What A Heart Attack Feels Like with Leslie Cho, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

When you think of what a heart attack might feel like, most people imagine crushing pressure on their chest. It's a classic sign of the dangerous condition, but it's not what most people typically experience. Heart attack symptoms are usually far less subtle and can even be confused with minor health issues. So, what might indicate that you're having a heart attack? We're going to find out today from cardiologist Leslie Cho. Dr. Cho is one of the many experts at Cleveland Clinic who visit our podcast every week to share their medical wisdom. Now, let's learn the heart attack warning signs that deserve your attention. It's information that could be lifesaving for you or for someone you love. Welcome to the podcast, Dr. Cho. Thank you so much for joining us today.

Dr. Leslie Cho:

Thank you so much for having me.

John Horton:

Well, so today, we're talking about heart attacks, which is I guess a pretty scary medical situation that's even more terrifying when you realize how often it happens. I saw a statistic that noted a heart attack happens every 40 seconds in the United States. That's a pretty startling fact.

Dr. Leslie Cho:

Yeah, it is very scary, and I think knowledge is power. So today, we're going to be talking about some of the symptoms so people can understand what they are and then be proactive.

John Horton:

Well, you're exactly right. That's why we have you here. But before we get to the warning signs, let's kind of build a knowledge foundation for everyone listening, which is kind of a basic explanation as to what a heart attack is, what causes it and the possible outcomes.

Dr. Leslie Cho:

So, heart attack is when a coronary artery becomes completely blocked off, and usually, this happens when a soft plaque or a soft cholesterol plaque breaks off and then lodges in the coronary artery, and then you have all these sorts of clotting factors that are recruited, and the artery becomes completely closed. One of the things we've learned in the recent era is that opening up the artery as quickly as we can saves people's lives - people actually live longer - they have less heart attacks if we're able to go in there and quickly open it up. And so that's why it's so important for people to come to the emergency room, get medical attention as soon as they experience the symptoms because within the first two hours of having the chest pain and having a heart attack, if you can come into the emergency room, that dramatically improves your survival rate.

John Horton:

Well, and that's the thing we are talking about, survival rates, because heart attacks, I mean, can be very deadly, right?

Dr. Leslie Cho:

Absolutely. And the heart attack is for most people, they think that "Oh my gosh, if I have a heart attack, I'm going to die." But that's actually not true. In the modern era, people survive, but depending on how quickly you present to the hospital or to the medical personnel, your heart actually depends on how fast you get seen because time is muscle. One of the things that we always want to prevent is that we want you to never have a heart attack and control risk factors like blood pressure, cholesterol, diabetes, not smoking - those things dramatically decrease your risk of having a heart attack.

John Horton:

And clearly, nobody wants one. Now, as we talk about a heart attack and you think of it as such a serious thing, and it seems so massive, it's hard to believe that people have heart attacks, and it can be overlooked. So, what are those simple symptoms that can come with a heart attack?

Dr. Leslie Cho:

So, most patients, whether you are a man or a woman, they complain of chest pressure or chest tightness. Most people will say like 70 percent of people will say they feel like somebody's just sitting on their chest. It feels very oppressive. They feel like this sort of doomed feeling, something horrible is happening. Some people sweat, they get very sweaty, like this cold sweat. Some people will say they feel like they have pain radiating up to their left jaw or down their left arm. Other people complain of nausea. Some people are extremely nauseous. Some people become very, very short of breath. I've heard people describe it as a backache, like a very unusual but just very steady backache that just felt sort of relentless.

There are patients who have atypical symptoms, like women are more likely to have atypical symptoms. Sometimes, they have severe fatigue as one of their symptoms, but there are also people who don't have any symptoms, and those are diabetics. Diabetics have what we call silent ischemia. They're more likely to have silent ischemia. And so, it's very important to be attuned to our body and if there's something going on, we don't want you to be "Dr. Google," we want you to go to your physician or go to the emergency room and be seen. That's really important. Obviously, we don't want you to cry wolf every time you feel a chest pain, but what we're talking about is sort of this extreme feeling, this sort of extreme fatigue or shortness of breath or chest pressure, chest tightness, nausea.

John Horton:

Now, do you, a lot of people just kind of explain away those sorts of symptoms? I saw where it can feel very much like bad heartburn or acid reflux and people just go, "Oh, it was my taco at lunch," and they don't seek care.

Dr. Leslie Cho:

I mean, sometimes, I've heard patients talk about how they wanted it to be reflux, so it's like a form of denial. They knew something was wrong, but they felt like it was reflux or they hoped it was reflux so they tried to go to bed, but it wouldn't go away. So, their husband or their wife forced them to go to the emergency room and that's how they got seen. It's important to be sort of [have] self-aware of our bodies. Nobody knows our bodies better than ourselves. So, it's really important to listen to your body, but also denial is a real thing.

You want to wish it away. You don't want to have a heart attack, so you wish it away. I'm sure this is not heart attack symptom, but the great news - really, truly the great news is that in 2023, there is really good treatments for heart attack. You can have minimal muscle damage, minimal heart damage if you get seen right away. So, if there's one message, I want people to hear from this podcast is that if you feel like something's wrong, please get seen because time is muscle, and every minute truly counts in a heart attack.

John Horton:

So how can you really know that your ticker's in trouble? I mean, what are the big signs that say, "Man, I need to dial 911 now"?

Dr. Leslie Cho:

So, I mean, the most important symptom is chest pressure, chest heaviness. We call it chest pain, but it's really not pain. It's that severe pressure, that severe sort of feeling of doom and feeling like there's something wrong. If you feel that with diaphoresis, the sweating, with radiating down the left arm, if you are short of breath, that's a really classic sign you should get seen. You should really get seen. You should call 911. You should go to the emergency room. We're not talking about sharp little chest pains that come and go, that last seconds. That's not what we're talking about. We're talking about chest pressure, chest heaviness. We're also talking about significant shortness of breath, significant fatigue, that really significant nausea, not like, "Oh, I'm just a little nauseous," but significant nausea. And if you are not sure, that's OK. You're not a doctor. You don't have to be sure. You can go to urgent care. You can get seen. The important thing is not to be your own doctor.

John Horton:

And that is the key. And I think a lot of us, as you said, try to self-diagnose and like you said, you don't want it to be a heart attack. You almost want to wish it away.

Dr. Leslie Cho:

That's right. You want to wish it away because, I mean, the thing is, most people who are having a heart attack know because this is different than anything they've ever felt before. This is very different than something they felt before. It's pretty significant. They feel pain. I've had patients who are very stoic, and they are at home, but even those people, they get to a point where they're like, "You know what? Something's just not right. This just does not feel good or right." That's when you need to pull the trigger and go to the emergency room or call 911.

I think oftentimes, people feel they don't want to cry wolf. They don't want to go to the emergency room. Who wants to go to the emergency room? It's a horrible place to spend your Saturday or even any day. But the important thing is if you feel like something's wrong, if you feel that chest pressure, chest tightness, if you feel short of breath, if you feel significant nausea and it's getting worse, it's not getting any better and it's lasted for greater than 15 minutes, you need to pull the trigger.

John Horton:

Now also, I take it you should pay attention to your own medical history and your family history because there are people who have higher risk for this, right?

Dr. Leslie Cho:

Absolutely. I mean, people who have family history, we always say family history, but nobody really knows what that means. What that means is somebody in your family, like your mom or your dad had a heart attack before the age of 55 — if it was your father or before the age of 65 if it was your mother — and then if you had brothers or sisters, or if you had aunts and uncles who've had a disease. Now, grandparents also count, but your great uncle twice removed, doesn't count. Having high cholesterol in the family really doesn't count. What we are talking about when we say family history of premature coronary artery disease is people having heart attacks, people needing stents, people needing bypasses, people having stroke, people dying of sudden cardiac death before the age of 55 if you're a man or before the age of 65 if you're a woman.

John Horton:

Yeah, I definitely try to pay attention to family history. We've got some Slovenian blood and I think way too many kielbasas that have been served up over the years. So, you definitely got to look at that.

Dr. Leslie Cho:

I mean, the other sort of important risk factor is if you're diabetic, if you have high blood pressure, if you have had high cholesterol, I mean, those are important risk factors. Obviously, if you're a smoker, that's a bad thing. And then, there are patients who've had stents and bypasses before. They may never have had a heart attack, but they've had those procedures before and that's an important risk for having recurrent disease or recurrent events. So, it's really important to be attuned to our body.

John Horton:

Well, that's great advice, Dr. Cho. Before we wrap things up, is there anything that we missed or something you'd like to add regarding heart attacks and just overall heart health?

Dr. Leslie Cho:

I mean, the only thing I want to add is the wonderful thing about heart disease is that 90 percent is preventable. So, heart attacks are preventable, and even if you have the world's worst family history, you can prevent heart disease and heart attacks, and you do that by controlling blood pressure, controlling your cholesterol, not smoking, exercising, keeping your weight good in a good range and never smoking, obviously. And so, the good news — truly, the good news in 2023 is that heart disease is preventable. And the other good news is that even if you have a heart attack, if you get seen early enough, you can save heart muscle, you can lead a normal life, normal expectancy. So, I guess the biggest take home message is to be proactive, control your risk factors, and then if you have symptoms, heaven forbid, but if you do have symptoms, get seen early.

John Horton:

Dr. Cho, thank you very much. That is great advice. So, looking forward to having you back on.

Dr. Leslie Cho:

Thank you so much.

John Horton:

Heart attacks often don't present in dramatic fashion, but mild symptoms don't mean a situation isn't serious. Look for the warning signs shared by Dr. Cho. If you have even an inkling that you're having a heart attack, get checked out immediately. Until next time, be well.

Speaker 3:

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