heart attack symptoms Archives - University Health News University Health News partners with expert sources from some of America’s most respected medical schools, hospitals, and health centers. Mon, 22 Jan 2024 19:32:27 +0000 en-US hourly 1 Be Aware of Subtle Heart Attack Symptoms https://universityhealthnews.com/topics/heart-health-topics/be-aware-of-subtle-heart-attack-symptoms/ Mon, 22 Jan 2024 19:32:27 +0000 https://universityhealthnews.com/?p=147056 Heart disease is the leading cause of death among women in the United States, and women may be twice as likely as men to experience a fatal heart attack. Despite this, the misconception that heart disease and heart attacks are more of a man’s problem is still prevalent, and women spend a lot more time […]

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Heart disease is the leading cause of death among women in the United States, and women may be twice as likely as men to experience a fatal heart attack. Despite this, the misconception that heart disease and heart attacks are more of a man’s problem is still prevalent, and women spend a lot more time worrying about and getting tested for breast cancer than they do monitoring and treating heart-related issues such as cholesterol and blood sugar.

Why is this so? For one thing, women are less likely to survive a heart attack because they don’t recognize the atypical symptoms that are specific to heart attacks in women. Women also wait too long to go to the ER. A woman might be having a heart attack if she has pain in her arms, shoulder, upper back, abdomen, neck, jaw, or chest. Other signs of heart attack in women (such as vomiting, shortness of breath, lightheadedness, weakness, exhaustion, and indigestion) could be confused with any number of illnesses—including a stomach bug or common cold. However, because the symptoms of heart attack in women are somewhat ambiguous, it’s not uncommon for them to be ignored.

In fact, a recent study showed that women who were experiencing heart attack symptoms waited more than two days before heading to the hospital, whereas men went to the hospital about a day and a half sooner. Another study showed that women are more likely to call an ambulance if their husband is having heart attack symptoms than if they are. Some of these discrepancies can be chalked up to the fact that women’s heart attack symptoms are often subtle and do not always include the crushing chest pain that most people associate with this coronary event—but sometimes they do.

It is critical to understand that heart disease and heart attack pose a major risk for women, and that being familiar with both the typical—and atypical—signs of heart attack can literally save your life. Take this information to heart and share it with your mothers, sisters, daughters, and friends. Recognizing and acknowledging symptoms of a heart attack, calling 911, and quickly getting to the hospital are all within your reach.

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Be Alert for Both Classic and Atypical Signs of Heart Attack https://universityhealthnews.com/topics/heart-health-topics/be-alert-for-both-classic-and-atypical-signs-of-heart-attack/ Mon, 22 Jan 2024 19:30:51 +0000 https://universityhealthnews.com/?p=147053 More than 60 million women in the United States have heart disease, and one of the most common events caused by heart disease is a heart attack. This reinforces the need for women to recognize the classic signs of heart attack in women and men—such as chest pain and pressure—as well as the lesserknown symptoms […]

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More than 60 million women in the United States have heart disease, and one of the most common events caused by heart disease is a heart attack. This reinforces the need for women to recognize the classic signs of heart attack in women and men—such as chest pain and pressure—as well as the lesserknown symptoms associated specifically with heart attack in women—including jaw pain, extreme fatigue, and sudden nausea.

While chest discomfort, pressure, and pain are common symptoms of heart attack for both sexes, women often suffer a heart attack with more subtle symptoms, which makes recognizing a heart attack more difficult—unless you know what to look for. You could be having a heart attack if you experience pain in your arms, shoulder, upper back, abdomen, neck, or jaw. Heart attack symptoms in women that are unrelated to physical pain include vomiting, shortness of breath, lightheadedness, weakness, exhaustion, and indigestion.

When to Go to the ER

Women are more likely than men to dismiss or minimize possible heart attack symptoms because they can be mistaken for any number of illnesses—including flu. This may explain why women are less likely than men to survive their first heart attack. One study found that women waited 54 hours—more than two days—to seek treatment for heart attack symptoms, compared with men, who waited just 16 hours. According to Tracy K. Paul, MD, a cardiologist at Weill Cornell Medicine, if you have active chest pain, or new noticeable shortness of breath with your usual level of exertion, you should head to the ER. “If you are experiencing these symptoms, the best thing to do is trust your gut and get checked out,” says Dr. Paul. If these symptoms come on with exercise or other types of exertion and go away with rest, Dr. Paul suggests making an appointment with your family doctor or a cardiologist.

Cardiac Care for Women

Because women don’t always experience chest pain when having a heart attack, their symptoms are sometimes dismissed by health-care providers. Progress has been made over the years in recognizing that heart attack symptoms can vary between women and men, but disparities in diagnosis and treatment still exist. For instance, one study revealed that women who go to the ER with chest pain are 4 percent less likely than men to have an electrocardiogram, which checks electrical activity in the heart and can indicate a heart attack.

The study also found that women with chest pain are not seen by a doctor as quickly as men, and are 5.5 percent less likely to be admitted to the hospital for observation. “Unfortunately, there is still education that needs to be done to dispel the myth that women do not have heart attacks. Hopefully, through continuing education and strategies targeted to health-care providers to combat health-care disparities, we will be better able to achieve equitable cardiac care between women and men,” says Dr. Paul.

Heart Disease Risk Factors

In general, heart disease risk factors include cigarette smoking, high blood cholesterol, high blood pressure, diabetes, obesity, physical inactivity, and having a family history of early heart disease. In addition, heart disease risk factors unique to women include the natural decline in estrogen after menopause and having a history of pregnancy-related complications such as eclampsia, preeclampsia, or gestational diabetes.

To fully understand their risk of heart disease and heart attack, women need to know their numbers—meaning their blood pressure, weight, glucose levels, and cholesterol numbers, Dr. Paul says. “If these are in the abnormal range, it is important to work on lifestyle interventions— such as getting more exercise, and eliminating unhealthy fats— to improve them. However, even with consistent lifestyle modifications, certain women may still need medications to help decrease their risk of having a heart attack,” Dr. Paul says.

If You Experience Symptoms

“Trust your instinct if you feel symptoms that are suggestive of a possible cardiac event,” Dr. Paul says. If you experience chest discomfort, or pain in your arms, shoulder, upper back, abdomen, neck, or jaw, or if you have sudden nausea, vomiting, shortness of breath, lightheadedness, weakness, extreme fatigue, or indigestion, consider that these symptoms might be related to an impending heart attack. If you have sudden-onset of any of these symptoms, call 911.

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How to Recognize and Respond to a Panic Attack https://universityhealthnews.com/topics/depression-topics/how-to-recognize-and-respond-to-a-panic-attack/ Mon, 22 Jan 2024 19:23:36 +0000 https://universityhealthnews.com/?p=147157 Your heart starts racing. You’re having trouble catching your breath. Something seems very wrong. When these sensations come on suddenly, you might first think you’re having a heart attack. But for millions of people, those are symp­toms of a panic attack, an event experienced by about one in 10 adults at some point in their […]

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Your heart starts racing. Youre having trouble catching your breath. Something seems very wrong.

When these sensations come on suddenly, you might first think youre having a heart attack. But for millions of people, those are symp­toms of a panic attack, an event experienced by about one in 10 adults at some point in their lives.

If you’ve never had a panic attack, the first time you do can be alarming and may fill you with questions. How long will it last? Will I have more of these? Does this indicate a mental health problem?

 

 

Nicole LeBlanc, PhD, a clinical psychologist with Massachusetts General Hospitals Center for Anxi­ety and Traumatic Stress Disorders, says that one way to think about a panic attack is that its a sudden onset of the bodys fight or flight response.”

It’s not always clear what causes a panic attack, though genetics and changes in certain brain functions may play a role. Likewise, a buildup of stress or having a temperament that tends to become overwhelmed by stress or negative feelings may also raise your risk of having a panic attack.

“A panic attack is a sudden, intense surge of fear that comes on quickly and peaks within a few minutes,” Dr. LeBlanc explains, adding that a panic attack is usually accompanied by physical symptoms of fear such as heart pounding, sweating, shortness of breath, feel­ing of choking, nausea, dizziness, chills or hot flashes, and numbness or tingling. Things around you also may seem strange or unreal.

Panic Attack or Heart Attack?

Given the nature of a panic attack’s symptoms, their onset may have you thinking you’re having a heart attack or that some other medical condition has developed unrelated to anxiety or fear. Dr. LeBlanc notes that there are indeed many medical conditions with symp­toms similar to those associated with panic attacks.

“For example, hyperthyroidism, seizure disorders, and cardiac condi­tions can all cause symptoms that look like a panic attack,” she says. “If a person has had a panic attack, they should see their doctor, who will order tests to assess for a medical cause for the symptoms. Once a medical cause has been ruled out, a person can be diagnosed with a panic attack.”

Unlike a panic attack, heart attack symptoms tend to last and even worsen until you are treated. They also may come and go, while panic attack symp­toms usually last for a short, finite amount of time (often about 20 minutes or less) without lingering or returning within minutes after they fade.

And while a heart attack frequently brings on severe chest pain, a panic attack may or may not cause chest pain. When chest pain is present during a panic attack, it’s often described as a sharp or shooting pain. Chest pain associ­ated with a heart attack, however, often feels like intense pressure or squeezing of the heart. Heart attack symptoms also may, but not always, include pain in the arms, neck, back, or jaw. Pain in these areas is less common during a panic attack.

It’s also worth noting that a panic attack shares some of the same characteristics as an anxiety attack, but they are two different events. Common features include worry and fear, as well as physical symptoms such as a racing heart, shortness of breath, and, in many cases, dizziness or lightheadedness.

But anxiety and panic attacks differ in some important ways. While a panic attack can erupt suddenly and without any warn­ing, an anxiety attack tends to build gradually, allowing you to become aware that your stress or fear is bringing on physical symp­toms. Panic attacks may or may not have an obvious or definable trigger, but anxiety attacks can usually be traced to a particular stressor. Finally, panic attacks typ­ically resolve in a matter of min­utes. An anxiety attack may last for hours, days, or weeks.

Do You Have Panic Disorder?

If you have occasional panic attacks, you may learn to recog­nize their symptoms early on, so youll have a good idea of whats happening. But having more than one panic attack may stir up other health concerns. Namely, you may wonder if you have panic disorder.

“Many people will experience one or more panic attacks in their lives,” Dr. LeBlanc says. “Having a panic attack does not mean that a person has panic disorder. A person has panic disorder if they have panic attacks and start to worry so much about the panic attacks that it interferes with their life. For example, a person with panic disorder might worry that having a panic attack means they racing heart, sometimes accompanied by chest pain, is a common symptom of a panic attack.

 

are going crazy, so they start to avoid situations that they think could trigger panic attacks, like going into crowded places.

When a Panic Attack Occurs

If you sense that youre having a panic attack, or if you know one is coming on because you’ve experi­enced one or more attacks previ­ously, the best advice is to let it run its course. “Trying to stop or fight off a panic attack usually makes it worse,” Dr. LeBlanc says. “Instead, a person can think about ‘riding the wave’ of their panic attack until it passes on its own.

She adds that if a person knows they have panic attacks (and not a medical condition), they can cope with the discomfort of an attack by reminding themselves that the attacks aren’t dangerous and are usually short-lived.

Treatment is available for panic attacks, but its not always necessary, r. LeBlanc says. “If a person expe­riences occasional panic attacks that do not bother them too much, they likely don’t need treatment,” she says. “However, if a person is both­ered by their panic attacks, there are very effective treatments that can help. One of the most effective treatments for panic disorder is called cognitive behavioral therapy. In cognitive behavioral therapy, patients learn skills to cope with panic attacks in the moment when they occur. A medical doctor can also prescribe medications that can help with panic attacks.

If you have had one or more panic attacks, or youre not sure if a recent event was a panic attack, talk with your doctor. If you find your­self occasionally or frequently feel­ing overwhelmed by stress or fear, talk with a mental health profes­sional soon.

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How Heart Smart Are You? https://universityhealthnews.com/topics/heart-health-topics/how-heart-smart-are-you/ Wed, 22 Feb 2023 19:57:45 +0000 https://universityhealthnews.com/?p=144241 Heart-health advice has many messengers: your doctor, promotional fliers in the mail, family and Facebook friends, the National Institutes of Health, internet ads, and of course Dr. Google. Some health advice comes from science-based evidence, others not so much. Credible sources include the Centers for Disease Control and Prevention (CDC), where researchers make conclusions based […]

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Heart-health advice has many messengers: your doctor, promotional fliers in the mail, family and Facebook friends, the National Institutes of Health, internet ads, and of course Dr. Google. Some health advice comes from science-based evidence, others not so much. Credible sources include the Centers for Disease Control and Prevention (CDC), where researchers make conclusions based on the latest science-based, data-driven information. When it comes to cardiovascular disease (CVD), the CDC has tracked heart-related events and fatalities for decades. Heart disease is the leading cause of death for men and women, and it is responsible for about one in four deaths each year. That’s more fatalities than any one single cancer, and it’s more than all cancers combined.

So, taking care of your heart, is obviously an imperative if you aspire to live a long and healthy life. That’s why we asked UCLA cardiologists to address some commonly held misconceptions they receive from their patients.

Sea Salt Is Better Than Other Salts

Q: I know that regular salt is bad for my heart. That why I only use sea salt. It’s better, right?

The main differences between sea salt and table salt are in their taste, texture and processing,” explains Boris Arbit, MD, UCLA Division of Cardiology. “The effects on your water retention and blood pressure are the same. It would be better to use sodium-free salt alternatives.”

Your body needs some sodium, but not too much. Too much sodium (a.k.a. salt) results in fluid retention, which drives up blood pressure. This, in turn, can strain blood vessels and the heart. According to the CDC, 86% of adults with high blood pressure overconsume sodium. Sodium lurks in unsuspecting products in higher amounts than you might realize, such as breads. Canned, preserved, and processed foods, as well as smoked foods are notoriously high in sodium.

Heart Disease and Genetics

Q: My mom had heart failure and my dad died of a heart attack. Obviously, I am genetically predisposed to having a major heart event myself. So why bother with diet and exercise?

Genetics play an enormous role in our heart health, but that doesn’t mean we can’t modify other risk factors,” says cardiology fellow Marwah Shahid, MD, Ronald Reagan UCLA Medical Center. “Having a balanced diet, particularly a Mediterranean diet, can help lower cholesterol and blood pressure, which are both risk factors for heart attacks. Beyond diet, exercise is the cornerstone for a heart-healthy lifestyle. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. The key to lifestyle modifications is to find what works best for you, and remember that genetics is only one of many risk factors for heart disease.”

Exercise intensity is key. A walk in the woods is nice, but heart-enhancing exercise requires a sustained increased heart rate. You know you’re working hard enough when you can talk but not sing during the exercise. Talk to your doctor and/or see a physical therapist to create a program that is right for your current fitness level and health status.

© ANDRZEJ WOJCICKI | Getty Images Heart disease claims more lives that all cancers combined.

Preventing Heart Disease with Aspirin

Q: I’m 70 years old, take a baby aspirin every day, and I tell my kids to follow in my footsteps because my heart is fine.

Current guidelines advise against this,” says Dr. Arbit. “While a baby aspirin may be indicated for patients at very high risk of a heart attack or stroke, one should not start/ stop taking aspirin without speaking to their doctor. For patients at lower cardiovascular risk, the risk of bleeding with the medication may be higher than the benefit.”

Dr. Shahid adds, “Not everyone may have the same benefit from aspirin as you. For younger people such as your family members ages 40 to 59, the best strategy is to have individuals discuss their risk factors with their doctors to see if they would benefit from aspirin.”

Health guidelines evolve as studies advance medical knowledge. Not long ago, taking low-dose daily aspirin was generally recommended for everyone. But that’s changed as several high-quality studies increasingly investigated the approach. On April 26, 2022, an editorial in JAMA Network Open summarized recent studies and reported that “…clinical benefit of aspirin was marginal, and, in most individuals, the benefit was offset by the excessive risk of bleeding.”

The American College of Cardiology and American Heart Association updated their positions and state that low-dose aspirin use is not recommended on a routine basis for primary prevention of cardiovascular disease (CVD) in adults older than 70 years, or among adults of any age who are at increased risk of bleeding. The bottom-line is aspirin as prevention against cardiovascular disease is no longer a one-size-fits all recommendation. Doctors and patients need to discuss personal heart risk factors to determine the most appropriate course of action.

Heart Disease and Exercise

Q: I have heart disease and need to relax. Can’t I hurt myself with too much exercise?

One of the best things you can do for yourself is exert yourself with exercise to help strengthen your cardiovascular system,” advises Dr. Shahid. “Exercise is not only an outlet for stress relief, which can have long-term consequences on the heart, but numerous studies show that people who are physically active live longer. If you are starting from scratch, you should start with low-intensity exercise, such as walking, and progress from there. If you have recently had a heart attack, talk to your doctor about enrolling in a cardiac rehabilitation program. There also are certain people who require a modified exercise routine, so it is best to speak with your doctor about creating an exercise plan.”

The Ornish Lifestyle Medicine program (ornish.com/intensive-cardiac-rehab) is a scientifically-proven program to stop the progression and even reverse the effects of heart disease. This program has been so effective in undoing years of damage to the heart that Medicare and some other insurers cover it under the benefit category intensive cardiac rehabilitation. Coverage is dependent upon qualifications. Check with your insurance.

Cigarettes vs Cigars and Vape Pens

Q: Of course, I know I shouldn’t smoke cigarettes. That’s why I smoke cigars (I don’t inhale them) and I might occasionally use a vape pen. Those options are safer, aren’t they?

This is simply false,” says Dr. Arbit. “Cigar smoke contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers. During the fermentation process for cigar tobacco, high concentrations of cancer-causing nitrosamines are produced. The harm in vape pens comes from the aerosol (the vapor) that is used.”

© Gabe Ginsberg | Getty Images
Smoking of any kind is bad for your heart.

It’s never too late to gain the many health benefits of not smoking, no matter how old you are or how long you’ve been smoking. Quitting reduces the risk of coronary heart disease and death, and risk falls sharply one to two years after cessation. The CDC website (smokefree.gov) has an abundance of tools and resources to help you quit. For example, you can receive daily text messages with encouragement, advice, and tips to help you quit smoking. To sign up, text CDC to 47848.

Statins Have Too Many Side Effects

Q: Don’t statins cause muscle pain and fatigue?

Statins have had a significant positive effect on reducing heart attacks and strokes, and they are very well tolerated,” Dr. Arbit explains. “Like any medication, it must be prescribed and taken with care. However, most side effects are due to the “nocebo” effect.”

The “nocebo” effect refers to an inert substance that causes perceived harm. The placebo effect is when an inert substance results in perceived benefit (a placebo also refers to a chemically inactive substance). A 2021 study assessed people’s daily symptom scores on statin and placebo treatment in study participants who had abandoned statins, citing side effects. There were 60 participants (mean age 65.5) in the yearlong study. The most common symptoms causing statin abandonment before enrollment were muscle ache, fatigue, and cramps. The researchers found that the intensity of symptom onset was unrelated to whether people were taking a statin or placebo tablet. Similarly, symptom relief scores dropped within three days of stopping the tablets, again, regardless of whether the tablet was a statin or placebo. The authors conclude that statins side effects are verifiable but are driven by the act of taking tablets not whether the tablets contain a statin.

Heart Disease Is a Man’s Disease

Q: Heart disease affects more men than women. As a woman, what I must worry about is breast cancer, right?

While many people associate heart disease with men, it is the leading cause of death for women in the United States,” says Dr. Shahid.

Heart disease claims the lives of more men and women than all cancers combined. However, compared with men, women are more likely to die of a heart attack. One reason is how heart attacks are diagnosed, namely by measuring the amount of a protein called troponin (an indicator that the heart muscles isn’t receiving enough oxygen). In men having a heart attack, the troponin levels are much higher compared with women. Studies suggest that standard tests may not be sensitive enough to pick the lower, but relevant, troponin levels in females. Heart attack symptoms in women also can be different than in men. Learn more here: tinyurl.com/AHAHeartAttackWomen.

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Understanding Heart Disease in Women https://universityhealthnews.com/topics/womens-health/understanding-heart-disease-in-women/ Mon, 19 Sep 2022 18:27:07 +0000 https://universityhealthnews.com/?p=142383 Heart disease is the number one cause of death in both men and women. However, compared with men, women are more likely to die of a heart attack. Women also face a 20% increased risk of developing heart failure or dying within five years after their first severe heart attack compared with men, according to a […]

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© Science Photo Library | Getty Images
Heart disease kills more women than all cancers combined.

Heart disease is the number one cause of death in both men and women. However, compared with men, women are more likely to die of a heart attack. Women also face a 20% increased risk of developing heart failure or dying within five years after their first severe heart attack compared with men, according to a 2020 research study published in the American Heart Association’s journal Circulation. In addition, women are less likely to be prescribed medications such as beta blockers or cholesterol-lowering drugs and have lower rates of revascularization procedures to restore blood flow, such as catheter-based angioplasty.

Why the Disparities?

Many of the poorer heart-health outcomes in women have to do with the fact that women have been underrepresented and historically excluded from heart disease clinical trials. The first National Heart, Lung, and Blood Institute (NHLBI) workshop examining heart disease in women took place in 1986. Women’s participation in heart trials have since increased, though there’s a long way to go to reach parity with men’s studies.

Studies direct the development of therapies and protocols, including evidence-based guidelines, diagnostic biomarkers and thresholds, risk factor identification, and medication recommendations. Much of today’s approach to heart disease prevention, diagnosis and treatment has been primarily based on the male heart. To be fair, it was once believed that men’s and women’s hearts were essentially the same. But as studies have rolled out, findings clearly show biological and functional differences between the sexes. These include:

The size and structure of the heart. A woman’s heart and blood vessels are smaller, and the muscular walls of women’s hearts are thinner.

Greater prevalance of coronary microvascular disease in women. This type of heart disease means the walls of the tiny arteries of the heart are damaged or diseased. The standard tests for coronary heart disease aren’t designed to detect coronary microvascular disease. The consequence of this is that women’s test results may incorrectly show that they’re at low risk for heart disease, and therefore they may not be offered preventive medications, such as statins and beta-blockers.

Differences in troponin. Troponin is a protein that can indicate that the heart muscle isn’t receiving enough oxygen because of an obstruction in its blood vessels. Physicians measure levels of troponin to help diagnose a heart attack. However, the blood levels of troponin that signal damage to the heart muscle in men is higher than in women. This means that tests may not be sensitive enough to detect the lower, but clinically relevant, level of troponin that would allow them to identify women’s heart attacks.

Evidence-based medicine relies on available data. When the evidence is lacking, diagnosis, treatment, and prevention for women may lag. Fortunately, knowledge gaps are closing. Programs such as the American Heart Association’s Go Red for Women (goredforwomen.org) tracks and posts some of the latest findings on ­women’s heart health.

How Menopause Affects the Heart

In premenopausal women, estrogen provides a protective effect on the heart. However, that changes after menopause. “In postmenopausal women, cardiovascular disease risk is increased,” says Marwah Shahid, MD, David Geffen School of Medicine at UCLA. “Several longitudinal studies show that there are distinct patterns of changes in sex hormones in women as we age and experience menopause. These hormone changes contribute to changes in body fat distribution, levels of cholesterol (lipids and lipoproteins) and the composition and structure of blood vessels.”

Some studies have suggested that hormone replacement treatments (HRT) for women may be beneficial for heart health; however, further research paints a different picture. “More recent robust clinical trials have not shown any cardiovascular benefit with hormone therapy on cardiovascular outcomes,” says Dr. Shahid. “There is also an additional risk for deep vein thrombosis and pulmonary embolism (blood clots in the legs and lungs, respectively) with the use of hormone therapy. We generally recommend an individual approach to the use of hormone therapy in women with significant vasomotor or genitourinary symptoms, with low- dose and short duration of hormone therapy use for patients with severe menopause symptoms. In patients with higher-risk disease including known heart disease, prior strokes, or breast cancer, we generally avoid hormone therapy.”

Understanding Risk Factors

Women over age 65 should pay particular attention to, and manage as needed, high blood pressure, obesity, and inflammatory and autoimmune diseases, as these put women at greater risk for heart disease. Though some of the risk factors for men and women are the same, studies have shown that these same factors raise women’s risk more. They include diabetes, having low levels of high-density lipoprotein cholesterol (HDL, a.k.a. good cholesterol), and smoking. The same lifestyle changes, however, can reduce risk in both sexes and include a healthy diet, such the Mediterranean diet or the DASH diet (Dietary Approaches to Stop Hypertension) and being physically active (at least 30 minutes of moderately vigorous aerobic activity five days per week).

“Several studies have shown that diet and exercise can significantly improve lipid profiles and reduce central obesity in postmenopausal women,” says Dr. Shahid. “The best time to start a heart healthy diet and exercise is now, since the effects of a long-term healthy lifestyle can help prevent and improve the pre-existing risk of cardiovascular disease-related outcomes.”

Heart Attack Symptoms in Women

Women with myocardial infarction (heart attack) can have angina (chest pressure and pain) just like men, but women are likely to have more symptoms, such as pain in the shoulder, back, or arm, and anxiety. According to the NHLBI, in women:

  • Different activities bring on chest pain. In men, angina (chest pain/discomfort) tends to worsen with physical activity and go away with rest. Women are more likely than men to have angina while they are resting. In women who have coronary microvascular disease, angina often happens during routine daily activities, such as shopping or cooking, rather than during exercise. Microvascular angina events may last longer and be more painful than other types of angina.
  • Mental stress. It is more likely to trigger angina pain in women than in men.
  • The location and type of pain may differ. Pain symptoms are different for each person. Women having angina or a heart attack often describe their chest pain as crushing, or they say it feels like pressure, squeezing, or tightness. Women also may have pain in the chest or the neck and throat.
  • Other symptoms common for women include nausea, vomiting, shortness of breath, abdominal pain, sleep problems, tiredness, and lack of energy.

According to the American Heart Association, heart attacks can be sudden and intense, but most start slowly, with mild pain or discomfort that gradually worsens over a few minutes. These episodes might come and go several times before the actual heart attack occurs. If a symptom occurs out of the ordinary, during an activity or a stressful event, and doesn’t go away after you stopped the activity or at rest, seek emergency care by calling 9-1-1. Early treatment can limit damage to your heart, reduce the risk of heart failure, and can save your life.

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Symptoms of Brain Damage After Heart Attack – Is Memory Loss Permanent? https://universityhealthnews.com/daily/memory/symptoms-of-brain-damage-after-heart-attack-is-memory-loss-permanent/ Wed, 27 Apr 2022 16:16:13 +0000 https://universityhealthnews.com/?p=141220 Myocardial infarction, commonly known as a heart attack, is the most common cause of death in the western world. Although most people survive a heart attack, they may be left with disabilities caused by the heart attack. In fact, a heart attack is also the leading cause of disability. Heart attack research now shows that […]

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Myocardial infarction, commonly known as a heart attack, is the most common cause of death in the western world. Although most people survive a heart attack, they may be left with disabilities caused by the heart attack. In fact, a heart attack is also the leading cause of disability. Heart attack research now shows that one common disability found after a heart attack is a mental disability, called cognitive impairment.

What Is Cognitive Impairment?

Cognitive impairment is any loss of high-level intelligence that includes brain functions like memory, attention, language, judgment, reasoning, and understanding. Cognitive impairment can be severe, like Alzheimer’s disease and or mild cognitive impairment that comes with aging. There are many causes of cognitive impairment, but all the causes result from damage to brain cells called neurons.

Cognitive Impairment and Heart Attack?

A heart attack is decreased blood flow through the arteries that supply your heart muscles. When your heart is not getting enough blood, it is not getting enough oxygen carried by your blood, so heart muscle cells become damaged and may die. Also, when you are having a heart attack, your heart is not pumping out blood to the rest of your body very well.

A heart attack deprives your body of oxygen, explaining heart attack symptoms like shortness of breath and dizziness. Another type of body cell that needs a constant supply of blood and oxygen are your brain cells, called neurons. Damage to neurons starts to occur quickly if blood flow is decreased, which can happen during a heart attack. Recent studies find that about half the people who have a heart attack have enough decreased blood flow to the brain to cause some cognitive impairment.

What Does the Research Show About Memory Loss After Heart Attack?

Back in 2011, a study reported in the American Heart Journal found that out of 772 patients who had a heart attack and were tested for cognitive function one month later, only about 45 percent had normal cognitive test results. About 30 percent had mild cognitive impairment and 25 percent had moderate to severe impairment. The authors of the study concluded that cognitive impairment after a heart attack could be a common problem and suggested that patients have support and assistance after coming home from a heart attack and that they participate in a cardiac rehabilitation program.

In 2019, one of the largest studies on cognitive impairment after a diagnosis of coronary heart disease was published in the Journal of the American College of Cardiology. It included close to 8000 patients. These patients did not have dementia before their heart disease diagnosis. Over a period of 12 years, they were tested for memory, language, and knowledge of present circumstances. Patients with a diagnosis of heart attack had significant impairment in all three tests over the 12 years. The authors of this study conclude that cognitive impairment after a heart attack is common and probably due to decreased blood flow. They suggested that the best way to prevent this type of impairment is to prevent heart disease, called primary prevention.

Most recently, in a study presented at the 2022 meeting of the American College of Cardiology, researchers pointed out the accumulating evidence of the link between heart attack and cognitive impairment. This study found a high rate of cognitive impairment in patients after a heart attack who had no diagnosis of cognitive impairment before their heart attack.

The researchers tested 220 patients with a cognitive test called the Mini-Mental State Examination. They tested at the beginning of the study and six months later.  According to the mini-mental exam, 40 to 41 percent of the patients had cognitive impairment right after the heart attack. At six months, the rate of cognitive impairment went down to between 33 and 34 percent. The authors of this study concluded that cognitive impairment after a heart attack may be both temporary and permanent and that patients after a heart attack should be checked regularly for any signs of cognitive impairment.

What Are the Symptoms of Cognitive Impairment?

You may notice symptoms of cognitive impairment yourself, but more often a friend or loved one will notice warning signs. These signs and symptoms may come and go at first, so it is important to tell your health care provider about them:

  • Trouble remembering
  • Asking the same questions over and over
  • Telling the same stories over and over
  • Difficulty learning new information
  • Missing appointments
  • Trouble concentrating enough to follow a conversation, book, or movie
  • Trouble finding the right words when speaking, or losing your train of thought while talking
  • Becoming easily confused and agitated
  • Trouble doing simple tasks

Prevention and Treatment

All the things you do for heart health will also help protect your brain before or after a heart attack. Lifestyle changes that reduce your risk of heart disease and cognitive impairment include:

  • Regular physical activity
  • Proper sleep, at least seven hours every night
  • Relaxation techniques to reduce stress
  • The Mediterranean diet, which is low in saturated fat and features whole grains, fruits, vegetables, and fish
  • Limiting your use of alcohol
  • Not smoking
  • Maintaining a healthy weight

Work with your doctor to control your blood sugar, blood pressure, and cholesterol. If you have sleep apnea, get that under control. You can also protect your brain by building up cognitive resilience. The more exercise you give your brain by doing brain-teasing puzzles or learning new activities that require thought and memory, the more you can lose some brain cells and still have enough reserve to avoid cognitive impairment.

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Identifying (and Avoiding) a Heart Attack https://universityhealthnews.com/topics/heart-health-topics/identifying-and-avoiding-a-heart-attack/ Fri, 22 Jan 2021 19:10:36 +0000 https://universityhealthnews.com/?p=135741 Someone has a heart attack in the United States every 40 seconds. Blood flow to a section of the heart becomes blocked and, starved of oxygen, that section of heart muscle is injured or even dies. Here are some simple dos and don’ts that can lower the risk of heart attack—and save your life or […]

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Someone has a heart attack in the United States every 40 seconds. Blood flow to a section of the heart becomes blocked and, starved of oxygen, that section of heart muscle is injured or even dies. Here are some simple dos and don’ts that can lower the risk of heart attack—and save your life or the life of a loved one.

✖ DON’T assume you know what a heart attack feels like. When someone on TV clutches their chest, we know they are having a heart attack. But in real life, heart attack symptoms are more varied. “We typically picture it as pressure deep in the middle of the chest,” says James Udelson, MD, chief of the Division of Cardiology at Tufts Medical Center, “but some people just feel it in the left arm, some in the neck, jaw, or back. Some have sharp pain instead of pressure. Some people just get short of breath. Nausea and vomiting are also possible. For reasons we don’t understand, women are more likely than men to experience these atypical symptoms.” In a study that asked 515 women about their symptoms before a heart attack, chest pain was not one of the most frequently reported symptoms. Symptoms commonly reported included unusual fatigue, sleep disturbances, anxiety and lightheadedness. (See Possible Heart Attack Symptoms.) People with diabetes are prone to nerve damage (neuropathy), which can make them more likely to have an unusual presentation of heart attack symptoms.

✖ DON’T hesitate to call for help. Many people think they have indigestion or hope what they’re feeling will pass. “The earlier a heart attack is treated, the more heart muscle we can save,” says Udelson. “The most important thing someone can do is seek help quickly. Don’t worry about a false alarm. Assume it’s a heart attack and call 911.”

✔ DO know your risk factors. Major risk factors for heart attack all relate to lifestyle: smoking; not consuming a healthy dietary pattern; physical inactivity; being overweight or obese; or having high blood pressure, diabetes, chronic inflammation, or abnormal blood cholesterol levels (high LDL cholesterol, high triglycerides, and/or low HDL cholesterol).

“Older age is one of the strongest risk factors,” says Dariush Mozaffarian, MD, DrPH, dean of the Friedman School and editor-in-chief of Tufts Health & Nutrition Letter. “Having a first degree relative with a history of a heart attack also raises your risk, especially if that heart attack occurred at a younger age. Because your age, gender, and family history cannot be controlled, it’s even more important to address the lifestyle risk factors that can be controlled.”

✔ DO take basic steps, every day, to protect your heart. Studies show that healthy eating (like a Mediterranean-style dietary pattern and the DASH diet) could reduce heart attack risk up to 30 percent. See the Take Charge! box for more proven steps you can take to reduce your heart attack risk.

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Heart Damage from COVID-19 https://universityhealthnews.com/topics/heart-health-topics/heart-damage-from-covid-19/ Fri, 22 Jan 2021 18:33:42 +0000 https://universityhealthnews.com/?p=135592 After more than a year with the COVID-19 disease swirling around the globe, researchers have learned a lot about what this novel virus does in the body and how it does it. Though COVID-19 was initially defined primarily as a respiratory illness resulting in lung impairment, within months it became clear that the heart could […]

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After more than a year with the COVID-19 disease swirling around the globe, researchers have learned a lot about what this novel virus does in the body and how it does it. Though COVID-19 was initially defined primarily as a respiratory illness resulting in lung impairment, within months it became clear that the heart could also be affected in various ways. The American Heart Association (AHA) reported that studies suggest many COVID-19 survivors experience some type of heart damage. That includes people who did not have underlying heart disease and were not sick enough to be hospitalized.

“Magnetic resonance imaging studies showing involvement of the heart muscle two months after infection in minimally symptomatic patients is quite concerning,” says cardiologist Boris Arbit, MD, UCLA Medical Center. “We know that regular respiratory viruses can affect the heart about 1% of the time, but the rate of cardiac involvement in COVID-19 is much higher, up to 22%.”

Gregg Fonarow, MD, Chief, Division of Cardiology, UCLA Medical Center, explains that there may be individuals who get through the initial infection but are left with cardiovascular damage and complications. However, it’s possible that some of the cardiovascular damage seen following the disease could heal itself.

“We’ve seen with other viruses where there is inflammation of the heart, there are individuals for whom there is spontaneous recovery. And in some people, we can treat this effectively with medication,” says Dr. Fonarow in the AHA report.

However, many questions remain, including to what extent will the heart be damaged, how long will it last, and who will be affected?

“We simply don’t know yet,” explains Dr. Arbit. “It seems that the vast majority of patients are able to return to regular life and prior level of physical activity. But for some, the journey is longer.”

Inflammatory Damage

The heart needs oxygen, and it is also responsible for pumping oxygen-rich blood from the lungs to tissues throughout the body. Many viruses, including COVID-19, can trigger an intense inflammatory reaction in the body, and the heart is especially vulnerable to its damaging effects. Inflammation is needed to help fight infections, but in some people it goes into severe overdrive (sometimes referred to as a cytokine storm). The resulting onslaught of pro-inflammatory chemicals can injure the heart muscle or disrupt the heart’s electrical signals. A weakened heart muscle can’t effectively pump blood and has to work harder to try to distribute blood. Disrupted electrical signals may result in an abnormal heart rhythm called an arrythmia. Existing arrythmias may worsen.

In some cases, the virus may also infect the heart cells. Researchers are working to understand if and how much this contributes to the heart damage in people with COVID- 19. Some people seriously ill with the disease form many small blood clots throughout the body, including their heart, which can also cause damage. Researchers think inflammation may, in part, trigger the clots.

Through September 2020, nearly one-fourth of those hospitalized with COVID-19 have been diagnosed with cardiovascular complications, which have been shown to contribute to roughly 40% of all COVID-19-related deaths.

Pandemic Stress and the Heart

Ongoing stress can lead to serious heart problems. In July of last year, a Cleveland Clinic study showed an increase in “broken-heart” syndrome. This highlights the very real impact of psychological and emotional stress on physical health. Broken-heart syndrome is a colloquial name for stress-induced cardiac symptoms that mimic those of a heart attack. The difference is that people with this syndrome usually don’t have blocked coronary arteries. Most recover from such episodes within days or weeks. Nonetheless, it’s important to seek emergency medical care when experiencing heart attack symptoms because it’s impossible to know in the moment if symptoms are stress-induced or related to blockages.

Managing stress is critical. Stress-reduction techniques include: meditation, relaxing music, a soothing herbal tea, regular exercise, and deep abdominal breathing. A daily practice of some kind is like making a deposit into a mental health bank. That way, when extreme stress comes your way, you’ll have resources to dip in to when more peace and calm are needed.

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Mild Heart Attack Symptoms and What to Do When It Happens https://universityhealthnews.com/daily/heart-health/mild-heart-attack-symptoms-what-do-they-mean/ https://universityhealthnews.com/daily/heart-health/mild-heart-attack-symptoms-what-do-they-mean/#comments Mon, 14 Dec 2020 05:00:48 +0000 https://universityhealthnews.com/?p=16685 A stroke can have relatively minor consequences or be severely debilitating. So can a heart attack be mild or major?

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What is a “mild heart attack”? You may have heard the expression and wondered exactly what it means. A bone can have a hairline fracture or a major break. A stroke can have relatively minor consequences or be severely debilitating. So can a heart attack be mild or major?

The short answer is yes. What determines whether a heart attack is minor or major is the extent of damage to the heart muscle itself.

Keep in mind, however, that mild heart attack symptoms can resemble those of a more serious heart attack. That’s because heart attack causes refer to the blockage in one or more coronary arteries, no matter what kind of lasting consequences they leave behind. Heart attack is either complete blockage of a coronary artery, called ST-elevation myocardial infarction (STEMI), or partial blockage called non-ST elevation MI (NSTEMI). A person cannot tell the difference by symptoms, and the treatment is different: STEMI is treated with a stent, and NSTEMI treatment starts with anticoagulation and stent as a second line treatment.

But whether they’re mild, major, or somewhere in between, heart attack symptoms should be treated with emergency care.

NEW HYPERTENSION GUIDELINES

Does 140/90 still serve as the threshold for high blood pressure? New hypertension guidelines issued by the American College of Cardiology (ACC) and American Heart Association (AHA) call for a lower reading. Click here for our report.

What Causes a Heart Attack?

By definition, a heart attack is the result of blockage in an artery that supplies blood to the heart muscle. These blood vessels are called coronary arteries. You’ve probably heard the term “coronary artery disease,” or CAD. That just means that there’s plaque buildup in one or more of the heart’s arteries, and that it’s reducing or blocking blood flow in those arteries. The plaque is a waxy substance that includes LDL cholesterol, fats, and other waste products from your bloodstream.

The process of plaque building up in your arteries is called atherosclerosis. You may know it by a more familiar name: “hardening of the arteries.” This buildup takes place over many years.

There are some less-common heart attack causes, too. One of your coronary arteries could spasm and shut off blood flow to the heart muscle. Sometimes smoking or illicit drugs can result in coronary artery spasm. A spasm can occur in a coronary artery that isn’t affected by atherosclerosis.

Also unusual, but still possible, is a tear in the inner wall of a coronary artery; this is called a spontaneous coronary artery dissection. An artery has three walls or layers. When blood seeps through a tear in the inner layer, it can become trapped and bulge inward. As a result, blood flow through that artery becomes blocked.

Heart Attack Symptoms

The clinical name for a heart attack is a myocardial infarction. If one is in your future, of course you want it to be a mild heart attack. Symptoms for any type of heart attack, however, include the following signs:

mild heart attack symptoms — blocked artery

Pictured: a normal artery and (at right) one showing a blood clot. (Photo: © Guniita | Dreamstime.com)

  • Chest pain, in many cases pain that comes and goes. It may be centered in the chest or spread from one side to the other.
  • Shortness of breath.
  • Nausea, sometimes with vomiting.
  • Pain or tingling in one or both arms. Don’t be lulled into a false sense of security if the pain is only in your right arm. Arm discomfort due to a heart attack isn’t limited to the left side.
  • Jaw pain, neck pain, or back pain.
  • Breaking into a cold sweat.
  • Feeling unusually tired, sometimes for days.

Symptoms may last for a few minutes and then subside, only to return again. Symptoms that come and go should be taken seriously as clues that you may be having a heart attack. Many heart attack survivors describe chest discomfort as “pressure,” rather than “pain.” Don’t be thrown off if you don’t feel a sudden, sharp pain in the middle of your chest. It may feel as though something is squeezing your heart or that something is pressing on your chest.

Understand, too, that major or mild heart attack symptoms vary from person to person. So if the pain or pressure you’re feeling in your chest seems minor, don’t dismiss it as unimportant.

One study found that patients with mild heart attack symptoms (pain or discomfort that starts slowly and gradually worsens) take about eight hours to seek care, while those with sudden heart attack symptoms take less than three hours to seek care. The American Heart Association recommends receiving treatment within two hours to reduce death, regardless of symptoms.

People who have a greater tolerance for pain tend to ignore heart attack signs that feel tolerable. Don’t try to tough it out or worry that you’re inconveniencing people around you by revealing your symptoms.

You should also keep in mind that if you have already had one heart attack, the signs of a second event may be much different.

Anxiety as a Heart Attack Symptom

One other common heart attack symptom is anxiety, or a vague but undeniable feeling that something’s wrong.

Research shows that a heart attack causes victims to feel like they’re having a panic attack. But this is a dangerous assumption. Rather than get help immediately, some individuals having a heart attack want to chalk up their symptoms to indigestion or anxiety or feeling worn out from too much exertion.

In addition, if the pressure in your chest isn’t too uncomfortable and you’re just a little short of breath, you may think you’re having some mild heart attack symptoms. This could lead you to not take them seriously.

(Note: There can be gender differences that reveal heart trouble; there heart attack symptoms common in men, and heart attack symptoms common in women.) see our posts “Heart Attack Symptoms in Men: 5 Common Signs” and “Heart Attack Symptoms in Women.”)

What Is a Silent Heart Attack?

It’s true that some people have what are sometimes referred to as silent heart attacks. These result from temporary blockages in the coronary arteries. Sometimes they don’t even produce mild heart attack symptoms, but many times they do. Evidence of a silent heart attack may only appear much later when your doctor is examining your heart for other reasons.

Silent heart attacks usually cause the same symptoms as other heart attacks but they are milder and don’t last as long. Because they may never result in a visit to the ER, they remain silent.

But you can’t count on a heart attack to be temporary or to cause only minimal damage. So treat major or minor heart attack symptoms as an emergency. The faster you seek medical help for a heart attack, the less damage your heart will suffer. A disruption of blood flow to the heart is a problem, and there will be consequences.

If you have risk factors for a heart attack, including high LDL cholesterol, high blood pressure, smoking, obesity, diabetes, or a family history of heart disease, and you start to feel heart attack symptoms of any kind, call 911. Don’t try to drive yourself to a hospital. Your symptoms may become overwhelming, placing yourself and other motorists at risk on the road.

Make sure your loved ones know the symptoms of a heart attack and what to do if you or someone in your home starts to experience one. Sometimes fast treatment is what makes the difference between a heart attack being mild or major.


Originally published in 2016, this post is regularly updated.

SOURCES

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Heart Attack Symptoms You Need to Know https://universityhealthnews.com/topics/heart-health-topics/heart-attack-symptoms-you-need-to-know/ Mon, 15 Jun 2020 18:17:32 +0000 https://universityhealthnews.com/?p=132801 Many Americans aren’t as well informed about heart attack symptoms as they should be, according to a large 2019 study. This doesn’t bode well for the millions of people with heart attack risk factors, because time is of the essence when it comes to treating a heart attack. If you are unaware of the most […]

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Many Americans aren’t as well informed about heart attack symptoms as they should be, according to a large 2019 study. This doesn’t bode well for the millions of people with heart attack risk factors, because time is of the essence when it comes to treating a heart attack. If you are unaware of the most common symptoms, you may not respond promptly to a potentially serious health crisis—but Mount Sinai cardiologist Bruce Darrow, MD, PhD, emphasizes that you also need to keep in mind the fact that a heart attack may manifest differently in women and older adults.

Awareness Lacking The study (JAMA Network Open, Dec. 19, 2019) surveyed 25,271 people, assessing their awareness of five common heart attack symptoms: chest pain or discomfort; shortness of breath; pain or discomfort in the arms and/or shoulders; feeling weak, lightheaded or faint; and pain in the jaw, neck, or back. Researchers also assessed the participants’ response if they believed they might be having a heart attack.

The analysis showed that only about half of the study participants were aware of all five heart attack symptoms. More than 20 percent were unable to name the three most common signs (chest pain, shortness of breath, and pain in the arms and/or shoulders). About 6 percent were unaware of any single heart attack symptom, with men, African Americans and Hispanic Americans more likely to fall into this category.

Less Obvious Symptoms in Seniors and Women As an older adult, you’re at greater risk of a heart attack. So, it pays to be aware of the five heart attack symptoms included in the study—but Dr. Darrow says seniors also may experience other less obvious signs. “These include weakness, fatigue, dizziness, nausea and vomiting, and confusion,” he says. “Pain may not occur, and if it does, the discomfort may be felt more as heartburn or as a sense of pressure in the chest that waxes and wanes.” This may be why many seniors don’t immediately seek medical help when having a heart attack, according to research. In one 2017 study of 2,500 people who suffered a heart attack, 21 percent of the participants reported experiencing no chest pain, and 42 percent delayed going to the hospital for six or more hours. “Women also tend to experience atypical symptoms, including anxiety, a sense of impending doom, and cold sweats that can be mistaken for the hot flashes that can linger after menopause,” Dr. Darrow adds.

Early Warning Signs May Be Subtle While a heart attack is often perceived as something that happens suddenly, Dr. Darrow says that mild warning signs often occur for days, weeks, and even months before a heart attack strikes. Familiarize yourself with the symptoms highlighted here and you may be able to recognize them early enough to consult your doctor before a crisis. He or she can then get you started on a treatment plan that may prevent a heart attack from occurring in the first place.

Act Fast If you suspect you may be having a heart attack, call 911—don’t attempt to drive yourself to the hospital. “Calling an ambulance means you will receive treatment from emergency medical technicians who can assess any possible heart damage and notify the hospital ahead of your arrival there,” Dr. Darrow explains. “They also can perform cardiopulmonary resuscitation or use a defibrillator if your heart stops beating.”

Another vital measure if you think you’re having a heart attack is to chew an adult-strength aspirin. “Aspirin is known to prevent blood clots and may help keep an artery partially open,” Dr. Darrow says. “If you’re high-risk for a heart attack, keep some in your home and make sure everyone who lives there with you knows where to find it.” Aside from older age, factors that increase your risk of heart attack include a family history of heart attacks; high blood pressure, cholesterol and/or blood sugar; obesity; diabetes; and smoking.

In the study we reference, 1,130 people chose a different response to their symptoms than calling the emergency services, and these individuals included people who were aware of common heart attack symptoms. “It’s possible some of them misattributed their symptoms to other causes and self-treated them, or feared wasting their healthcare provider’s time if it turned out that their symptoms were non-serious,” Dr. Darrow observes. “The financial cost of diagnosis and treatment are also likely a factor. However, getting to the emergency department quickly gives you the best chance of receiving treatment to restore blood flow through your heart.”

Opening Up Coronary Arteries Heart attack treatment typically means a procedure called balloon angioplasty, which opens up coronary (heart) arteries that have been blocked by cholesterol deposits and restores blood flow to the heart muscle. “During angioplasty, a catheter is inserted into an artery in the wrist, arm, or groin, and threaded up to the blocked coronary artery,” Dr. Darrow explains. “Once the catheter is in position, a balloon at the tip is inflated to expand the artery and restore blood flow.” A tiny mesh tube called a stent may be positioned in the artery at the same time, to keep it open.

Missing out on this early treatment is associated with increased damage to the heart that can result in heart failure—a condition in which the heart is unable to effectively pump blood to your vital organs. “Previous research suggests that people who take two to four hours or longer from the onset of heart attack symptoms to get treated with angioplasty are less likely to have blood flow fully restored to their heart,” Dr. Darrow adds. “They also are more likely to die within three years than people who are treated more quickly after a heart attack.”   

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