Heart
attacks are the number one cause of death in the United States
and many other industrialized nations. But how do you know if
you or someone you love is having a heart attack? The following
discussion centers on the symptoms and diagnosis of a heart
attack.
What
happens in a heart attack?
First,
it is important to understand how a heart attack occurs. (The
medical name is myocardial
infarction or MI.) When we say someone had a heart attack,
we mean that the heart muscle did not receive enough oxygen
and thus part of the muscle died from "suffocation."
In
most cases, heart attacks occur because the blood vessels that
supply the heart become clogged (the scientific term for clogging
of the arteries is atherosclerosis). Atherosclerosis is a process
that occurs over decades and tends to occur in people for both
genetic and environmental reasons.
What
are the risk factors?
The risk factors for clogging of the arteries (and thus heart
attacks) are not all well understood. The five main known risk
factors include a family history of heart attacks in first-degree
relatives, high blood pressure, diabetes, smoking, and abnormal
cholesterol. Heart attacks also become more common with age,
especially affecting men over age 45 and women over age 55 (the
sixth main risk factor is age).
This
being said, it is important to remember that a 25-year-old with
no risk factors is extremely unlikely to have a heart attack
even if he or she has symptoms of a heart attack. Conversely,
a 70-year-old with all five risk factors makes a doctor worry
even if they only have a little "twinge" in their chest and
otherwise feel okay.
What
are the symptoms?
The
symptoms of a heart attack are not always present, but are an
important sign if they are present. The classic symptom is chest
pain, which usually lasts at least 15 minutes. The pain is usually
described as a pressure-like sensation, almost as if a heavy
weight was sitting on the person's chest.
Radiation
of the pain into the jaw or down the shoulders or arms may occur.
Pain from a heart attack will generally not respond to food;
water; stomach medicines such as Tums, Maalox, or Pepcid; or
pain medications such as Tylenol or aspirin.
Other
common symptoms are shortness of breath, sweating, nausea and
vomiting, and a sense of impending doom or marked anxiety. Often,
an event occurs to trigger the chest pain that heralds a heart
attack, such as stress, fear, or exercise. However, remember
that a heart attack can occur at any time.
What
should I do if these symptoms occur?
If
you suspect that you or someone you are with is having a heart
attack, get transportation to the nearest emergency room without
delay. Half of all heart attacks end in death before the person
can reach the hospital, so every minute counts. People with
heart attacks who are cared for in the hospital have a much
higher survival rate.
In
the emergency room, a physician will ask you several questions
about your medical history and examine you. If the doctor suspects
heart trouble, he or she will order several different tests
to determine whether or not a heart attack has occurred.
Unfortunately,
there is no one test that can say with 100 percent certainty
that a person had a heart attack.
Blood
is drawn for lab tests that can detect certain proteins that
become elevated after a heart attack. A heart tracing, known
as an EKG, is also done. This painless test involves hooking
up several electrodes to your skin so that the electrical activity
of the heart can be measured. Usually, a chest x-ray is also
done.
In
the meantime, if the doctor is worried about a heart attack,
he or she will give you supplemental oxygen to breathe. You
may be given an aspirin, some morphine to relieve the pain and
anxiety, and possibly some heart medications.
Further
treatment will depend on the result of the initial tests. If
the initial tests are negative or make the diagnosis uncertain,
you may be asked to spend the night in the hospital for further
observation and testing.
The
very idea of having a heart attack is enough to make us all
a little nervous. If you suspect that you or someone you love
may be having a heart attack, go to the nearest emergency room
as soon as possible. It could mean the difference between life
and death.
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