Heart attack and HIV

A heart attack is a medical emergency which happens when your heart can’t get enough oxygen. This is often caused by a blood clot stopping blood from flowing through your heart properly. When a part of your heart isn’t getting enough oxygen it starts to die, which means that blood can’t be pumped around your body in the way it should. If you don’t get urgent medical attention, a heart attack can cause serious, permanent damage to your heart and even death.

There are different types of heart attacks. Type 1 heart attacks are caused by fatty deposits that build up in your arteries over time (atherosclerosis). These can break off and cause blood clots which stop blood from getting to a part of your heart.

Type 2 heart attacks are caused when there isn’t enough oxygen for your heart to work properly, even though blood is flowing to it. This can be caused by several things, including an infection (sepsis), respiratory failure, and using cocaine.

You might sometimes hear a heart attack called a ‘myocardial infarction’ or ‘MI’ for short.

Your lifestyle and heart attack

You can reduce your risk of having a heart attack by making changes to your lifestyle. These changes will generally improve your heart health and can help reduce the chance of you developing heart disease.

• Eat a healthy, balanced diet that contains plenty of fruits, vegetables and whole grains such as brown rice.
• Eat fewer foods that contain saturated fats, such as butter, cheese, and coconut oil. Instead, replace them with foods that contain unsaturated fats, such as vegetable oils and nuts.  
• Avoid highly processed foods wherever possible as these tend to contain large amounts of salt, sugar, and trans fats.
• Eat less than 6g of salt a day (about 1 teaspoon). Try to cut down or remove salt when you’re cooking from scratch and check the labels of the foods you’re buying.
• Get regular exercise. Try to aim for 150 minutes of moderate-intensity exercise, such as cycling or brisk walking, each week. If you have very high blood pressure you should speak to a doctor about what type of exercise is safe for you.
• Don’t smoke. If you are a smoker, you can get support to stop smoking from your doctor.
• Limit your intake of alcohol. In the UK, the recommended limit is no more than 14 units a week.
• Limit your intake of caffeine. Avoid drinks and foods that contain a lot of caffeine such as coffee, Coca Cola and Red Bull.
• Limit your use of recreational drugs. Taking cocaine, MDMA (ecstasy), and amphetamines (such as meth) increases the risk of heart attack. If you’re concerned about your drug use, speak to your doctor.
• Manage your weight. If you're overweight try to lose weight in a safe and healthy way by eating a healthy balanced diet and getting enough exercise.
• Get enough rest and sleep. Try to get around eight hours of sleep each night. If you’re having trouble sleeping, speak to your doctor.
• Find ways to manage or cope with stress. This might involve exercise, mindfulness, or making time to do the things you enjoy.

Who is at risk of having a heart attack?

Many of the causes of heart attacks are linked to people’s lifestyles. However, some people are at higher risk for other reasons.

• Having other health conditions such as high blood pressure, high cholesterol and diabetes.
• Having a close family member who has or had heart disease before the age of 50 years old.
• Your risk increases as you age, so older people are at higher risk.
• Being from certain ethnic groups, such as people from a South Asian background.

Heart attack in people living with HIV

There is evidence that people living with HIV have an increased risk of having a heart attack. The risk is higher if you have a low CD4 count. However, it’s important to know that although the risk of having a heart attack is higher for people living with HIV, the overall risk of it happening is still quite low.

Type 1 heart attacks (caused by fatty deposits in your arteries) are the most common type of heart attack.

Type 2 heart attacks (when there isn’t a blockage in your heart) seem to be more common in younger people living with HIV than in the general population. In people living with HIV, type 2 heart attacks can be caused by sepsis. Sepsis happens when your body responds to an infection in a harmful way.

Type 2 heart attacks are also linked to the use of recreational drugs such as cocaine, MDMA (ecstasy), and amphetamines such as crystal meth.

Anti-HIV medication

There is also a link between some anti-HIV medications and heart attacks. Some studies have found that abacavir (Ziagen, also in Kivexa, Epzicom, Triumeq, and Trizivir) is linked to an increased risk of heart attack and heart disease. It’s not known for sure why this link might exist. You might be told not to take abacavir if you are already at a higher risk of heart disease.

One study found that darunavir (Prezista, also in Rezolsta and Symtuza) might increase your risk of heart attack when compared to atazanavir (Reyataz, also in Evotaz). More studies are needed to know if this link exists for sure.

Some anti-HIV medications can affect your heart more generally. More information about this can be found on our page Coronary heart disease and HIV.

Symptoms

If you think you might be having a heart attack, call an ambulance immediately. Lots of people put off getting help for symptoms of a heart attack, but the sooner you receive treatment the better your chances of recovery are. There are many heart attack symptoms, and you might only have one or two.

• Chest pain. This is the most commonly reported symptom of a heart attack. Your chest might feel tight or heavy. You might feel like your chest is being squeezed or under pressure. It can also feel like burning or indigestion.
• Pain in other parts of your body. The pain might spread to your arms, jaw, back and stomach.
• Feeling lightheaded or dizzy.
• Sweating.
• Feeling sick (nausea) or being sick (vomiting).
• Feeling suddenly very anxious. This can feel like a panic attack.
• Coughing, wheezing and being unable to breathe.

You might experience symptoms that come on very suddenly or you might feel unwell for a few days beforehand.

Diagnosis and monitoring

If you think you’ve had – or are having – a heart attack, call an ambulance immediately. You should sit down and try to remain as calm as possible while you wait for help to arrive. If you are not allergic to aspirin, try to chew on a 300mg aspirin tablet before swallowing it. This helps to improve blood flow.

When you get to the hospital you will have an electrocardiogram (ECG). This type of test tells doctors whether you have had a heart attack, and how serious it was. It’s done by placing pads on your chest and reading the electrical activity in your heart. You might also have other tests in the days after your heart attack, such as:

• a chest X-ray
• blood tests
• an echocardiogram, which is a scan that creates a picture of your heart
• an angiography, which involves dye being injected into an artery before an X-ray is taken.

Treatment and management

Your treatment will depend on the type of heart attack you had and how serious it was. Some people need to have surgery.

Medication

Soon after your heart attack, you might be given medication to stop blood clots. This is sometimes called 'clot-busting' medication or 'thrombolytic' medication. It is given by injection or infusion. This might happen in the hospital, or the ambulance on the way there. There shouldn’t be any interaction between clot-busting medication and HIV treatment.

After a heart attack, you will usually be prescribed medication that will reduce your risk of having another one. This might include anti-platelet medications, statins, diuretics, beta-blockers, and ACE inhibitors. Some of these medications can interact with anti-HIV treatment, so it’s important that your healthcare team know which medications you are already taking.

Clopidogrel (Grepid, Plavix), rivaroxaban (Xarelto) and ticagrelor (Brilique) are three different antiplatelet medications. It's important to know that you shouldn't take them with:

• elvitegravir (Vitekta) when taken with cobicistat, including in the combination pills Stribild (with cobicistat, tenofovir disoproxil fumarate and emtricitabine) and Genvoya (with cobicistat, tenofovir alafenamide and emtricitabine)
• protease inhibitors such as darunavir (Prezista, also in Rezolsta and Symtuza), atazanavir (Reyataz, also in Evotaz) and lopinavir (Kaletra) when they are taken with ritonavir (Norvir) or cobicistat (Tybost). You might take a booster separately, or it may be included in a combination pill.

Some heart medications, called statins, can also interact with anti-HIV treatment. There is more information about this on our Cholesterol and HIV page.

ACE inhibitors, beta-blockers, and diuretics are all medications used to reduce your blood pressure. There is more information about them on our page High blood pressure and HIV.

Surgery

Some people need surgery after a heart attack to improve the blood flow to their heart. This can be done in two different ways.

• A coronary angioplasty. A balloon is inserted into your artery to make it wider. Usually, you’ll also have a thin tube put into your artery at the same time. This tube is called a stent. A stent keeps your artery open to allow blood to flow more easily.
• A coronary artery bypass graft (CABG). You might have heard this called a 'heart bypass'. A blood vessel from somewhere else in your body is used to divert blood around a blockage in your artery. This means the blood has a new way to flow into your heart.

Lifestyle changes

If you have had a heart attack, you will usually be advised to make the lifestyle changes mentioned at the top of this page. You might also be able to join a cardiac rehabilitation programme. Cardiac rehabilitation can help you to change your diet and safely start exercising. This can help prevent another heart attack.

You might find that your mental and emotional health is also affected by having a heart attack. It can be a very frightening experience, and you might feel sad, worried, or stressed afterwards. Some people also find it affects their sex life. If you’re concerned, speak to your doctor.

Other useful sources of information

For more information, you may find the website of the British Heart Foundation helpful: www.bhf.org. If you’re in the UK, you can also contact their helpline team on 0300 330 3311.