Here are some important symptoms:
Chest pain is common for both sexes. It could feel like heaviness, burning, or squeezing in the center of the chest. Some people describe the discomfort in terms of tightness or pressure, which may radiate from the chest to either arm, the jaw, neck, or back.Less common symptoms for both sexes include breaking out in a cold sweat, general weakness, nausea, shortness of breath, dizziness and/or lightheadedness, and/or discomfort or pain between the shoulder blades.Women are more likely than men to complain of the less common symptoms listed above, as well as jaw and back pain, unusual fatigue, and trouble sleeping due to the pain. They may also have a sense that something is terribly wrong or feel an impending sense of doom. Because these are not necessarily the typical symptoms, and women still often perceive themselves as being less likely to experience a heart attack than men, they are slower to seek medical attention and therefore are at greater risk of dying from a heart attack than men.
Brief episodes of chest pain or breathlessness and/or discomfort or pain between the shoulder blades may occur weeks before a heart attack, especially upon exertion. You may first notice symptoms while exercising or walking up a flight of steps, or even during sex, if that’s the most demanding physical activity you engage in. These symptoms could be angina, brief periods when the bloodflow is temporarily cut off from a portion of the heart. Are you at risk for the #1 cause of heart-related death? If you have any of the symptoms described above, especially if you’ve never experienced them before, and even if they come and go, call 911 and then take one 325-milligram, preferably uncoated, aspirin. An aspirin can help break up the blood clot that is causing the heart attack. (If you are allergic to aspirin or think you’re having a stroke, don’t take it.) Is It Indigestion, Angina, or a Heart Attack? Many people get chest pains, the great majority of which do not signal the presence of a heart problem. My standard advice is, if you have a symptom that is new and does not represent an established pattern, call 911 immediately for an ambulance and have someone call your doctor. The modern, well-equipped ambulance is a bit like the emergency room brought to your doorstep, and the emergency medical services (EMS) team can perform CPR or use a defibrillator to restore normal heart rhythm if need be. Calling 911 is certainly safer than taking yourself to the ER (if you must, have someone else drive you or go with you). Even if you and your doctor have agreed ahead of time that a certain hospital’s ER is best, if you’re having a heart attack and the EMS team advises you to go to the nearest hospital in order to save your life, go there—don’t argue. When you arrive in the ER, immediately communicate your concern that you are having a heart attack and describe your symptoms. This is not the time to be shy about asserting yourself. At the hospital, you will be given an electrocardiogram (EKG or ECG), a noninvasive test used to check for any sign of injury to the heart muscle and to detect an irregular heartbeat. If, based on the EKG and your symptoms, the doctor judges that you are having an acute coronary syndrome (a heart attack or unstable angina), he or she will treat you immediately. If the EKG is inconclusive, a blood test that identifies certain heart enzymes will confirm whether or not you are having a heart attack. These enzymes are substances that perform vital functions in the heart muscle; they leak out of dying cells into the bloodstream during a heart attack. If you are having a heart attack, you will most likely be sent for an invasive angiogram or given a clot-busting drug intravenously. There are also times when these approaches may not be appropriate and medical therapy may be the best treatment. Do whatever your doctor tells you to do. Now is not the time to talk about aggressive prevention, demand a noninvasive heart scan, or get a second opinion. Now is the time for aggressive intervention. In the event of a heart attack, angioplasty, bypass surgery, and clot busters can be true lifesavers. Women, take note: Many studies indicate that women are more likely to sustain a heart attack without the classic symptoms, such as chest pain, described on the preceding pages. This raises the possibility of misdiagnosis by both the patient and the physician. Women may only experience the less typical symptoms, such as shortness of breath, weakness, or dizziness. As a woman, you have to be extra vigilant to make sure that an EKG and heart enzyme test are performed if you are experiencing symptoms that are new and that concern you. Whether you’re a man or woman, once you’ve had a heart attack, you have a 20 percent chance of dying within 10 years of the first attack, unless you have significantly altered the risk factors that caused the heart attack in the first place. That’s why, as soon as you begin recovering from a first heart attack, it’s time to begin an aggressive prevention program to make sure that it never happens again. Heart attack victims, take note: According to a Mayo Clinic study, for the first month after having a heart attack, your risk of having a stroke is 44 times higher than normal. The risk for stroke declines rapidly after the first month; nevertheless, anyone who has just had a heart attack should be familiar with the symptoms of stroke. When Chest Pain Isn’t a Heart Attack Almost all of us will experience chest pain from time to time. In my experience, the most common cause of chest pain is reflux of stomach acid into the esophagus, widely known as GERD (gastroesophageal reflux disease). If the esophagus goes into spasm, it can cause severe chest pain that closely mimics the symptoms of a heart attack. Muscle spasm can also cause chest pain, and women may experience chest discomfort under the left breast due to muscle strain. Transient sharp pains or “sticks in the chest” lasting for only seconds are frequent complaints that are also uncharacteristic of limited coronary bloodflow. However, if you experience any chest discomfort, especially if you have risk factors for heart disease, do not self-diagnose. Let your doctor make the diagnosis. The first sign of chronic angina typically occurs when you are under unusual physical or emotional stress. In such situations, your heart beats faster and your blood pressure increases, and bloodflow through your coronary arteries must increase in response. If one or more of your arteries is substantially blocked, you may be unable to supply the required increase in bloodflow and your heart muscle will, in a sense, cry out for more blood. This “cry” is manifested as chest pain. When the stress is removed (you stop running or reach the top of the stairs, for example), your heart rate and blood pressure return toward normal, your heart muscle requires less blood, and the chest pain goes away. More from Prevention: 6 Unexpected Heart Attack Triggers Although the plaque rupture leading to the obstruction may have occurred months or even years ago, it will not become apparent until you do an activity that requires a substantial increase in coronary bloodflow. Many of us who do not regularly do vigorous exercise will remain oblivious to a new obstruction. If we rush for a plane, shovel snow, move furniture, or experience unusual emotional stress, suddenly the heart muscle will require more bloodflow than can be supplied through the obstructed coronary artery, and chest pain will result. At rest or with mild exertion, the bloodflow will be adequate and chest pain will not be experienced. In patients with the exertional symptoms or with a chest pain pattern that is atypical for angina, I perform a stress test to first establish whether the symptoms are due to a limitation of bloodflow. If that is the case, I then determine how much of the heart muscle is compromised and at what level of exercise capacity the symptoms and limitation of bloodflow occur. The earlier symptoms occur and the greater the amount of heart muscle affected, the more likely I am to proceed with an invasive approach. When exercise capacity is good and compromise of bloodflow is limited, the more likely I am to treat with medications and lifestyle interventions alone. For many people, this type of medical therapy can relieve angina and reverse the abnormalities seen on the stress test. Is It a Stroke? Many of us fear a stroke more than a heart attack because if we survive, we may be left with paralysis and a severely reduced quality of life. Each year, approximately 700,000 Americans suffer a stroke and 273,000 people die from one. Today more than 1 million American adults have long-term disabilities as the result of a stroke. You don’t have to be one of those people. As with treating heart disease, aggressive risk-factor intervention can prevent stroke. The same medications and lifestyle therapies that can reduce the risk of having a heart attack can do the same for stroke. There are two different types of stroke: hemorrhagic stroke and ischemic stroke. Hemorrhagic stroke is caused by the rupture of an artery and the release of blood into the brain. The major risk factor for hemorrhagic stroke is high blood pressure. An ischemic stroke is caused by a sudden blockage of one of the arteries leading to the brain due to the rupture of a soft plaque and the resulting blood clot. Or it may be caused by a clot or atherosclerotic debris that has traveled to the brain from the heart or the vessels leading to the brain. Almost 90 percent of strokes are ischemic. An ischemic stroke is very similar to a heart attack, which is why some people refer to this type of stroke as a “brain attack.” Therapies that reduce the risk of soft plaque rupture in the coronary arteries also reduce the risk of soft plaque rupture in the arteries leading to the brain. If the clot blocks a small artery leading to the brain, the stroke may be so minor that the person is not aware of having had one. This is called a silent stroke. Silent strokes are quite common in older people and are believed to cause problems with memory and the ability to think. In a study of 5,000 people 65 years of age and older, brain scans showed that 31 percent had some stroke-related brain damage. Another 28 percent had clear evidence of brain damage, even though they were not aware of having had a stroke or any stroke symptoms. It’s critical to know the symptoms of stroke so you can recognize when it’s happening to you and get help. Stroke symptoms in both men and women include:
Sudden weakness or numbness in the face, arm, or leg on one side of the bodyA severe headache worse than anything you have ever experienced (this is most characteristic of a bleed into the brain)Slurred speech, loss of speech, and/or sudden blurring or loss of visionDizziness, drowsiness, or falls
You may experience one or more of these symptoms briefly and then go back to feeling normal. This is called a transient ischemic attack (TIA). It is common to have several TIAs prior to having a stroke. If you think you have experienced a TIA, seek immediate medical attention. For the most part, the same risk factors for heart disease apply to stroke. Women, take note: If you take estrogen either in the form of oral contraceptives, the Patch, or hormone replacement therapy, you are at greater risk for stroke. Women who smoke and take birth control pills have a considerably greater risk of stroke (and heart attack) because each predisposes you to abnormal blood clot formation. If you suspect that you are having a stroke, get medical attention immediately. Call 911 for an ambulance to take you to the hospital, and have someone call your doctor. If you are in the midst of having a stroke, the ER physician may administer a drug to break up the clot to restore normal bloodflow to your brain. Drug therapy works best during the first 3 hours of a stroke and can make a real difference in terms of outcome. However, treatment once a stroke has occurred is quite limited. The best strategy is prevention. Fortunately, the simple, painless, noninvasive carotid ultrasound test we discussed in Step 3 can be performed to detect the buildup of plaque in the carotid arteries, which carry blood to your brain. Plaque buildup in the carotids generally occurs later than it does in the coronary arteries; however, atherosclerosis in the carotids can still be seen years before it could lead to a stroke. If you have cardiac risk factors and a family history of heart disease or stroke, then a screening carotid ultrasound can be very helpful. If atherosclerosis is detected, its response to therapy and lifestyle changes can be monitored. Discuss your risk of stroke and the potential benefits of a carotid ultrasound with your doctor. With the information obtained from the ultrasound, your doctor can decide if you need to make any changes in your lifestyle or take medications such as a statin drug, a blood pressure lowering drug, or a blood thinner to prevent a stroke. (Posted December 2006) More from Prevention: How To Lower Your Risk For Stroke
