Monday, July 3, 2017

What Are the Symptoms of a Heart Attack?

Eighty percent of women DON'T have chest pain before they have a heart attack. Here's an essential list of symptoms, and how often they occur, for women, plus a list of unusual heart attack symptoms for men.

I've survived 11 heart attacks.  (The doctors finally figured out the underlying problem and I haven't had a heart attack since.)  Only once did I have chest pain radiating to my left arm. Here's what I learned the hard way, that might help you get to the doctor on time. The symptoms I've had can occur in either men or women. Then a little later in this article I'll have a list of heart attack symptoms that every woman needs to know.

We all know the classic symptoms of a heart attack. Someone clutches at their chest in pain. It's their left arm they are bringing up to their chest. They are sweaty. They are short of breath. They quickly lose consciousness.

Or maybe none of that happens. Forgive me a couple of paragraphs while I share my own experiences.

When I had my first heart attack, I thought for sure I had broken my left leg. It had never felt such an awful pain in my thigh radiating down to my toes. I finally got an ambulance to take me to the hospital thinking I desperately needed to have a bone set. Instead, my leg was fine. I had a blood clot in the left ascending artery (LAD), a widowmaker heart attack.

One time my main symptom was severe fatigue. Another time my main symptom was an odd change in my vision. I was walking along and suddenly felt really tired, and something like a dark curtain was falling over my field of vision. My first thought was that I had somehow managed to detach a retina. However, a doctor diagnosed the problem as a severe loss of circulation.

But this article isn't all about me. Here are the symptoms you need to know to get timely diagnosis and treatment of possible heart attack.

In both women and men, heart attack symptoms may include:

  • Heavy, sometimes "crushing" pain on the left side of your chest. This pain may radiate up to your jaw or down to your left arm. However, it's quality of the pain, not the location of the pain, that makes a critical difference. Not everybody has pain that travels left and up. It's also possible to have pain on just the right side of your chest while having a heart attack. Pain associated with a heart attack is from the "inside out." It doesn't get worse when you press down on your chest. It's dull pain or pressure pain rather than sharp, stabbing or burning pain. However, some people have no pain at all.
  • Racing pulse. Your heart may try very hard to compensate for a heart attack in its early stages.
  • Unusually high blood pressure. You can be having a heart attack even as your heart is working overtime to get blood to your brain.
  • Seizures in someone who doesn't have a seizure disorder. This is a sign of imminent cardiac arrest. Life-saving treatment is probably going to be needed immediately (CPR, or shock from an AED).
  • Nausea, vomiting, or gassiness. Most of your blood supply flows through the aorta, which is squeezed by your digestive tract. A series of neurohormonal reactions may accelerate movement of food, or gas, through your digestive tract as your body tries to take pressure off your aorta.
  • Feeling exhausted after doing something that's usually easy for you. 
  • A sensation of "breathing through a blanket" when you lie down on your back.
  • Unusually loud snoring.
  • A cough that just won't quit, especially if you haven't had a cold or allergy lately.
  • Lump in your throat, as if you were very nervous before giving a vocal performance or a speech.
  • Breaking out in a cold sweat.
  • Confusion or wild mood swings. 
  • Memory problems.
  • Vision problems, especially color going to black and white, seeing everything as "blue," and seeing lots and lots of tiny black dots. This is a sign of severe loss of circulation, although it may still be possible to call for an ambulance and walk to a safer place, but maybe only for a few minutes.
  • Unusual swelling in the feet or fingers.

Women, in particular, don't have typical symptoms of  heart attack. Dr. Jean McSweeney of the College of Nursing at the University of Arkansas and 14 of her colleagues interviewed 1,270 women about their most significant symptom of heart attack. Only 1 woman in 5 reported having had chest pain before her heart attack. But:

  • 77 percent reported severe fatigue before they had a heart attack. The figure was even higher for African-American women.
  • 51 percent of Black and Hispanic women and 37 percent of Caucasian women "just knew" they were going to have a heart attack, and developed severe anxiety about their health.
  • 40 percent of women reported digestive difficulties (nausea, vomiting, burping, belching, or flatulence) before they had their heart attack.
  • 40 percent of women had racing heart, over 100 beats per minute, before their heart attack.
  • 33 percent reported problems with short term memory
  • 33 percent had loss of appetite.
  • 32 percent had shortness of breath even when they weren't physically active.
  • 31 percent had numbness or tingling in the feet, hands, toes, or fingers.
  • 20 percent had a really bad headache that just wouldn't go away.
And it's worth repeating, 80 percent of women did not have chest pain before they had their heart attacks. Heart attack pain, the study showed, may occur in the legs (up to 15%), in both arms (up to 13%), just in the right arm (9%), or even in the jaws or teeth (up to 11%). Men can also have any or all of these symptoms, but about half of men have chest pain before an MI.


Some of these symptoms may appear several days before a heart attack. They may appear several weeks before a heart attack. You might have a lot of these symptoms. You might have just one of these symptoms.

And most of these symptoms also have other causes. So should you "bother" your doctor, your family, your friends, or the nice people who answer the phone at the emergency call center even when you might not be having a heart attack?

Yes!

If you are having a heart attack, the sooner you get treatment, the less damage will be done. Seeing a doctor may save your life.

Want to read some of  the medical literature on this topic?

Davis AM, Vinci LM, Okwuosa TM, Chase AR, Huang ES. Cardiovascular health disparities: a systematic review of health care interventions. Med Care Res Rev. 2007 Oct;64(5 Suppl):29S-100S. Review. PMID: 17881625. Free full text.

Flink LE, Sciacca RR, Bier ML, Rodriguez J, Giardina EG. Women at risk for cardiovascular disease lack knowledge of heart attack symptoms. Clin Cardiol. 2013 Mar;36(3):133-8. doi: 10.1002/clc.22092. Epub 2013 Jan 21. PMID: 23338973. Free full text.

Jackson MN, McCulloch BJ. 'Heart attack' symptoms and decision-making: the case of older rural women. Rural Remote Health. 2014;14:2560. Epub 2014 May 5.
PMID: 24793837. Free full text.

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