Severe chest pain is the most frequent symptom of a heart attack, although it is possible to be having a heart attack and not have chest pain at all. Another common symptom is a sensation of heavy pressure on the chest Figure 03. Signs of a heart attack can be subtle or very obvious, and they vary from person to person. Chest pain from a heart attack, if it is present, can be strong and constant and usually lasts for 30 minutes or more. Many people describe the pain as crushing, while others say it is like squeezing, or burning. The pain often radiates down the left arm, but can also spread to your neck, back, right arm, jaw or upper chest. Some people feel little pain, while others describe the sensation as similar to heartburn, or a tight feeling in the chest. If you have more than one heart attack in your lifetime, the second attack may feel different from the first, so it’s a good idea to be familiar with the possible symptoms.
Figure 03. Areas of pain with heart attack
You are likely to feel anxious, restless and nauseous, and look pale, gray, and sweaty.
You may feel faint, weak or short of breath, and have a sense of impending doom. You may even vomit.
The pain from a condition called angina (medical term for chest pain due to coronary heart disease) is similar to what you may feel during a heart attack. If you have angina, and the pain does not go away within a few minutes after resting or medication, you may be having a heart attack. Angina is a symptom of a condition myocardial ischemia (insufficient blood supply to the heart). This occurs when the heart muscle (myocardium) doesn't get as much blood (hence as much oxygen) as it needs for a given level of work. Angina attacks may be brought on by exercise, stress, or excitement, but can even happen when you are at rest. Angina is almost always an indication that you are at risk for a heart attack sometime in the future. Attacks usually only last a few minutes, and the pain can be eased with medication called nitroglycerin. The nitroglycerin pills are placed under the tongue and work almost immediately to control the pain, as they dissolve quickly and enter the bloodstream right away. If you take your medication and rest, but the pain does not go away, it may be due to a heart attack. If pain is not relieved after three nitroglycerin pills, you should seek immediate medical attention, usually by calling 911.
Being over the age of 50, being male, and having heart disease in your family all put you at greater risk for heart attack. Older adults are more likely to suffer from coronary artery disease than younger people. Eighty percent of people who die from the disease are 65 or older. Men are at greater risk of heart attack than women. A man’s risk begins around the age of 35 or 40, although even younger men have been known to have heart attacks. Women become at risk for coronary artery disease by the time they are in their late fifties or early sixties. Once a woman has been postmenopausal for 10 years, her risk is equal to that of a man.
Estrogen is believed to protect the heart from the disease, which is why more heart attacks are seen in post-menopausal women. After a woman stops menstruating (menopause), which usually occurs in the mid to late forties, the amount of estrogen she produces drops significantly. It is not a coincidence that more heart attacks are seen in post-menopausal women.
Children of people with coronary heart disease are more prone to the condition.
If you smoke cigarettes, cigars, and pipes, your risk of heart attack is doubled. Smoking increases the rate fatty material builds up in the arteries. In addition, secondhand smoke can up the odds for nonsmokers who are exposed to it.
Having high blood pressure and high blood cholesterol makes you more likely to have a heart attack. The buildup of fatty material, called plaque, can be caused by consuming too much of certain types of fats. High blood pressure (hypertension) exaggerates this process.
Having a diet that contains high levels of bad cholesterol puts you at greater risk for developing high blood pressure and coronary artery disease. Cholesterol is a type of soft, fat-like substance (lipid) critical to good health in moderate quantities. It is a part of cell membranes, is found in all body tissues, and can be converted into various hormones. Cholesterol comes from two sources: your own liver produces it, and it is also found in food you eat (especially animal products such as meat, poultry, seafood, dairy products, and eggs).
Risk factors like smoking tobacco, not getting enough exercise, and being overweight or obese can be controlled. Having high blood pressure, high cholesterol, and high fat levels in the blood are also risk factors that you can manage. Medications, if necessary, can be used to control cholesterol and high blood pressure, and are usually very effective, as is diet and exercise.
If you have diabetes mellitus, you are at greater risk of heart attack than nondiabetics. Even if you maintain good control of your blood sugar levels, about 66% of those with diabetes die of a heart or blood vessel condition.
Your chances of developing coronary artery disease increase with each risk factor you have. If you are an obese smoker with high blood pressure, high cholesterol, and a family history of heart disease, you have a greater chance of developing heart disease than someone who has only one of these conditions. The level of severity in each risk factor also increases the possibility of getting heart disease.
Increased homocysteine (a naturally occurring amino acid) levels are also a risk factor. Homocysteine is a naturally occurring amino acid. A high blood level of homocysteine (known as hyperhomocysteinemia) is thought to be a risk factor because it can irritate your arteries, making them rigid and rough, which can lead to plaque buildup. Doctors are still looking into the connection between homocysteine and heart disease, but many believe taking folic acid and vitamins B6 and B12 may help lower your homocysteine levels and thus your risk of developing coronary heart disease.
Stress plays a part as well. Stress hormones may make fatty material built up in the artery more likely to break, because they cause the arteries to constrict. Stress management may help you to better cope with situations that make you mad. Whether this reduces the likelihood of a heart attack is not known at present.
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