Recognizing the Early Signs of a Heart Attack

Heart attacks, in medical jargon called myocardial infarctions, are a leading cause of death
worldwide. Early recognition of symptoms and immediate medical intervention can
significantly improve outcomes for individuals experiencing a heart attack. Dr Bart
Olechowski apart from being a general cardiologist is also a consultant interventional
cardiologist, which means that he specialises in management of heart attacks including
implanting coronary stents
The article below will help you to understand the early signs and symptoms of a heart attack
and the importance of not ignoring any chest discomforts or aches. It will also describe heart
attack prevention strategies and risk factors that impact the chances of suffering a myocardial
infarction. In addition to this, we will explain the differences between heart attacks in men
and women. Finally, this article will also cover heart attack first aid and the broader context
of heart health emergencies, supported by the latest research and clinical trials.

Understanding the Early Signs of a Heart Attack

Recognising the early signs of a heart attack is very important and can be lifesaving. These
signs often start subtly and can be mistaken for less serious conditions. Crucial early signs
include:
1. Chest Discomfort: This is the hallmark symptom of a heart attack. It can manifest as
pressure, squeezing, fullness, or pain in the centre of the chest that lasts more than a
few minutes or goes away and comes back. This can occur either on exertion or
suddenly, out of the blue.
2. Upper Body Discomfort: Pain or discomfort can spread beyond the chest to the
shoulders, arms, back, neck, jaw, or stomach. Often during medical history taking,
doctors ask about the `radiation` of the chest pains and indeed if it spreads to either
jaw or left arm, this can be viewed as a sign of a myocardial infarction.
3. Shortness of Breath: This can occur with or without chest discomfort. It often starts
before the onset of chest pain. Sudden breathlessness can mimic a chest pain and
often accompanies slightly less obvious chest tightness.
4. Cold Sweat: This is not an usual symptom, which patients describe in addition to the
above.
5. Nausea or vomiting: Although it may be a sign also of a stomach or gastrointestinal
pathology, especially nausea can be an early sign of a heart attack.
6. Light-headedness or feeling dizzy: These symptoms may accompany the chest
discomfort or occur independently, particularly in women.
Interesting study was presented at European Heart Congress in 2023. The researchers
demonstrated that patients who correctly recognised their symptoms of a heart attack had
higher chance to receive treatment that opens their arteries and restores blood flow (57.4% vs
47.2%). Additionally, individuals, who recognised symptoms had a lower in-hospital death
rate (1.5%) in comparison to those who did not recognise their symptoms of a myocardial
infarction (6.7%). (https://www.escardio.org/The-ESC/Press-Office/Press-releases/Heart-
attack-victims-who-recognise-symptoms-are-less-likely-to-die-in-hospital)

Heart Attack Symptoms

Heart attack symptoms can vary widely based on individual characteristics. Nevertheless,
common symptoms, which can be observed in the majority of patients include:
 Chest Pain or Discomfort: Either constant or coming and going intermittently.
 Upper Body Pain: Radiation to one or both arms, back, neck, jaw, or stomach.
 Shortness of Breath: At rest or during physical exertion.
 Nausea or Vomiting: Commonly mistaken for indigestion or food poisoning,
sometimes with important consequences.
 Sweating: Cold, clammy skin, which is often also a symptom of early pulmonary
oedema, accumulation of extra `water` in the lungs.
 Light-headedness or Dizziness: Feeling faint or sudden dizzy spells.
 Unexplained Fatigue: Observed more often in female patients, extreme tiredness can
be an early sign.
 Heartburn or indigestion: Patients often describe these symptoms, not being aware
of the underlying diagnosis of a heart attack.
 Palpitations: More subtle symptoms when often goes unnoticed.
According to a study published in 2019, by far the most symptom of a heart attack is chest
pains with over 90% of patients (both male and female) presenting with this symptom.
https://www.ahajournals.org/doi/10.1161/JAHA.119.012307#:~:text=Chest%20pain%20was
%20the%20presenting,9%5D%3B%20P%3D0.22).

The Importance of Chest Discomfort

Chest discomfort is a critical symptom that should never be ignored. It is the most common
sign of a heart attack and can vary in intensity. It might feel like a heavy weight on the chest,
tightness, or a squeezing sensation. Even if the pain is mild, it should be taken seriously,
especially if it is accompanied by other symptoms. This symptom in conjunction with risk
factors described below makes it even more likely that the ultimate diagnosis is of a heart
attack.
According to a study published in 2023, four questions below can help to diagnose a
myocardial infarction. Although this appears less sensitive in female patients or patients who
have diabetes.
1) Did the chest pain occur at the left/middle chest?
2) Did the chest pain radiate to the back?
3) Was the chest pain provoked by activity and relieved by rest?
4) Was the chest pain provoked by food ingestion, positional changes, or breathing?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10120604/

Heart Attack Prevention Strategies

Preventing a heart attack involves lifestyle changes and medical interventions: Both are
equally important a play a key role in a long term management of patients who suffered a
myocardial infarction.

1. Healthy Diet: Eating a balanced diet rich in fruits, vegetables, whole grains, lean
proteins, and healthy fats.
2. Regular Exercise: Engaging in at least 150 minutes of moderate aerobic activity or
75 minutes of vigorous activity each week. This has been described in more details in
our previous blog entry – `Managing Heart Disease: Treatment and Therapies.`
3. Avoiding Tobacco: Quitting, or even more importantly not starting smoking. This
also includes e-cigarettes.
4. Managing Stress and maintaining social contacts: Practicing stress-reduction
techniques such as yoga, meditation, or deep breathing. Transcendental meditation
was shown to reduce chronic stress, anxiety, burnout and insomnia among Health
Care Workers, according to this study:
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2796494
5. Regular Health Check-ups: Monitoring blood pressure, cholesterol levels, and other
risk factors, described below.
6. High Blood Pressure: Hypertension strains the heart.
7. High Cholesterol: Excess cholesterol can lead to atherosclerosis.
8. Obesity: Excess weight increases the burden on the heart.
9. Diabetes: Poorly controlled blood sugar levels damage blood vessels.
The INTERHEART study, an international case-control study, identified that over 90% of
heart attacks could be attributed to nine modifiable risk factors, emphasizing the importance
of lifestyle changes in prevention. The authors of this study, which was published in 2004
concluded: `Abnormal lipids, smoking, hypertension, diabetes, abdominal obesity,
psychosocial factors, consumption of fruits, vegetables, and alcohol, and regular physical
activity account for most of the risk of myocardial infarction worldwide in both sexes and at
all ages in all regions. This finding suggests that approaches to prevention can be based on
similar principles worldwide and have the potential to prevent most premature cases of
myocardial infarction.`
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(04)17018-9/abstract

Heart Attack Risk Factors

In addition to the above nine modifiable risk factors, certain non modifiable risk factors
increase the likelihood of a heart attack. These include:
 Age: Risk increases with age.
 Gender: Men are at higher risk, though women's risk increases post-menopause.
 Family History: A family history of heart disease.
The Framingham Heart Study, ongoing since 1948, has provided substantial evidence linking
both modifiable and non modifiable risk factors to an increased likelihood of heart attacks,
guiding public health policies and individual preventive measures.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159698/

Recognising Heart Attack in Women

By far the most common symptom of a heart attack in female is chest pain, according to a
study published in 2019. Having said that, women can experience heart attack symptoms

differently than men. Symptoms of myocardial infarction that can be present in women
include:
 Atypical Chest Pain: Sharp, burning, or a feeling of fullness.
 Unusual Fatigue: Unexplained and sudden tiredness.
 Shortness of Breath: Often without chest discomfort.
 Nausea or Vomiting: More common in women.
 Back or Jaw Pain: Often without chest pain.
According to a study published the Journal of American Heart Association, the most common
sign of a heart attack in both genders in chest pain. The authors wrote: Chest pain was the
presenting symptom in 91% (1081/1185) of men and 92% (698/756) of women.
https://www.ahajournals.org/doi/10.1161/JAHA.119.012307#:~:text=Chest%20pain%20was
%20the%20presenting,9%5D%3B%20P%3D0.22).

Diagnosing Heart Attack in Men

According to the traditional view men are likely to experience the classic heart attack
symptoms such as:
 Severe Chest Pain: Often described as an elephant sitting on the chest.
 Upper Body Pain: Especially in the left arm.
 Shortness of Breath: Especially with exertion.
 Sweating: Profuse and unexplained sweating.
In public opinion heart attacks and ischaemic heart disease are still seen as male disease and
we as cardiologists have to do more to change this perception.

Heart Attack First Aid, Seeking Help

Immediate response to a suspected heart attack saves lives. There is only a limited time that
we can open a blocked artery, before scarring of the heart tissue occurs. Key steps include:
1. Call Emergency Services: Dial emergency services immediately.
2. Keep the Person Calm: Help the person sit down and stay calm.
3. Perform Cardiopulmonary Resuscitation: If the person becomes unconscious and
unresponsive, begin CPR if you are trained.
4. Use an AED: If available, use an automated external defibrillator (AED) as
instructed.
The European Resuscitation Council Guidelines emphasize the importance of early CPR and
AED use, showing a dramatic increase in survival rates when these measures are
implemented promptly .
https://cprguidelines.eu/assets/guidelines/European-Resuscitation-Council-Guidelines-2021-
Sy.pdf

According to a study published in New England Journal of Medicine in 2012,  initiation of
bystander-administered cardiopulmonary resuscitation is a strong predictor of survival in
long distance runners who suffered cardiac arrest during racing.
https://www.nejm.org/doi/full/10.1056/NEJMoa1106468

Heart Health Emergency

Understanding the broader context of heart health emergencies is crucial for effective
response and prevention:
1. Education and Awareness: Increasing public knowledge about heart attack signs and
symptoms.
2. Community Programs: Promoting heart health through local initiatives.
3. Workplace Preparedness: Encouraging workplaces to have Automated External
Defibrillators (AEDs) and train employees in Cardiopulmonary Resuscitation (CPR).
4. Policy Advocacy: Supporting policies that promote heart health, such as smoking
bans and healthy food initiatives.

Conclusions

The article above integrates the latest research evidence and clinical trials and tries to explain
early signs of heart attack, heart attack symptoms, chest discomfort, heart attack prevention,
heart attack risk factors, recognizing heart attack, heart attack first aid, heart attack in women,
heart attack in men, and heart health emergency. Dr Bart Olechowski, often talks to his
patients about the importance of preventive strategies. He sees his patients in Winchester,
Basingstoke, Farnham and London. To summarise, recognising the early signs of a heart
attack and understanding the associated symptoms, particularly chest discomfort, can
significantly improve survival rates. Awareness of prevention strategies, risk factors, and the
differences in how heart attacks present in men and women are essential for effective
management and prevention. In the event of a heart attack, prompt first aid and emergency
response can make a critical difference. By promoting heart health awareness and education,
we can reduce the incidence of heart attacks and improve outcomes for those affected.