Heart Attack Early Warning Signs

Heart attack is the number one killer of both men and women in the U.S. Each year, about 1.1 million Americans suffer a heart attack, and 460,000 of these are fatal. Most of the deaths from heart attacks are caused by ventricular fibrillation of the heart that occurs before the victim of the heart attack can reach an emergency room. Those who reach the emergency room have an excellent prognosis; survival from a heart attack with modern treatment should exceed 90%. The 1% to 10% of heart attack victims who die later include those victims who suffer major damage to the heart muscle initially or who suffer additional damage at a later time. Fortunately, procedures such as coronary angiogram and PTCA (coronary balloon angioplasty), and clot dissolving drugs are available that can quickly open blocked arteries in order to restore circulation to the heart and limit heart muscle damage. In order to optimally benefit heart attack victims and limit the extent of heart damage, these treatments to open blocked arteries should be given early during a heart attack. 

Knowing the early warning signs of heart attack is critical for prompt recognition and treatment. Many heart attacks start slowly, unlike the dramatic portrayal often seen in the movies. A person experiencing a heart attack may not even be sure of what is happening. Heart attack symptoms vary among individuals, and even a person who has had a previous heart attack may have different symptoms in a subsequent heart attack. Although chest pain or pressure is the most common symptom of a heart attack, heart attack victims may experience a diversity of symptoms that include:

• pain, fullness, and/or squeezing sensation of the chest;
• jaw pain, toothache, headache;
• shortness of breath;
• nausea, vomiting, and/or general epigastric (upper middle abdomen) discomfort;
• sweating;
• heartburn and/or indigestion;
• arm pain (more commonly the left arm, but may be either arm);
• upper back pain;
• general malaise (vague feeling of illness); and
• no symptoms (approximately one quarter of all heart attacks are silent, without chest pain or new symptoms and silent heart attacks are especially common among patients with diabetes mellitus).

Even though the symptoms of a heart attack at times can be vague and mild, it is important to remember that heart attacks producing no symptoms or only mild symptoms can be just as serious and life-threatening as heart attacks that cause severe chest pain. Too often patients attribute heart attack symptoms to "indigestion," "fatigue," or "stress," and consequently delay seeking prompt medical attention. One cannot overemphasize the importance of seeking prompt medical attention in the presence of symptoms that suggest a heart attack. Early diagnosis and treatment saves lives, and delays in reaching medical assistance can be fatal. A delay in treatment can lead to permanently reduced function of the heart due to more extensive damage to the heart muscle. Death also may occur as a result of the sudden onset of arrhythmias such as ventricular fibrillation.

What should you do if you experience these symptoms? Doctors agree that if you're in doubt, get checked out anyway. Even if you're not sure if something is really wrong, you should call 9-1-1 if you experience heart attack symptoms. Prompt administration of drugs can help restore circulation to the heart and increase your chances of survival.

REFERENCE: U.S. NIH, National Heart, Blood, and Lung Institute (NHLBI)

Previouis contributing medical editor: Dennis Lee, MD