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Surviving a Heart Attack: Timing Is Crucial


Is it indigestion or chest pain? Knowing the symptoms of a heart attack can literally save your life.

John H., 46, a medical doctor, thought he had indigestion. He felt discomfort in his abdomen on and off for about a month, took antacid tablets, and went about his life. One day, his wife came home to find him lying on the floor, clutching his chest in pain. She called an ambulance and had him rushed to the emergency room. There, he learned he was having a myocardial infarction (MI), a type of heart attack that causes damage to heart cells. If Dr. H. had waited much longer to get to the hospital, doctors told him, it is quite likely he would have died.

Every year, over a million Americans suffer heart attacks. And heart disease is the leading cause of death in the United States.

The Death of Heart Cells

Most heart attacks are a result of atherosclerosis: deposits of lipids or fatty cells, which build up and cause damage to the arterial walls. The body responds by creating plaque, which forms a scar inside the artery. If the plaque ruptures, it releases its contents that block the flow of blood to the heart. Without blood, the heart does not receive the oxygen it needs, and cells of the heart muscle begin to die.

While a heart attack may describe several possible conditions, MI refers strictly to the death of heart cells. The longer the heart muscle goes without blood, the more severe the damage and the greater the risk of ongoing heart muscle weakness, or even death. MIs can also be caused by drug use, particularly cocaine.

Immediate Treatment Is Essential

A heart attack is a medical emergency and needs immediate care. The first thing you need to do is call 9-1-1. Your survival chances increase with earlier emergency treatment. Heart damage can often be minimized or averted by immediate treatment.

Why People Delay

There are many reasons why people having heart attacks delay getting medical help. Some are fearful or in denial. Others are put off by complications or costs of the medical system, have trouble reaching their doctors, run into language or cultural barriers, or do not have access to care. But many people simply do not realize that they are having a heart attack. That is because the warning signs vary widely, and the symptoms can be unclear.

The Symptoms

The classic symptom is intense, central chest pressure. However, many people do not experience typical chest pain during a heart attack. Other common symptoms include: pain or heaviness in the left arm, nausea, shortness of breath, increased perspiration, a feeling of impending doom, or pain in the jaw, teeth, arm, or abdomen. It is especially common for women to present with symptoms other than chest pain. Symptoms may come on gradually and may be intermittent or vague. A small percentage of patients—particularly those with diabetes—experience no symptoms at all.

If you have any concerning symptoms, you should let your doctor know. By asking questions about your symptoms and what precipitates them, your doctor may determine that the problem is minor; it might be indigestion or a pulled muscle. If a heart attack is suspected, your doctor will send you to the hospital for tests to determine if your heart has been damaged. But, if your symptoms come on suddenly and you think they might be due to a heart attack, call 911 immediately. Time is precious when blood flow to the heart muscle stops, and your life may depend on how quickly help comes.

Are You at Risk?

Because heart attack symptoms can be difficult to recognize, it is important to know if you are at risk. You may be at higher risk if you:

Help From Medical Technology

At the hospital, you will have an electrocardiogram (ECG). This quick test reads your heart rhythm and can detect abnormalities and damage. Blood tests can detect enzymes or markers in the blood which may indicate a heart attack. A more invasive method called cardiac catheterization can quickly determine whether an artery is blocked, where, and to what extent.

Drugs may also be prescribed to break up clots, and doctors may use a catheter device to open blocked arteries; they may even prop open an artery with a stent, so blood can continue to flow freely. In some cases, bypass surgery may be needed.

Life After a Heart Attack

To minimize the risk of a future MI, doctors usually prescribe medicines, such as beta blockers, ACE inhibitors, statins and aspirin to prevent future coronary blood clots. Doctors may also recommend a low-fat, high-fiber diet, a regular program of aerobic exercise, smoking cessation, diabetes control, blood pressure control, and weight management.

RESOURCES:

American Heart Association
http://www.heart.org/

National Heart, Lung, and Blood Institute
http://www.nhlbi.nih.gov/

CANADIAN RESOURCES:

Canadian Cardiovascular Society
http://www.ccs.ca/

Canadian Family Physician
http://www.cfpc.ca/

References:

Acute Coronary Syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated October 2, 2012. Accessed December 20, 2012.

Brophy JM, Lévesque LE, Zhang B. The coronary risk of cyclo-oxygenase-2 inhibitors in patients with a previous myocardial infarction. Heart. 2007; 93(2):189-194.

Cocaine abuse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.. Updated January 26, 2012. Accessed December 20, 2012.

Coronary Artery Disease Major Risk Factors. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated September 17, 2012. Accessed December 20, 2012.

Coronary Artery Disease Possible Risk Factors. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated November 30, 2012. Accessed December 20, 2012.

Greenlund KJ, Keenan NL, Giles WH, et al. Public recognition of major signs and symptoms of heart attack: seventeen states and the US Virgin Islands, 2001. Am Heart J . 2004;147(6):1010-1016.

Heart Attack. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartAttack/Heart-Attack_UCM_001092_SubHomePage.jsp. Accessed December 20, 2012.

Heart Attack. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/heartdisease/heart_attack.htm. Updated April 9, 2012. Accessed December 20, 2012.

Leading causes of death. Centers for Disease Control and Prevention website. Available at: http://www.cdc.gov/nchs/fastats/lcod.htm. Updated October 19, 2012. Accessed December 20, 2012.

McDonald MA, Simpson SH, Ezekowitz JA, Gyenes G, Tsuyuki RT. Angiotensin receptor blockers and risk of myocardial infarction: systematic review. BMJ . 2005;331:873.

Pfeffer MA, Braunwald E, Moye LA, et al. Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med. 1992;327:669-677.

Sullivan MD, Ciechanowski PS, Russo JE, et al. Understanding Why Patients Delay Seeking Care for Acute Coronary Syndromes. Circ Cardiovasc Qual Outcomes. 2009;2(3):148-154.



Last reviewed December 2012 by Brian Randall, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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