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A heart attack (or myocardial infarction) was the sudden interruption of oxygen-rich blood supply to the heart muscle. It occurred with people who had coronary artery disease or other conditions that restricted blood flow through the arteries, such as atherosclerosis. Build up within the arteries that resulted in plaque formation of different sizes were the main causes of a heart attack. A heart attack resulted in damage to the heart muscle - which, depending on the general health status of the heart and severity of blockage, could be reversible or not. A heart attack was different from cardiac arrest, in which the heart itself stopped due to failure to contract effectively. Depending on the severity, a heart attack could lead to death if not treated immediately.
In February of 2154, Major J. Hayes suffered a heart attack after being shot through the heart by a Xindi-Reptilian while being beamed away. Dr. Phlox tried to revive him, but was unsuccessful. (ENT: "Countdown")
In 2268, Sarek had a malfunction in one of his heart valves. Dr. Leonard McCoy told James T. Kirk that it was similar to a heart attack, but with Vulcan physiology, it was impossible to tell without surgery. (TOS: "Journey to Babel")
In 2287, Captain James T. Kirk, Captain Spock, and Dr. Leonard McCoy climbed a turboshaft on the USS Enterprise-A to evade Sybok's followers. Kirk told them "look at it this way, we'll get a good workout" to which McCoy replied "yeah, or a heart attack." (Star Trek V: The Final Frontier)
In 2313, Acamarian Gatherer Penthor-Mul was killed by Yuta, the last surviving member of the Tralesta clan. She used a microvirus on him which caused a fatal heart attack. In 2366, Yuta murdered Volnoth, who like Penthor-Mul, also died from a heart attack caused by the microvirus. (TNG: "The Vengeance Factor")
In 2372, while at a reception for the Trill scientists who had arrived at Deep Space 9, Dr. Lenara Kahn suggested to Jadzia Dax that they should profess their love for each other and disregard the reassociation of the Trill. Dax replied that they should probably not do that, as Dr. Hanor Pren would probably have a heart attack. (DS9: "Rejoined")
The Clown, a manifestation of fear produced by Viorsa's artificial reality, liked to behead people as a means of killing them. As he was not real, the actual deaths came in the form of a heart attack caused by unmanageable stress levels resulting from intense fear. (VOY: "The Thaw")
When Grand Nagus Zek was deposed because he gave females equal rights, Ishka was set to meet with Nilva, an influential member of the Ferengi Commerce Authority, to convince him that women can live as equals. However, during an argument with Quark, Ishka suffered a possible heart attack or cardiac arrest and collapsed on the spot. She had to be given a new heart. (DS9: "Profit and Lace")
In 2376, The Doctor asked Lieutenant B'Elanna Torres to delete his medical database. Torres sarcastically asked him if he was sure about doing that, in case he gave his Qomar fans a heart attack and couldn't revive them. (VOY: "Virtuoso")