Early Warning Symptoms and Signs of a Heart Attack

A heart attack is medically known as myocardial infarction. It happens when the blood supply to the heart becomes blocked, and the heart muscle does not receive enough oxygen. The lack of oxygen leads to tissue death of part of the heart muscle. Oxygen is normally provided to the heart muscle through the coronary arteries. When these become blocked (as in the case of atherosclerosis), the blood supply to the heart is reduced.

Characteristic symptoms of a heart attack include;

• chest discomfort,
• pain,
• fullness, and/or a pressure or squeezing sensation of the chest.

Other symptoms may vary but can include;

• jaw pain,
• shortness of breath,
• upper abdominal discomfort, and
• a feeling of heartburn or indigestion.

Symptoms in women and the elderly may be different than those of a typical heart attack. Other associated symptoms in women and the elderly can include;

• angina,
• pain in the upper back,
• nausea,
• vomiting,
• sweating,
• upper stomach pain,
• headache,
• fatigue, and
• toothache.

Classic symptoms of a heart attack may include:

Chest pain associated with;

1. shortness of breath,
2. profuse sweating, and
3. nausea.

The chest pain may be described as;

1. tightness,
2. fullness,
3. a pressure, or
4. an ache.

Pain may also radiate from the chest to the;

1. neck,
2. jaw,
3. shoulder, back, and be associated with;
   1. shortness of breath,
   2. nausea, and
   3. profuse sweating.

Unfortunately, many men and women do not have these classic signs. Other signs and symptoms of heart attack may include:

1. indigestion,
2. jaw ache,
3. the pain only in the shoulders or arms,
4. shortness of breath, or
5. nausea and vomiting.

This list is not complete, since many times people can experience a heart attack with minimal symptoms.

Heart attack symptoms and signs in women and the elderly can be atypical and sometimes so vague they are easily missed. The only symptoms may be extreme weakness or fatigue.

• Yes. Both men and women have heart attacks, but more women who have heart attacks die from them. Despite increases in awareness over the past decades, only about half (56%) of women recognize that heart disease is their number 1 killer. 
• Among all women who die each year, one in four dies of heart disease. According to the CDC, in 2017 heart disease is the leading cause of death in the US, killing 299,578. Nearly 60% more women died of cardiovascular disease (both heart disease and stroke) than from all cancers combined.
• As a woman ages, the more likely she is to get heart disease. Women of all ages should be concerned about heart disease, and should take steps to prevent heart disease.
• Some women have no symptoms or signs of a heart attack, but other women may experience;
  • angina, a dull and heavy sharp chest pain or discomfort,
  • pain in the upper back or abdomen, and 
  • fatigue.
• These symptoms may occur when resting or doing regular daily activities.
• Heart attacks in women have different numbers and outcomes based on race.
• Treatments can limit heart damage, but they must be given as soon as possible after a heart attack starts. Ideally, treatment should start within one hour of the first symptoms.

If you think you're having a heart attack, call 911 right away. Tell the operator your symptoms and that you think you're having a heart attack.

• Chest pain
• Shortness of breath

A transient ischemic attack (TIA) is a brief interruption of blood flow to part of the brain that causes temporary stroke-like symptoms, which include;

1. confusion,
2. lethargy, and 
3. weakness.

If the blood supply loss is located in an area in the middle cerebral artery, a classic sign may be weakness or paralysis and numbness of one side of the body.

Over time, plaque can build up along the course of an artery and narrow the channel through which blood flows. Plaque is made up of cholesterol buildup and eventually may calcify or harden, with calcium deposits. If the artery becomes too narrow, it cannot supply enough blood to the heart muscle when it becomes stressed. Just like arm muscles that begin to ache or hurt when heavy things are lifted, or legs that ache when you run too fast; the heart muscle will ache if it doesn't get adequate blood supply. This ache or pain is called angina. It is important to know that angina can manifest in many different ways and does not always need to be experienced as chest pain.

If the plaque ruptures, a small blood clot can form within the blood vessel, acting like a dam and acutely blocking the blood flow beyond the clot. When that part of the heart loses its blood supply completely, the muscle dies. This is called a heart attack, or an MI - a myocardial infarction (myo=muscle +cardial=heart; infarction=death due to lack of oxygen).

A heart attack is most often caused by narrowing of the arteries by cholesterol plaque and their subsequent rupture. This is known as atherosclerotic heart disease (AHSD) or coronary artery disease (CAD).

The risk factors for AHSD are the same as those for stroke (cerebrovascular disease) or peripheral vascular disease. These risk factors include:

• a family history or heredity,
• cigarette smoking,
• high blood pressure,
• high cholesterol, and
• diabetes.

While heredity is beyond a person's control, all the other risk factors can be minimized to try to prevent coronary artery disease from developing. If atherosclerosis (atheroma=fatty plaque + sclerosis=hardening) is already present, minimizing these risk factors can decrease further narrowing.

Non-coronary artery disease causes a heart attack may also occur. Examples include:

• Cocaine use. This drug can cause the coronary arteries to go into enough spasm to cause a heart attack. Because of the irritant effect on the heart's electrical system, cocaine can also cause fatal heart rhythms.
• Prinzmetal angina or coronary artery vasospasm. Coronary arteries can go into spasm and cause angina without a specific cause, this is known as Prinzmetal angina. There can be EKG changes associated with this situation, and the diagnosis is made by heart catheterization showing normal coronary arteries that go into spasm when challenged with a medication injected in the cath lab. Approximately 2% to 3% of patients with heart disease have coronary artery vasospasm.
• Anomalous coronary artery. In their normal position, the coronary arteries lie on the surface of the heart. On occasion, in the course of a part the artery can dive into the heart muscle itself. When the heart muscle contracts, it can temporarily kink the artery and cause angina. Again, diagnosis is made by heart catheterization.
• Inadequate oxygenation. Just like any other muscle, heart muscle requires adequate oxygen supply for it to work. If there isn't adequate oxygen delivery, angina and heart attack can occur. There need to be enough red blood cells circulating in the body and enough lung function to deliver oxygen from the air, so that heart cells can be supplied with the nutrients that they need. Profound anemia from bleeding or failure of the body to make enough red blood cells can precipitate angina symptoms. Lack of oxygen in the bloodstream can occur due to a variety of causes including respiratory failure, carbon monoxide poisoning or cyanide poisoning.