What Symptoms Should Tip You Off a Heart Attack ?
The classic symptoms of a heart attack include intense, sometimes squeezing, chest pressure or pain, often radiating to the jaw or left arm, and frequently accompanied by profuse sweating, or a nearly overwhelming sense of fear or impending doom.
Unfortunately, many patients with heart attacks do not have this classic presentation. Their discomfort may be relatively mild, and may be localized to the back, abdomen, shoulders, or either or both arms. Nausea and vomiting, or merely a feeling of heartburn, may be the only symptom. These less classic symptoms may not make patients think of a heart problem, and may keep them from seeking medical help. Indeed, up to 30% of heart attacks are diagnosed by taking a routine ECG long after the fact.
This is why people with one or more risk factors for coronary artery disease need to pay close attention to any unusual symptoms involving the upper half of the body. This warning would apply, for instance, for any middle-aged or older person who is obese, sedentary, a smoker, a diabetic, overweight, has high cholesterol, or has a family history of heart disease. (Ideally, of course, such people will have been evaluated by a competent physician who will have screened them for the presence of coronary artery disease, coached them on risk factor modification, and heightened their awareness of potential cardiac problems.)
What are the Consequences of a Heart Attack?
When a portion of heart muscle dies, several bad things can happen. If the amount of damage is large enough, the patient can develop immediate heart failure and shock. (When doctors refer to “shock,” they are talking about extremely low blood pressure, caused by the heart’s inability to pump sufficient blood to the body’s tissues.) When heart failure occurs immediately after a heart attack, there is an extremely high risk of early death.
If the amount of heart damage is only mild or moderate, heart failure does not occur – at least, not right away. However, in the effort to heal itself, the heart goes through a period of “remodeling,” in which the heart enlarges and changes shape. This remodeling eventually leads to a decrease in cardiac pumping efficiency, and can lead to a more gradual onset of heart failure months or years after the heart attack. To a large degree, the outcome of a heart attack depends on the amount of heart muscle that dies. This, in turn, is related to which coronary artery is blocked (click here for a description of the coronary arteries), and to where in the artery the blockage occurs. (A blockage near the origin of an artery will affect more heart muscle than a blockage farther down the artery.)
During the first few hours of an acute heart attack, a transient form of electrical instability occurs that makes the heart prone to develop ventricular tachycardia and ventricular fibrillation - frequently lethal heart arrhythmias. Furthermore, during the healing process, the scar tissue that replaces the dead heart muscle can cause a permanent electrical instability. Thus, sudden death is common both during acute heart attacks and among survivors of heart attacks, and accounts for approximately 50% of all deaths due to coronary artery disease.
What Causes a Heart Attack?
Heart attacks happen when blood flow to the heart is blocked. This usually occurs because fatty deposits called plaque have built up inside the coronary arteries, which supply blood to the heart. If a plaque breaks open, the body tries to fix it by forming a clot around it. The clot can block the artery, preventing the flow of blood and oxygen to the heart. See a picture of how plaque causes a heart attack.
This process of plaque buildup in the coronary arteries is called coronary artery disease, or CAD. In many people, plaque begins to form in childhood and gradually builds up over a lifetime. Plaque deposits may limit blood flow to the heart and cause angina. But too often, a heart attack is the first sign of CAD.
Things like intense exercise, sudden strong emotion, or illegal drug use (such as a stimulant, like cocaine) can trigger a heart attack. But in many cases, there is no clear reason why heart attacks occur when they do.
What is Angina, and Why is Unstable Angina a Concern?
Angina (say “ANN-juh-nuh” or “ann-JY-nuh”) is a type of chest pain or discomfort that occurs when there is not enough blood flow to the heart. Angina can be dangerous, so it is important to pay attention to chest pain, know what is typical for you, learn how to control it, and understand when you need to get treatment.
There are two types of angina:
Stable angina is chest pain that has a typical pattern. It happens when your heart is working harder and needs more oxygen, such as during exercise. The pain goes away when you rest.
Unstable angina is chest pain that is unexpected, and resting or taking nitroglycerin may not help. Your doctor will probably diagnose unstable angina if you are having chest pain for the first time or if your pain is getting worse, lasting longer, happening more often, or happening at rest.
Unstable angina is a warning sign that a heart attack may happen soon, so it requires treatment right away. But if you have any type of chest pain, see your doctor.
Quitting Smoking Can Save Your Life
If asthma, lung cancer, and emphysema aren’t enough to scare you off, it turns out smokers are two to four times more likely to develop coronary artery disease (CAD) than nonsmokers. Cardiovascular disease—including CAD, heart failure, and heart attack—is the leading killer in the U.S., claiming more than 860,000 lives in 2005.
Smoking ups your risk for heart disease by decreasing the flow of oxygen to the heart and raises your risk for atherosclerosis, or hardening of the arteries. Lighting up also damages the cells that line the coronary arteries and increases your likelihood of blood clots. In fact, heart-related complications are one of the main reasons cigarettes can take so much time off a smoker’s lifespan.
But there’s good news: Once you quit, your risk for heart disease is substantially reduced within one to two years. Smoking is the single most preventable cause of death, and putting out your butts significantly brings down your risk for heart disease.
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