What are some signs of a heart attack?

What are some signs of a heart attack?

Blood is required for the heart, as well as all other organs and tissues in the body, to work. When one of the arteries supplying blood to the heart gets blocked, it causes a heart attack, also known as a myocardial infarction, or MI. This article will address the pathophysiology of a heart attack, epidemiology, the most essential signs and symptoms in history and physical examination, as well as differential diagnosis.

Heart attacks are often caused by coronary artery disease, which is a leading cause of mortality and disability in developed countries. Plaques of fatty deposits grow on the walls of the coronary arteries in this condition (atherosclerosis). When plaques develop within a coronary artery, the portion of heart muscle supplied by that artery no longer receives adequate blood flow.

This lack of blood flow is referred to as "ischemia," and the longer the artery is blocked, the worse the heart attack and the greater the loss of cardiac muscle, referred to as "infarction." Additionally, a significant coronary artery spasm is a less common cause of heart attack. The spasm stops blood from flowing through the artery and can occur in coronary arteries that aren't blocked by atherosclerosis.

It is necessary to emphasize that most cardiac attacks occur early in the morning most frequently. The potential causes could be explained by the increase of sympathetic tone in the morning which leads to an increase of blood pressure, heart rates, coronary tone, and contractility of the myocardial tones as well as an increase in blood viscosity, platelet aggregability in the morning. Another factor might be elevated morning levels of serum cortisol and plasma catecholamines, which enhance myocardial demand.

Epidemiology

• Coronary artery disease (CAD) is the largest cause of mortality in the United States, with an estimated 500,000-700,000 fatality due to CAD each year, accounting for almost one-third of all deaths in the population over the age of 35.
• Males have a nearly three-fold higher mortality rate from acute MI than females. It affects more black people than whites.

Note

Smoking, dyslipidemia, hypertension, diabetes, obesity, sedentary lifestyle, alcohol use, and psychosocial factors are the key risk factors for heart attack, accounting for 90% of the risk.

Signs and Symptoms of Heart Attack  

• History

In the early stages of a patient's presentation, the patient's history is crucial in detecting a heart attack, and it may give the main indicators that lead to a diagnosis. Patients with typical acute heart attack symptoms typically have chest pain and may experience prodromal symptoms such as weariness, chest tightness, or malaise in the days immediately prior to the attack.

• Chest pain

One of the most prevalent symptoms that sends people to the hospital's emergency department is chest pain. Chest pain can be caused by a variety of conditions, with cardiac abnormalities accounting for almost half of all cases. Substernal In general, chest discomfort caused by a heart attack or another type of cardiac disease can be described or associated to one or more of the following:

• crushing or squeezing pain, and often radiates up to the neck, shoulder, and jaw, and down the left arm
• Pressure, fullness, burning or tightness in your chest
• Pain that lasts more than a few minutes, gets worse with activity,
• Shortness of breath
• Dizziness , weakness or/and cold sweats

Alert!

Myocardial ischemia symptoms in the epigastric region may be misattributed to a gastrointestinal (GI) cause. Furthermore, individuals with cardiac ischemia may experience alleviation or improvement from GI treatments (eg, antacids).

• Other symptoms of heart attack

Although chest pain or pressure is the most common symptom of a heart attack, heart attack victims may experience a variety of conditions including:

• Anxiety, commonly described as a sense of impending doom
• General malaise
• Lightheadedness, with or without syncope
• Palpitations (skipped heartbeats)
• Cough or/and Shortness of breath
• Nausea, with or without vomiting
• Profuse sweating
• Wheezing
• Fullness, indigestion, or choking feeling
• Any sudden, new symptom or a change in the pattern of symptoms you already have

Physical Examination

Physical examination of heart attack patients revealed that not all patients presented with the same severity. While some patients may be comfortable in bed and have normal examination results, others may be in severe pain, have major respiratory distress, and require ventilatory assistance.

The patient’s vital signs may demonstrate the following in MI:

• The heart rate of the patient is frequently raised (tachycardic) due to elevated sympathoadrenal release. The rhythm may be irregular such as ventricular tachycardia, atrial fibrillation or other supraventricular arrhythmias .moreover, bradyarrhythmias may be present.
• The patient's blood pressure rises first due to peripheral arterial vasoconstriction caused by an adrenergic response to pain and ventricular dysfunction. However, hypotension and cardiogenic shock can occur in patients with right ventricular MI or significant left ventricular failure.
• The respiratory rate may be increased in response to pulmonary congestion or anxiety

Alert!

Tenderness of the chest wall has been recorded in up to 5% of myocardial infarction patients (MI). If no injury or trauma has been identified that may have resulted in a soft-tissue injury, the physician should be cautious about making a diagnosis of musculoskeletal chest pain.

Note

Depending on what the EKG shows, there are distinct forms of myocardial infarction (MI). ST elevation MI (STEMI) and non-ST elevation MI are the two primary forms. The type of MI you have will determine how you are treated. The prevalence of non-ST elevation MI (NSTEMI) has increased in comparison to ST elevation MI.

Remember!

The electrocardiogram (ECG) is the most important tool in the initial assessment and triage of patients suspected of having an acute coronary syndrome (ACS), such as a heart attack. Measurement of cardiac enzymes in the blood is useful as well.

Heart Attack Symptoms in Women

For a variety of reasons, women are more likely than males to experience delays in establishing a heart attack diagnosis.  First of all, women have higher chance than males of having atypical symptoms of a heart attack such as Pain in the neck, shoulder pain and abdomen as well as fatigue, sleep disturbances, anxiety, shortness of breath. Second, women are more likely than males to experience chest discomfort that is not caused by heart disease. Finally, women are more likely than males to suffer a heart attack caused by coronary artery spasm.

Silent Heart Attack!

Patients with an extremely high pain threshold or a disorder that inhibits pain perception (eg, diabetes mellitus) and resulting in a defective anginal warning system may fail to notice chest pain. Some patients including the elderly who have a changed mental state because of drugs or poor brain perfusion may suffer cardiac episodes without warning. It's crucial to note that heart attacks with no or moderate symptoms, which may be detected with an exercise ECG or ambulatory ECG monitoring, can be just as dangerous and deadly as heart attacks with significant chest pain.

Differential diagnosis of heart attack

The main causes of chest pain include:

• Acute pericarditis.
• Pneumonia, pulmonary embolism, pneumothorax.
•  
• Gallstones, cholecystitis.
• Acute pancreatitis.
• Chest wall pain - eg, Tietze's syndrome, trauma, shingles, osteoporosis.
• Aortic dissection.
• Anxiety, depression.

Instructions following a heart attack episode

After you've had a heart attack, you will probably need to:

• Modify your risk factors such as managing diabetes, high cholesterol levels, high blood pressure, and other conditions
• Take all your medicines every day to prevent other heart attacks
• Avoid fried foods and too many foods with sugar. Eat lots of fruits and vegetables.
• Lose weight as losing extra weight reduces the chance of another heart attack and can make you feel better.
• getting regular exercise
• avoiding or quitting smoking and limiting alcohol intake

Conclusion

A heart attack happens when blood flow to the heart suddenly becomes blocked. Without the blood coming in, the heart can't get oxygen. If not treated quickly, the heart muscle begins to die. A delay in treatment can lead to permanently reduced function of the heart due to more extensive damage to the heart muscle. Many signs and symptoms accompanying heart attacks, the most significant of which is chest pain, as well as additional symptoms such as dyspnea, anxiety, and lightheadedness. If you have any of these symptoms, do not hesitate to seek medical assistance and go to the hospital right away.

References

• Lenfant, C. (2010). Chest pain of cardiac and noncardiac origin. Metabolism, 59, S41-S46.
• Falk E, Shah PK, Fuster V. Coronary plaque disruption. Circulation. 1995 Aug 1. 92(3):657-71. [Medline].
• Cannon CP, Hand MH, Bahr R, et al. Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program. Am Heart J 2002; 143:777.
• Okrainec K, Banerjee DK, Eisenberg MJ. Coronary artery disease in the developing world. Am Heart J. 2004 Jul. 148 (1):7-15. [Medline].