis: 59
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Well it is a good strong family history of heart problems and I was expecting something was going to happen after the age of 50 because I looked into the generation after generation, and each generation is 10 years earlier having their heart attack. So my generation was in the region of 50. 

So I was expecting it to happen at any time, my two brothers had this same problem. My youngest brother I think he was born with congenital abnormalities. 

Some had been told by their doctors that smoking had been a major cause. Several older men who had stopped smoking fifteen to thirty years ago felt it couldn't have been a major factor.

 

Smoking eighty cigarettes a day contributed to his heart attack.

Smoking eighty cigarettes a day contributed to his heart attack.

Age at interview: 51
Sex: Male
Age at diagnosis: 49
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I was a big smoker, big smoker, four packets, twenty cigarettes in a day. Two packets, three packets, that's normal you know. But now I advise everybody and advise, advise, advise, to stop smoking. That's killing life you know, not good for life. But this smoking, it's no good.

Did you find it difficult to actually stop smoking?

No, no because when doctors told me that this happened, and it comes with the smoking, I hated tobacco. The same day I stopped that. If now somebody is smoking, I go away. I don't like to stand by there and stay with them.

 

Stanley gave up smoking one month before his heart attack because of the expense. He had no...

Stanley gave up smoking one month before his heart attack because of the expense. He had no...

Age at interview: 59
Sex: Male
Age at diagnosis: 59
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How was your lifestyle before you had your heart attack?
 
Well I thought it was alright you know I kept fairly fit. I'm not like, you know, I'm not overweight. I do a manual job and I'm, you know, on my feet all day and I thought I was reasonably fit for my age.
 
OK so you did quite a lot of physical activities?
 
Yeah
 
What about, I don't know drinking or smoking?
 
I don't drink at all but I did smoke a lot.
 
A lot?
 
Yeah, yeah thirty, probably thirty a day but I had stopped smoking four weeks before I had the heart attack.
 
Any particular reason. Are you, were feeling bad? Your chest…?
 
No it was when, when they went up in the budget [laughs].
 
Ah because of price?
 
Yeah they got too expensive so I just stopped.
 
And did you have any problems stopping?
 
No, no not at all.
 
And you smoked for how long?
 
Twenty years.
 
Twenty years around thirty a day?
 
Yeah
 
And then you gave up with not much problem?
 
No, no problem at all, just stopped.
 
OK [laughs]. How much do you think smoking contributed to…?
 
A lot I think. Yeah I think a lot of it was to do with smoking.
 
Anyone in your family with a heart problem, your father or…?
 
Yeah my dad had a heart attack at fifty two but he was a heavy smoker as well.

 

One woman was told that high blood cholesterol was the only risk factor that doctors could identify as a reason for her heart attack, which she found disappointing because she had always made an effort to eat healthily. Some people have a hereditary tendency to have high cholesterol, which in an extreme case is called hyperlipidaemia.

 

High blood cholesterol was the only risk factor that might have contributed to her heart attack.

High blood cholesterol was the only risk factor that might have contributed to her heart attack.

Age at interview: 63
Sex: Female
Age at diagnosis: 63
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I do try to be careful, I always ate well and I've always eaten carefully; lots of fruit and veg, semi this and semi that and no fat this. So it was rather disappointing to learn that in fact the reason that I'd had the heart attack was because of cholesterol. I know that cholesterol is not necessarily from food; you've got your body cholesterol, which may be unbalanced or could be a cause. 

But they could find no other reason; no heart trouble in the family. I don't smoke, I did when I was younger, I think everybody probably smoked in the sixties, but not heavily, one a day. I don't drink, except at Christmas and I eat carefully and I do exercise so I seem to be doing all the right things but there you go.

They said it was cholesterol?

They said, that was the only thing, that was the only thing that came up positive. Cholesterol was the only one that was over the limit, so they put it down to cholesterol.

Several people felt that being overweight or eating a high fat diet could have contributed to their heart problems. One woman had tried to lose weight for many years without success and said she would have liked more support from her doctor to help her to do that. One man had been told by his doctors that his diet in childhood and during his twenties laid the foundations for a heart attack later on.

 

She had tried to lose weight unsuccessfully for years before her heart attack.

She had tried to lose weight unsuccessfully for years before her heart attack.

Age at interview: 63
Sex: Female
Age at diagnosis: 63
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And then she told me to lose weight, which is normal isn't it, that's what everybody says, I mean they, its either 'Do you smoke?'  'No.' 'Oh well then it's your weight.' Right. So it's the weight. Now for years, I've obviously tried to lose weight for years, and I've always had a very active life, I've always had I've worked on a farm, I've had a horse, I've ridden every day, I've walked the dog, I, all these things you know I've brought up three children and I've worked since I was 15 - hard. 

And it's only the last three years that I'd slowed down. I'd gone to the gym but even with my work I, I do, I used to do quite a lot of swimming, I used to go four times a week with this particular person for her to have this exercise. So, and we'd swim and we'd do aqua-aerobics and things.

And I, I was very bitter towards the doctor at first. Not her personally but that, the way, what I thought they should have done for me. I mean in all fairness they have always said, 'oh you must lose weight, you know you're too, you're overweight and all that.' But they've never ever helped. They seemed to think I could go home and just switch it off and I would lose weight. And every time I went back and I hadn't lost weight they 'Oh well.' 'And I've stuck to this diet,' they didn't believe me.

I've been to Weight Watchers, I've done Slimming World, I've done every diet in the book and I've never lost any weight. And I've had, they've had my thyroid checked, I haven't got sugar diabetes, there's nothing wrong with me, I'm perfectly healthy. 

 

Diet in his childhood and during his twenties may have been a factor in causing his heart attack.

Diet in his childhood and during his twenties may have been a factor in causing his heart attack.

Age at interview: 66
Sex: Male
Age at diagnosis: 65
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So I said to the doctor, the surgeon, 'why did I have a heart attack?  All my friends say you are the last person to have a heart attack. I'm relaxed, I don't work, I've been retired now, fully retired for six years and semi-retired for ten. I have no great stresses or needs, no family worries. Two kids are happily married with children. Happily married with the wife. Financially, reasonably financially secure. So I don't have any worries, so I don't have that sort of worry, I keep, I thought I keep myself fit, I don't eat to excess.'  

And the surgeon said a very telling thing, he said, 'you're a child of the war.' I was born in 1937. He said, 'you'll be a member of the dripping brigade.' He said, 'when you were a kid, your mum, on a Monday, after the Sunday roast on a Sunday, would have given you a dripping sandwich and you'd have loved it, dripping toast.' He said, 'you all did at that age and your mum thought it did you good, get some grease on your chest. Also because it was the war years you'd be eating the fattier things, leg of lamb, rack of lamb.'

And these were all the things I loved as a kid and funny enough I still love, [er] cottage pie, sausages. He said, 'you were a member of that and that's when you lay down this trouble, when you were a child.' And he said, 'then how did you live afterwards?' And I said, 'well okay, I got married when I was in my, end of my twenties but I was an engineer.' And I said to him, 'when you think of what you did to yourself.'

I was an engineer and we had a staff canteen and the only thing they could cook properly was chips so I would have chips every lunchtime with something. And I was going to college, so I'd go to college most nights so I'd have chips for my tea. So in my formative years, until I was probably thirty, I wasn't eating the right things and I was laying down this that's happened.          

One man wondered if stopping his earlier regular strenuous exercise could have contributed to his heart attack.

 

He thought taking less exercise in the years leading up to his heart attack could have contributed.

He thought taking less exercise in the years leading up to his heart attack could have contributed.

Age at interview: 52
Sex: Male
Age at diagnosis: 51
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It's very tricky seeing that I didn't, as I've said, I'd given up smoking fifteen years ago. I was certainly overweight, but I wouldn't say dramatically overweight. I said, I didn't have high blood pressure. Cholesterol was not a problem. Whether it's just years of bad living? 

The one thing which I wonder, because it's very interesting, the person who I did join at the rehab, I hadn't seen for a long time, was a former squash partner, who played regularly and I thought it was a strange coincidence both of us had a heart attack you know, within a month. 

And I just wonder whether, having taken a lot of exercise, being very energetic, playing squash at least twice a week for a considerable number of years, and then I just stopped, and not taking any exercise. Whether maybe the, you know, the body having been used to, and the heart having been used to sort of pumping around then suddenly it's not doing that, maybe that had some sort of contributory factor. I mean that's just my own personal feeling. 

Working too hard, stress and a busy lifestyle, without taking time to relax or exercise was thought by some to have been a contributing factor.

 

He had angina for 15 years and thought work stress and having little time to relax contributed to...

He had angina for 15 years and thought work stress and having little time to relax contributed to...

Age at interview: 67
Sex: Male
Age at diagnosis: 65
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I would say it was more to do with the stress of the job. The travelling because I was travelling, as I said, an hour and a half each way, an hour and a half, you know, 3 hours a day, basically. And that was when everything was running all right. I don't know if you know what the trains is like? [laughing]  

Sometimes it was 6 hours or maybe more, sometimes. And one of my biggest problems was I wouldn't take time off. Even when I wasn't feeling well, I wouldn't take time off. I should have realised anyway because I think about a month before I actually retired I actually collapsed on the train. And of course, I just thought it was one of them things, you know what I mean? I didn't realise [laughing]. 

But I think it was more to do with the actual stress of the job, the travelling and that sort of thing. And I'd had angina for a long time, but even because I had angina I never put the two and two together to say heart attack. Which is obvious [laughing] but then, of course, I'd had angina that long that I didn't, you know, it was just one of them things I had to take tablets for. 

 

James explains that a stressful work life, heavy smoking, lack of exercise and poor diet all...

James explains that a stressful work life, heavy smoking, lack of exercise and poor diet all...

Age at interview: 63
Sex: Male
Age at diagnosis: 62
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My biggest problem was I smoked.
 
You smoked?
 
Up until my stroke of course.
 
OK how many did you smoke?
 
I was smoking I would say twenty a day but I was probably smoking thirty. I knew they were bad for me. Everybody said it's about time you gave up. I promised I'd give up at fifty, fifty five and sixty and there I was at sixty and I still hadn't given up. Make so many excuses why you shouldn't [laughs], yeah.
 
Was it difficult to give up smoking after your stroke?
 
Yes, yes I mean I lapsed a little bit at times I've got to be honest and in fact there have been times I have lapsed over the last period and that got sorted out by my nurse with Champix. I'm actually finishing off the course on Champix and I haven't smoked for two months now.
 
What's that? Champix – can you explain that to us?
 
Champix is a new drug to help people who can't give up smoking. It makes the cigarette taste horrible and its well worth a try. If obviously you have to check with your doctor and make sure that it's OK but I sound like an advert for it don't I? [laughs] But it does help and you’ve got to be in the right mind, you want, must give, want to give up; a friend told me about an elderly woman who had to have Champix to give up smoking and he asked her how she was getting on and she said, "Oh I threw the Champix away because the cigarettes tasted horrible." That is the sort of mentality you don't want. You've got the mentality, "Yeah they do taste horrible, I must admit," and that is a good, another good thing that's come out of this is the fact that I don't smoke any more. I don't smoke at all. It's very difficult. You think to yourself, 'Well I've had a heart attack, ' but you're thinking, 'I'm going to have a fag,' and then you smoke the cigarette and you think, 'I shouldn't have had that,' [laughs] but you still yeah, whatever, you light another one and that is where the problems can really begin.
 
Where you smoking the same amount?
 
No, no, nowhere near. I reduced after my stroke, it was probably five a day something like that and that wasn't immediately, that came about a month to six weeks afterwards and it came at the time when I probably was depressed most actually after my stroke.
 
So your diet was kind of the wrong diet?
 
[laughs] It was completely the wrong diet yeah, yeah, yeah.
 
Big cheese rolls for lunch as well. You know those type of things with a rush, a rushed lunch as well which you're fitting in between working and half the time you don't eat half of it before you'll be back to work and this type of thing. It was very hard, hard mentally the job that I was doing, it was very stressful.
 
OK so would you say that sort of lifestyle was a big contributor to you having heart problems?
 
Yes, yes, yes. I mean the smoking, the eating and the lack of exercise. I mean three classics aren't they? [laughs] you know.
 
And the stress?
 
Yeah the stress. I mean yes which I'd probably put as the lowest one but nowadays they're saying probably it's the highest one, I don't know, you know, but those three were obviously my, my reasons that I had that heart attack most definitely.

 

A few people had had a history of high blood pressure. One woman felt that she would not have had her heart attack had she been given medication to control her high blood pressure. Two men had diabetes, which was controlled with medication. A woman, who had a heart attack when she was 37 years old, had been told that it had been caused by a blood clot in her leg, which had travelled to her heart.

Some people had a family history of heart attack or heart disease. One man with a strong family history of heart disease in his family said he was expecting to have a heart attack when he was in his fifties.

*Rates of high blood pressure and diabetes are higher in people of African and Afro-Caribbean descent, which means that they also have an increased risk of coronary heart disease and heart attacks.

People of South Asian descent (those of Indian, Bangladeshi, Pakistani, and Sri Lankan origin) are also more likely to develop diabetes compared to white European backgrounds. Again, this also increases their risks of coronary heart disease and heart attacks – NHS choices June 2017.

Last reviewed June 2017.

Last updated June 2017.

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