Warning Signs of a Heart Attack
Each year, approximately 715 000 Americans experience a heart attack, approximately 162 000 of which are fatal (Table 1).1 Of those who die, almost half die suddenly before they can get to a hospital. Although a heart attack is a frightening event, if you learn the signs of a heart attack and what steps to take, you can save a life, perhaps even your own. During a heart attack, a clot in one of the arteries of the heart suddenly blocks the flow of blood to the heart, and within minutes, heart muscle begins to die. This is technically called a myocardial infarction, meaning death of heart muscle. The more time that passes without treatment, the greater the damage. The part of the heart that dies during a heart attack cannot grow back or be repaired.
Fortunately, clot-dissolving drugs and other artery-opening treatments such as angioplasty (often followed by insertion of a stent, which helps to keep the artery open after the procedure) can stop a heart attack in its tracks. Given soon after symptoms begin, these treatments can prevent or limit damage to the heart. The quicker they are started, the more good they will do and the greater the chances are of a full recovery. These treatments are most effective if they are started in the first hour after the onset of heart attack symptoms. The benefit of opening the blocked artery decreases with each passing hour from symptom onset until treatment.
Learn the Signs
Many people think that a heart attack is sudden and intense, like the ‘“Hollywood” heart attack depicted in the movies where a person clutches his or her chest and falls over. The truth is that many heart attacks start as a mild discomfort in the center of the chest. Someone who feels such a “non-Hollywood” warning may not be sure what is wrong. The discomfort (and other symptoms) may even come and go. Even people who have had a heart attack may not recognize the signs because the next one can have entirely different symptoms. The warning signs of a heart attack are shown in Table 2. Learn them, but also remember the following: Even if you are not sure it is a heart attack, you should still check it out promptly. This includes any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, your symptoms become stronger, become more frequent, or last longer than usual).
The media (and often health professionals) mistakenly use the term heart attack when a person suffers a cardiac arrest, which is the term used when the heart suddenly stops beating (often as a result of a rhythm disturbance in the heart). Within seconds, a cardiac arrest victim loses consciousness and may have a few seconds of seizure activity (shaking of the body) as the flow of blood and oxygen to the brain stops. The victim lies pulseless but may continue to have abnormal (“agonal”) breathing for several minutes, which can confuse laypersons into thinking that the individual has just fainted. In such a case, it is critical for bystanders to call 9-1-1 immediately. The 9-1-1 operator will coach the bystander to do chest compressions on the victim and will dispatch emergency personnel and equipment needed to resuscitate the victim. A cardiac arrest can occur as a complication of a heart attack but can also be caused by other disorders.
Timing is everything. People who experience the warning signs of a heart attack often deny how serious the situation is and take a wait-and-see approach. But time is very important, and anyone with these warning signs needs to get medical evaluation and treatment right away. Do not wait more than a few minutes—5 minutes at most—to call 9-1-1. If your physician has prescribed nitroglycerin because you have chest discomfort that comes on with physical exertion and is relieved by rest (a condition called angina pectoris that is usually caused by partial blockage of 1 or more of the arteries nourishing the heart), you may take the medication as prescribed. If your symptoms are not relieved within 5 minutes, you should call 9-1-1 immediately and go to the hospital so that the physicians can determine whether you are having a heart attack. In the past, patients were often told to “take 1 nitroglycerin tablet every 5 minutes for up to 3 doses” if their symptoms were not relieved. This recommendation has been changed to allow only 1 nitroglycerin tablet with a maximum 5-minute period of observation to ensure that, if a heart attack is the cause of the symptoms, the patient will be transported to the hospital as soon as possible to get the blocked artery opened, to minimize heart damage, and to increase the odds of survival.
By calling 9-1-1 and taking an ambulance, you will get to the hospital in the fastest and safest way possible. There also are other benefits to calling 9-1-1:
Emergency personnel can begin treatment immediately, even before you arrive at the hospital.
Your heart may stop beating during a heart attack. Emergency personnel have the knowledge and equipment needed to start it beating again.
Patients having a heart attack who arrive by ambulance tend to receive faster treatment on their arrival at the hospital.
Note: If you are having heart attack symptoms and for some reason cannot call 9-1-1, have someone else drive you at once to the hospital. Never drive yourself unless there is absolutely no other choice because you could pass out while driving.
Questions You Will Likely Be Asked in the Emergency Department
When you get to the emergency department, you should be ready to answer, as best as you can, the following questions about your symptoms:
What time did your discomfort begin?
What were you doing when your discomfort began?
Was it at its most intense level immediately, or did it gradually build up to a peak?
Did you notice any additional symptoms in association with the discomfort such as nausea, sweating, or shortness of breath?
On a scale of 0 to 10, with 10 being the worst, what number would you use to describe your discomfort at this time?
Remember: Do Not Delay
The best way to find out whether symptoms are caused by a heart attack is to get checked at a hospital emergency department (Table 3).
In a heart attack, every minute that passes causes more of the heart muscle to die. You can save a life, your own or someone else’s, by calling 9-1-1 right away. Never delay calling 9-1-1 to take aspirin or do anything else you think might help.
Doctors and emergency personnel want anyone who may be having a heart attack to come to the emergency department without delay, even if the symptoms turn out to be a false alarm.
Make a plan now for what you would do if a heart attack should happen. It will save time and could help save a life. To plan ahead, do the following:
Learn the heart attack warning signs listed in this article.
Talk to your doctor about your heart attack risk and what you can do to reduce it.
Ask specifically about aspirin and the use of nitroglycerin.
Talk with your doctor, family members, friends, and coworkers about the heart attack warning signs and the importance of acting fast. Discuss the benefits of calling 9-1-1 instead of going to the hospital by car. Knowing what to do if a heart attack occurs could save your life or theirs.
For more information on lowering your risk of heart disease, check out the following American Heart Association and National Heart, Lung, and Blood Institute Web sites:
What Is A Heart Attack (http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack), information on heart attacks
Heart and Vascular Diseases (http://www.nhlbi.nih.gov/health/public/heart/index.htm), a directory of heart disease prevention and treatment information for patients and the public
High Blood Cholesterol: What You Need to Know (http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm), a patient brochure
Risk Assessment Tool for Estimating Your 10-Year Risk of Having a Heart Attack (http://cvdrisk.nhlbi.nih.gov/calculator.asp), a 10-year heart attack risk calculator
Mission: Lifeline Glossary (http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/Mission-Lifeline-Glossary_UCM_308046_Article.jsp), information on the American Heart Association Mission: Lifeline program
Heart Attack: Know the Symptoms, Take Action (http://www.nhlbi.nih.gov/health/public/heart/mi/heart_attack_wallet_card.pdf), a wallet card with heart attack symptom and response information
The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional.
- © 2014 American Heart Association, Inc.
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