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Did you know that chest pain is not the only sign of a heart attack? Dr. Jacqueline Tamis-Holland, Institute Director for Acute Coronary Care at Cleveland Clinic, describes other symptoms that may indicate you are having a heart attack and when to call for help.

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Early Signs of a Heart Attack

Podcast Transcript


Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Jacqueline Tamis-Holland, MD:

Hi, I'm Jacqueline Tamis-Holland. I'm an interventional cardiologist and I'm Institute Director for Acute Coronary Care at the Cleveland Clinic. So today I'm going to be talking to you about heart attacks and we call that acute myocardial infarction in physician clinician language. A heart attack is a situation in which the heart does not receive good blood flow, and it's usually because of a severe blockage or a clot that has developed in the artery of the heart that supplies blood flow to the heart muscle.

So, there are different types of heart attacks, and the two most common types are called STEMI, which stands for ST segment elevation infarction and non-STEMI, which stands for no ST-elevation myocardial infarction. STEMI heart attacks are the types of heart attacks that occur because of a clot that forms in the setting of a plaque that ruptured in the artery of the heart. And this type of heart attack is generally much more severe and can be much more devastating.

On the other hand, a non-STEMI can result in a relatively small heart attack, it's often a result of a tight blockage and some superimposed thrombus on top of that.

Both of these types of heart attacks are generally treated with medicines to take care of the blockage and medicines to prevent another heart attack. And usually, patients get procedures to fix the arteries when they have a heart attack.

Now, interestingly, when you have a heart attack, the size of the heart attack does not necessarily dictate somebody's symptoms. You can have a very severe heart attack and not necessarily have any worse symptoms than somebody who has a milder heart attack. So, you'll often get chest pain when you have a heart attack, and the chest pain can be anything from a pressure-like sensation, a squeezing like sensation or burning sensation. Oftentimes people don't even have what they call pain. It's more of a discomfort or an aching in the chest or in the upper abdomen. Sometimes people can have symptoms of shortness of breath along with chest discomfort, or they might even have sweating. Some patients might have back pain, jaw pain, shoulder pain. These are sometimes symptoms of a heart attack that patients don't often recognize.

Now, if it's a very severe heart attack, you may have symptoms of dizziness or sweat along with it because your blood pressure may be excessively low. But in general, patients with heart attacks, the majority of them will have some sort of chest discomfort, and other patients might have just symptoms of nausea or sweating or shortness of breath without any chest discomfort at all.

So sometimes patients don't always have chest discomfort, as I've already mentioned. They may have symptoms of just shortness of breath or just sweating, maybe some back pain. In general, we've noticed that patients who are older or sometimes female patients will have these atypical symptoms. And so, it's important to recognize that you don't always have to have chest discomfort if you're having a heart attack. Importantly, we want you to call 911 if you're having a heart attack and get immediate attention because the earlier you get attention, the better the outcome will be and the better we can treat you. However, sometimes people don't recognize that they're having a heart attack because they don't have those typical symptoms, and so it's important for you to be in tune with your body and get an idea of what's going on and how you're feeling.

A heart attack is an extremely serious condition, and so if something doesn't feel right with you, you probably do want to call 911. Certainly, if you have chest discomfort lasting more than 10 minutes, you should call 911. But if you also have symptoms of shortness of breath that you can't explain for any reason or profound sweats or nausea, that might be a sign of a heart attack, and it's always best to call 911 and be evaluated, then ignore it and find out too late that it was a heart attack.

So, on occasion, a heart attack is not a result of necessarily a severe blockage due to the buildup of plaque in the arteries. Sometimes a heart attack can occur because the inside of the artery tears and it causes blood to sort of leak into the lining of the artery and causes blockage of blood flow. That's called SCAD. Sometimes a heart attack occurs because the muscle around the lining of the artery will spasm or cramp. Just like you can get a cramp in the muscle in your leg, you can get a cramp in the muscle around the artery, and that's called coronary vasospasm. The doctors will look at the arteries and they seemingly look normal, but there could be spasm that temporarily obstructs blood flow. Sometimes there can be no blockages at all for other reasons. We call this condition MINOCA, which means myocardial infarction with no obstructive disease. And those types of heart attacks still require evaluation to understand what's going on and why somebody had a heart attack.

So, we always say in medicine, and I'm sure you've heard before, time is muscle. With every passing minute, part of the heart muscle dies as you're having a heart attack, and the outcome is worse as it takes longer to get treated and for the longer you have a heart attack, the outcome can become worse. So, you really want to call 911 or come to the hospital as soon as you recognize these symptoms, as soon as you feel these symptoms, to be sure that you get treated right away to have the best outcome.

In general, we recommend that you call 911 if you're having symptoms. And the reason for this is because patients can get seen by an ambulance and the doctors and the ambulance team can start treatment early on. They can also communicate with the hospitals and let the hospitals know they're coming, so the hospitals can be prepared ahead of time. And in some circumstances, sometimes people can have a cardiac arrest on the route to the hospital. So, you don't want to drive your own car to the hospital, you want to get through it through 911. So as soon as you notice you're having symptoms, or as soon as you feel symptoms of chest discomfort or shortness of breath, you don't want to wait long. And in general, calling 911 is preferred because it allows the ambulance staff to meet you in your own home, begin the evaluation process and assessment and start the treatments. They can also notify the hospital ahead of time that you are coming to the hospital so the hospital will be prepared.

So key points to remember, if you're having some sort of chest discomfort, and it doesn't have to be pain, if you're having severe shortness of breath or terrible sweats or nausea or vomiting, this could be a sign of a heart attack and you want to call 911 and get to the hospital quickly because time is muscle.


Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts or listen at clevelandclinic.org/loveyourheartpodcast.

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A Cleveland Clinic podcast to help you learn more about heart and vascular disease and conditions affecting your chest. We explore prevention, diagnostic tests, medical and surgical treatments, new innovations and more. 

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