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FAQ (Health)

 Dr. George Jacob
Heart Infocenter


Heart Attack (Myocardial Infarction)

How To Detect A Heart Attack

The first hour of a heart attack is known as the "golden hour." If you get help during that first hour, your chances of recovery are greatly improved. Yet many people hesitate to get help when they first experience symptoms. They're afraid of the embarrassment of going to the emergency room and finding that nothing is wrong. So, it is important that you know the symptoms that may indicate that a heart attack is in progress.

Many of the symptoms of heart attack can be brought on by digestive disturbances or other less serious conditions. But only sophisticated medical tests can determine for sure if you're having a heart attack. Heart attacks may vary from person to person, and from heart attack to heart attack. Women, for example, may experience "atypical' symptoms such as pain between the shoulder blades rather than crushing chest pain. This may result in them delaying seeking treatment. That is a great mistake.

Heart attack is one instance where getting treatment promptly can mean the difference between life and death. If you are in doubt, err on the side of being more cautious and go to the emergency room and get yourself checked. We will try to describe some of the most common characteristics of heart attack here. Before that we will introduce the other pain called angina which is often precursor to a heart attack.

Angina Pectoris or Angina

Angina pectoris is a precursor to a heart attack. Usually, what happens is this: During physical exertion, during stress or an emotionally charged situation, in cold weather or after a big meal, the heart beats faster. Heart requires more oxygenated blood flow to the heart muscle to maintain the beating. But if the channels by which the blood and oxygen flow to the heart are narrowed, not enough nutrients get to the heart muscle tissue. It suffers oxygen deficiency, and the heart tells you about this with a pain called angina pectoris.

The pain is quite distinct. It is described as: "a heavy, strangulating, suffocating experience-far more intense than anything like indigestion, chest wall injuries, pleurisy or spasms of the esophagus that you are familiar with. The pain may seem to start under the breastbone, on the left side of the chest, and sometimes radiates out to other places: throat, neck, jaw, left shoulder and arm and, occasionally, on to the right side.

Angina is an intense, scary episode. But with rest and calm (or by placing nitroglycerin or another kind of nitrate under the tongue), angina attacks usually go away in about 15 minutes or so. If they last longer than that, go to the hospital and have a thorough check up. Long-lasting angina attacks may be the prelude to heart attacks.

If you have never been diagnosed with heart disease but develop any of the following symptoms, consider the possibility that you have angina. Make an appointment with your doctor, and arrange for a cardiac screening as soon as possible.
  • Chest pain that comes with physical exertion and eases with rest.

  • Chest pain that is brought on by emotional stress.

  • New or unusual shortness of breath-if you suddenly find you're winded after climbing a flight of stairs when you used to be able to take the same flight of stairs in stride, for example.

  • Indigestion, particularly if indigestion is unusual for you, if it does not respond to antacids, or if you do not associate its occurrence with eating.

The statistics show that half of those with angina pectoris suffer sudden deaths, a third have heart attacks, and most victims are older men. And an estimated 350,000 new cases of angina occur each year.

Although you may not appreciate it when you are suffering from pain, angina itself is not bad. In fact it may be a blessing! Some doctors call angina "God's gift to humans" because many heart problems are silent, without symptoms, and go unnoticed until they become the cause of sudden death. Angina is an early warning sign that something is wrong. Its presence may help identify those at risk of heart attack so that you can seek proper medical treatment promptly.

Heart Attack

Dizziness can be an early symptom of heart attack

Cardiac chest pain is often vague, or dull, and may be described as a pressure or band-like sensation, squeezing, heaviness, or other discomfort.

Pain is Not Always a Symptom of Heart Attack

A heart attack often starts with mild symptoms that may not be painful. Many victims experience a tightness or squeezing sensation in the chest. Get emergency medical help immediately If you experience any of the following symptoms for two minutes or more:

  • Pressure, fullness, squeezing or pain in the center of the chest.

  • Pain spreading to the shoulders, neck or arms.

  • Severe pain, sudden weakness, dizziness, fainting, sweating, nausea or shortness of breath.

  • For those with angina, any change in the frequency, duration or intensity of the attacks, or symptoms that don't respond to nitroglycerin.

Heart attacks frequently occur from 4:00 A.M. to 10:00 A.M. due to higher adrenaline amounts released from the adrenal glands during the morning hours. Increased adrenaline in the bloodstream can contribute to the rupture of the plaque that causes the formation of the clot and the eventual heart attack.

Studies have found that, at least in northern regions, heart attacks may occur more often in the winter months.

Heart attacks do not usually happen during exercise, although exercise is commonly associated with exertional angina.

Approximately one quarter of all heart attacks are silent, without chest pain. In diabetics, the incidence of "silent" heart attacks may be much higher.

Typical Symptoms

The typical symptoms of a heart attack are similar to those of angina, but more severe and longer lasting. The victim feels a pain that is usually squeezing or burning or feels a terrible pressure in the middle of chest. This pain may also travel up to the neck, jaw, or shoulder or down the arm and into the back.

Sweating, dizziness, weakness, and shortness of breath often accompany the pain of a heart attack. If you have chest pain that lasts longer than 15 minutes and is not relieved by rest (or by a dose of nitroglycerin), get immediate medical attention.

Immediately after you call for medical help, chew and swallow an aspirin and drink a glass of water. (Don't take aspirin if you are allergic to aspirin.) Aspirin is known to thin the blood, which helps the heart get more blood if you are, indeed, having a heart attack.

In some cases, a heart attack may cause a sensation that feels like indigestion: you get a sick, aching feeling high in the middle of your abdomen. It can cause a feeling of great weakness, or a sense that you are about to faint. (Many of the people who had heart attacks thought that they had intestinal problem instead of associating it with a heart attack.)

Silent Heart Attack

Heart attacks can occur without any warning symptoms. These are called silent heart attacks. Some heart attacks may be associated with "atypical' symptoms, symptoms such as heartburn, nausea, or sudden light-headedness and sweating. These are more common in women, diabetics, and people older than 65.

The primary symptom of heart attack is a consistent deep, often severe, pain in the chest that can spread to the left arm, neck, jaw, or the area between the shoulder blades. The pain may be present for up to twelve hours.

Many people who have had heart attacks describe it as a heavy, substernal pressure that makes it feel as if the chest is being squeezed. Other symptoms may include shortness of breath, sweating, nausea, and vomiting. Heart attack can also cause abnormal heartbeat rhythms called arrhythmias.

Heart Attack Pain Areas

If you're having a heart attack, you might feel:

Crushing pain in your chest that may spread to your left shoulder

Chest pain that may spread to your neck, jaws, and/or down your back

Deep, dull pain or a tight, heavy, or squeezing sensation beneath your breastbone

The pain may be just in your arms

It may be in your jaw

Or it may be in your back

Early signals of heart attack

  • Uncomfortable pressure, fullness, squeezing, or pain in the chest, usually lasting longer than two minutes

  • Pain radiating to the shoulders, neck, jaw, arms, or back

  • Dizziness, fainting, sweating, nausea, shortness of breath, or weakness

None of these symptoms assures that a heart attack is in progress, but the more symptoms you have, the more likely it is a heart attack.

Other Symptoms of Heart Attack

  • Chest pressure

  • Sweating

  • Jaw pain

  • Heartburn and/or indigestion

  • Arm pain (more commonly the left arm, but may be either)

  • Upper back pain

  • General malaise (vague feeling of illness)

  • Nausea

  • Shortness of breath

See Also: 

What Should You Do If You Suspect You Are Having A Heart Attack

What to do if you are with someone who appears to be having a heart attack

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