Medical Compass: Recognizing if you’re having a heart attack
Be aware of more subtle symptoms — and seek medical attention
By David Dunaief, M.D.
It seems like we’ve made a lot of progress with heart disease, but it’s still the leading cause of death in the U.S. Each year, 605,000 people have a first heart attack, and an additional 200,000 people who’ve already had a heart attack experience another (1).
One in five heart attacks is “silent” – you might not be aware you’ve had it; however, you still experience its negative effects.
You can improve your outcomes if you recognize your heart attack symptoms and receive immediate medical attention.
Heart attack symptoms
The most recognizable symptom is chest pain. However, there are many, more subtle, symptoms, like discomfort or pain in your neck, back, jaw, arms or upper abdomen. You might also experience nausea, shortness of breath, sweating, light-headedness or tachycardia (racing heart rate).
Unfortunately, most people don’t identify these as symptoms of heart attack (2). According to one study, about 10 percent of patients present with atypical symptoms and without chest pain (3).
Symptom differences in men vs. women
There has been much discussion —especially online — claiming men and women have different symptoms. What does the research tell us?
There is data showing that, although men experience more heart attacks, women are more likely to die from them (4). In a Swedish study of 54,000 heart attack patients, one-third were women. After having a heart attack, a significantly greater number of women died in the hospital or near-term when compared to men. Interestingly, the women received aggressive treatments, such as reperfusion therapy, artery opening treatment that includes medications or invasive procedures, less often than the men.
However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram.
One theory about why women receive less aggressive treatment when first presenting in the ER is that they have more subtle symptoms — even chest pain symptoms may be different. Is this true?
In one observational study of 2,500 patients, results showed that, though there were some subtle differences, when men and women presented with chest pain as the main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: the duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.
This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. The population difference was a conspicuous weakness of an otherwise solid study, since age and previous heart attack history are important factors.
In the GENESIS-PRAXY study, another observational study, both men and women had a median age of 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings, significantly more were women than men.
Those who did not have chest pain symptoms may have experienced back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache. If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific.
Some studies suggest that up to 35 percent of patients do not have chest pain as their primary complaint (7).
What to do if someone is having a heart attack
If someone is having a heart attack, call 911 immediately, and have the patient chew an adult aspirin (325 mg) or four baby aspirins, provided they do not have a condition that precludes taking aspirin. The purpose of aspirin is to thin the blood quickly, but not if the person might have a ruptured blood vessel. The 911 operator or health professional who responds can help you determine whether aspirin is appropriate.
Don’t wait to seek medical attention; it’s better to have a medical professional determine that it’s not a heart attack than to ignore an actual heart attack.
The most frequently occurring heart attack symptoms to watch for
Most patients have similar types of chest pain, regardless of gender, when having a heart attack. However, this is where the complexity begins. The percentage of patients who present without chest pain varies depending on which study you review — from 10 to 35 percent.
Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath, light-headedness, heartburn, or unusual fatigue. These are seen in both men and women, although they occur more often in women. According to the Mayo Clinic, women tend to have symptoms more often when resting, or even when asleep, than men (8).
It’s important to recognize these symptoms as potential heart attacks, because quick action can save your life.
References:
(1) cdc.gov. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA. 2012;307:813-822. (8) mayoclinic.org.
Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
