Chest pain is one of the most feared symptoms, and people immediately think in a heart attack. Most people have a broad understanding about how patients perceive heart attacks, and they still take a very long time in calling a doctor or reaching the emergency room, usually about 2 or 3 hours. That is because people often misunderstand a few details about heart attack and they are not quite sure whether or not they should look for medical attention. Additionally, not all patients feel the same, and many cases of heart attack go unnoticed for a very long time.
The clinical name of a heart attack is myocardial infarction. It is caused by a sudden and unexpected interruption of the blood flow to the cardiac muscle. It is usually associated with atherosclerosis of the coronary arteries and certain heart symptoms enclosed in a clinical entity called a coronary syndrome. In most cases, patients are aware of a heart condition and may have had symptoms previously, but sometimes it is entirely unexpected with no warning signs or symptoms.
Thus, it is essential to recognise the symptoms of a heart attack if we want to respond immediately to this emergency and look for urgent medical attention. The most common symptoms are as follows:
Chest pain
It’s by far the most critical symptom in myocardial infarction. The type of chest pain usually described in heart attacks is a severe chest pain located in the middle of the chest, and sometimes taking the left shoulder or radiating to the left arm. In most cases, it is a very severe pain that would not let patients perform their activities, and they usually hold their chest with a tightened hand, desperate to relieve their symptoms in one way or another.
Sometimes there are patients with a very high pain threshold who do not recognise chest pain, and it goes unnoticed, but this is not common, usually appearing in very advanced cases of diabetes and other disorders affecting the nervous system. It is described as squeezing, burning, or aching. Sometimes it can be described as a sharp pain as well.
The typical chest pain starts all of a sudden with high intensity, but in some cases, patients may experience prodromal symptoms with chest discomfort instead of pain and general malaise.
Jaw pain and other types of pain
Even though the typical manifestation of myocardial infarction is chest pain, we still need to consider different variants of pain, such as epigastric pain, jaw pain, neck pain, and pain in the left arm and shoulder without the typical chest pain. It is possible to experience all of these variants, and some will be more common than others.
A special mention to senior women, who often describe heart attack symptoms differently and their diagnosis goes unnoticed. Impressively enough, most women with heart attacks have another type of pain but not chest pain. They may display the typical shoulder and left arm pain without any chest pain. In other cases, pain is located in the back or in the stomach area, very similar to gastritis pain. Another type of pain they commonly display is jaw pain.
In these women, taking into consideration other symptoms is essential to suspect a heart attack. Breathing difficulty, high blood pressure with an accelerated heartbeat and other symptoms may be even more useful than waiting for chest pain to show up.
Shortness of breath
Myocardial infarction is associated with a pressing sensation in the middle of the chest, and patients describe it as if something very heavy was stepping on their thorax. Thus, it makes it difficult to take a deep breath, and patients usually accelerate their respiration rate to compensate. Shortness of breath is often an accompanying symptom with tiredness and fatigue, and it is common in women than men.
The respiratory system is closely linked to the cardiovascular system because they work together to provide the rest of the body with the oxygen for living. When your heart becomes unable to pump out blood correctly, there’s insufficient circulation of blood, and you may start feeling short of breath.
Taking a loud gasp after day-to-day activities like going to pick up the mail or lifting a few stairs is not normal and should be assessed by your doctor. In most cases, it points out at a heart condition that should be addressed to avoid complications.
Fatigue
It is a common heart attack symptom in women. Altogether, their shortness of breath, fatigue, and general malaise may lead women to think they are having flu-like symptoms instead of a heart attack. However, they should be careful to note symptoms that definitely point out that something is not right. The sudden and unexpected onset of symptoms should also raise concern.
Heart attacks are a source of metabolic and physical stress to the organism. The heart tries to overcome the injury by pumping harder to provide more blood flow to the area, which sometimes results in worsening of the symptoms. Thus, if you start feeling exhausted all of a sudden and for no reason, this should be an alarm sign if you’re a woman with an underlying heart problem.
In some cases, fatigue is a prodromal sign of a heart attack, which means it is perceived a few days before the onset of the cardiac event. That’s not always the case, but if you have this symptom, it is a good idea to ask your doctor and get a full physical exam with lab tests to know what’s going on.
Impaired mental status
In many cases, patients may even lose consciousness or experience an altered mental status because there’s not enough blood flow to the brain and insufficient perfusion trigger confusion, drowsiness, fainting, and other symptoms associated with the central nervous system.
There’s a condition very similar and often confounded with heart attack, known as sudden cardiac arrest. In this situation, the heart stops beating all of a sudden because of an electrical abnormality, and it is not the same as a heart attack, which is mainly caused by a dysfunction in the coronary circulation. In these cases, patients often lose their consciousness and may stop having a pulse and death occurs when the patient is not properly managed.
Even if a heart attack is not the same as cardiac arrest, it may precipitate arrhythmia and increase the chance of this life-threatening outcome. Thus, if a family member is having chest pain or a series of warning signs and suddenly lose consciousness, look for medical attention right away before it’s too late.
Anxiety
Patients with a heart attack often reach the emergency anxious and very nervous because of the sudden and unexpected onset of their symptoms. However, anxiety and stress can be a cause of heart attacks as well. Either as a cause or as a consequence of heart attacks, it is a widespread symptom in these patients, and it often contributes to the severity of the cardiac event.
When patients become too anxious and nervous about their condition, their heart starts to pump faster and harder, increasing the activity and the energy requirements of this organ. Since there’s already insufficient blood flow to some regions of the heart, this increase in energy requirements will not be met by the coronary arteries, and the damage to the cardiac muscle becomes more extensive.
High blood pressure
This is another condition that may be a cause or a consequence of a heart attack. High blood pressure and hypertensive crisis are commonly associated with heart attacks. An increase in blood pressure makes the heart work harder and increases the energy expenditure of the cardiac muscle, with the results we have discussed above.
For this reason, if you are suspecting a heart attack it is recommended to keep your calm, try not to make efforts, lift stairs, lift heavy objects or run around your own home in a frenzy. Doing this will increase the workload to your heart and may worsen your condition. Instead, try to stay seated and get help to do whatever you need to do to prepare while calling the emergency services. Try to relax and practice breathing techniques and other forms of stress-releasing techniques.
Sweating
During a heart attack, patients often experience profuse sweating as their parasympathetic nervous system activates. This is a branch of the autonomous nervous system that prepares the body to run or defend itself from aggression. The organism is perceiving a source of danger, and it’s activating this parasympathetic nervous system to increase the function of the heart and overcome the blockage in the normal blood flow.
The parasympathetic branch of the nervous system activates various body functions, including the secretion of sweat glands in the skin. That is why people become sweaty when they are nervous or during a heart attack.
Night sweats can be a symptom of a heart condition, especially in women, but it is more commonly caused by menopause and other hormonal alterations. You should ask your doctor if your night sweats become excessive and profuse, such as constantly waking up in the middle of the night soaked in your own sweat.
Accelerated heartbeat
Another body function triggered by the parasympathetic nervous system is an increase in the heartbeat. Thus, during a heart attack, it is common to experience an accelerated heartbeat, clinically named tachycardia. What’s more, an accelerated heartbeat can even contribute to the damage in a heart attack and trigger other heart conditions.
In many cases, tachycardia would overstimulate the electric system in the heart and trigger an arrhythmia, which is an irregular and disordered heartbeat. In these cases, patients may feel their heart pumping hard against their chest all of a sudden. This is called heart palpitations, and it is a response to a delay in the transmission of the electrical impulse with a sudden and violent pump to compensate for the excess blood flow accumulated during the delay.
An accelerated heartbeat is also influenced by anxiety and uneasiness, which is why it is prevalent in the emergency room. However, if you have palpitations, dizziness or fainting, and chest discomfort, call for medical assistance immediately and try to calm down as the medical help arrives.
Cyanosis
It is the clinical name for a blueish coloration of the skin that results from a reduction in arterial blood flow in the area. In a heart attack, patients usually have something called peripheral cyanosis, which is a blueish color in their extremities, especially around the hands and feet. They often feel cold, and their pulse may be reduced.
Peripheral cyanosis is the result of vasoconstriction in these arteries. The natural response of the organism in the event of myocardial infarction is to reduce blood circulation to the extremities trying to increase blood circulation in susceptible organs such as the heart, brain, and kidneys. Thus, looking at your hands and feet might be an important part of the physical exam performed by your doctor.
Nausea, vomiting & other gastrointestinal symptoms
Patients usually describe nausea and vomiting during a heart attack, but some of them may have predominant gastrointestinal symptoms making them believe what they are feeling is common heartburn. This happens especially in the elderly, who often dismiss heart attacks and they are only reported during their check-ups as a past heart attack episode they can’t recall.
Thus, be careful around indigestion symptoms with fatigue and shortness of breath, especially when they start all of a sudden and for no reason. If you have an underlying heart condition or suspect you’re having one, talk to your doctor and get your check-up done as a routine even if you’re not feeling sick. Detecting heart disease early reduces your risk of a heart attack and will help you improve your quality of life.
References
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