Do you know the signs of a heart attack? It’s not always the same for everyone, and can be different in men and women…
The classic signs and symptoms include:
chest discomfort (pressure, squeezing, burning, heaviness, fullness or pain),
sweating,
upper body discomfort (pain in the neck, shoulder, back and/or one or both arms),
shortness of breath,
nausea and
light-headedness.
You may only have some of these symptoms.
In women, the signs of a heart attack may be less clear than in men. In some cases, a heart attack in women can mimic severe heartburn. A key difference is that the pain is not relieved by taking an antacid when it is caused by a heart attack. Since men are more likely to have heart disease than women and their symptoms are more classic (such as crushing chest pain), heart attacks are more easily missed in women.
Angina
Pain due to lack of oxygen reaching the heart muscle is called angina. When it occurs predictably, for example when you do a certain level of exercise, it is called stable angina. Stable angina pain does not always indicate that heart damage is occurring. However, if the pain suddenly becomes more severe or frequent, or occurs with less or even no exercise, it is called unstable angina. Unstable angina is a sign that change is occurring in the blood supply to the heart muscle and is a warning sign of a possible heart attack in the near future. Any change in angina is a reason to see a doctor as soon as possible.
Heart attack
A heart attack, also called a Myocardial Infarction or MI, occurs when the arteries around the outside of the heart that bring blood to the heart muscle become blocked enough to cause damage. An area of the heart muscle without blood supply becomes painful, and the muscle cells start to become damaged and die. The pain is sometimes “referred” or felt in a different part of the body, often the neck, jaw and one or both arms (but most commonly the left arm). You can feel tired, lightheaded and short of breath because the heart is becoming damaged and is not pumping blood as efficiently.
If the damage interferes with the electrical conduction system of the heart, this can be seen on an electrocardiogram (ECG). However, a heart attack that doesn’t show on an ECG can also occur. This would be considered a less severe attack because it is not interfering with the heartbeat, but it’s still serious and painful. When the heart muscle is damaged, enzymes are released into the blood. A blood test for these “cardiac enzymes” is used to confirm that a heart attack has happened. Sometimes, especially in women, a heart attack that was mistaken for heartburn is only diagnosed later with this blood test.
Act quickly
It's very important to get treatment as soon as possible, before serious damage occurs. In some cases, a person will feel mild angina pain that comes and goes, becoming noticeable when exercising or even worrying, and easing up when resting. Waking up with any of the heart attack symptoms above is a reason to seek help immediately – call 911! But even if the pain or pressure is mild and comes and goes, contact your doctor or go to the hospital as soon as possible to get treatment that can prevent possible damage to your heart from a blockage in blood supply.
Treatments
Nitroglycerin is a medicine that comes in small tablets or spray that is put under the tongue and in patches that are put on the skin. It opens blood vessels to help more blood get to the heart muscle and can relieve pain if the artery is not completely blocked. It’s often used to relieve pain and prevent damage while waiting for a procedure that will open the arteries to the heart.
A blocked artery to the heart is treated by cardiac catheterization. This is a procedure where a thin tube is inserted into an artery in either the wrist or the groin and is pushed along the artery until it reaches the coronary arteries that supply the heart. The surgeon squirts a special dye into the coronary artery and can view on monitoring equipment where the blockage is located. Depending where the blockage is, they can treat the problem in several ways. They can remove the blockage with suction, use a tiny balloon to stretch the artery open, or insert a tiny wire tube called a stent to hold the artery open. The whole procedure is done with anesthetic only needed on the wrist or groin where the tube is inserted. The patient is awake, and it takes about 30 minutes, or a little longer if a stent is put in place.
If the blockage is extensive, the surgeon may opt for a Coronary Artery Bypass Graft (CABG, also just called a "bypass"). In this procedure, a piece of artery or vein from another part of the body is inserted to carry blood around the blocked area. This is a more intensive procedure that takes several hours and a much longer recovery time.
Medications
Usually after a heart attack, several medications are given to help the heart heal and decrease the chance of another attack. Blood pressure medication lowers the blood pressure, making less work for the heart while it heals. Anti-clotting medication (also called blood thinners) help prevent blood clots from forming (the most common cause of a sudden blockage in blood supply to the heart). Cholesterol lowering medication (which also has anti-inflammatory, anti-clotting and antioxidant activities) is usually also added to reduce the deposits of fats and calcium (called plaque) inside the arteries, which also cause narrowing and reduced blood flow. Adding several new medications at once can be confusing, so be sure to ask your pharmacist any questions that your doctor hasn't already answered. Your pharmacist can also help you organize your medication so it's easier to take (and harder to forget!) as you get used to a new routine.
Other advice
Anyone at risk of heart disease, and especially those diagnosed with it, should work to follow a heart-healthy lifestyle:
Don’t smoke
Exercise regularly (aim for 30 mins a day, 5 days a week)
Follow a healthy diet with 7 servings of fruit or vegetables a day
Maintain a healthy weight
Reduce stress
Getting treatment soon is key
The key to successful treatment, the “heart of the matter”, is to call for help right away. The sooner treatment is started, the less heart damage will occur. If you seek treatment soon enough, you could avoid damage altogether! Remember, if pain is severe, call 911 – ambulance attendants can start treatment as soon as they arrive, saving precious minutes. They will also take you directly to the emergency department if necessary, avoiding time lost in the waiting room as you wait to be assessed.
This information is in my thoughts this week, as we needed to call 911 for my husband last Sunday morning. The ambulance attendants started treatment immediately and took him directly to the hospital. He just arrived back home today with a shiny new stent to replace a 15-year old one that had blocked up. He’ll need to take it easy for a few days but is already feeling better with the blood supply to his heart flowing well again. It was a worrisome week but it’s great to have a happy ending!
References:
Heart/Emergency Signs - Heart and Stroke Foundation
