We’ve all seen movies or television shows that depict someone having a heart attack. What we see is usually stereotypical — the person either suddenly collapses or clutches his chest, sweating and in pain.
Just how accurate are those symptoms and just what is a heart attack?
Dr. Melanie Patel, cardiologist, Heart and Vascular Center of Evangelical, explained that a heart attack is “essentially when the heart muscle isn’t getting enough oxygen.”
Usually it’s due to a blockage in the coronary arteries, she said. Common causes are the result of cholesterol plaque build-up, a blood clot, or — less often — there may be spasms in the heart’s arteries.
“Essentially, a heart attack means you’re not getting enough oxygen to the heart,” said Patel.
Dr. Adebola Ogunsakin, a Fellow in Cardiology at Geisinger, describes the heart as “a house,” and the arteries are like the plumbing.
“If you have a blockage in your plumbing system, you’ll have problems,” she said. “It’s the same way with the heart. Heart vessels that bring blood are like pipes — the heart is a pump, but your blood flows through those pipes to get into your heart.”
Therefore, anyone with issues with blockages is at risk for a heart attack.
Cardiac arrest or heart attack
In January, football fans saw Damar Hamlin, of the Buffalo Bills, collapse on the field following a play in which he took a hit from an opposing player. Hamlin got up, took a few steps and collapsed. It was later determined the 24 year-old professional athlete had suffered cardiac arrest. His heartbeat was restored on the field before he was transferred to the University of Cincinnati Medical Center. Prompt, expert medical attention saved his life.
Although cardiac arrest and heart attacks both affect the heart, they’re far from the same thing. If the heart is like a house and the arteries are the plumbing, said Ogunsakin, think of a cardiac arrest as a short circuit in the electrical system.
Defining the risk
Heart attacks can be caused by a variety of issues and can be the result of both lifestyle and genetics, or a mix of the two.
“We look at certain risk factors when we are talking about heart attack,” said Patel. “We look at age (there’s a higher risk as we age) and in addition to that, high blood pressure, cholesterol, and diabetes are all risk factors.”
Those with a history of family heart disease are also at a higher risk for heart attacks.
“Children can have a genetic component — if mom, dad or siblings have premature heart attacks then they’re at risk as well,” said Patel.
Dr. Renee Muchnik, Heart and Vascular Institute, UPMC in North Central Pa., pointed out that diabetics also have a much higher risk of having a heart attack.
“Both Type 1 and Type 2 diabetics are at risk of a heart attack,” said Muchnik. “They will often have more metabolic issues … hypertension and other co-morbidities.”
And, while the two vary vastly, Muchnik said a heart attack can sometimes lead to cardiac arrest.
As far as gender goes, Patel said men and women are equally at risk for a heart attack, although for different reasons and at different times in their lives.
“It’s a bit of a gender paradox,” she explained. “Men tend to suffer at younger ages while women end up having heart attacks as they get older. The loss of estrogen is a possible reason, so sometimes after they’ve been through menopause they’re at higher risk.”
Someone who’s had a heart attack is also at risk for having another, said Ogunsakin.
You can lower your chances of having a heart attack by paying attention to your lifestyle choices.
Clogging of the arteries happens slowly,” she explained. “If you think of your arteries as pipes, and you have gunk in those pipes, slowly, over time it starts to build up.” After a certain amount of time, there simply won’t be enough room for your blood to flow.
And if you’ve already had a heart attack, the chances of it happening in another vessel is high.
“As a heart doctor, I talk about risk factor modification — controlling high blood pressure, quitting smoking, watching high blood sugars. Those things, together with exercise and change in diet to modify those risks, will help,” said Ogunsakin.
To find out if you’re at risk, staying current with regular physical exams with your primary care doctors is a must. Your physician may decide to do a screening in terms of risk factors, chest pain or breathing difficulties. If abnormalities are found in your EKG, they’ll send you to a cardiologist.
Signs of a heart attack
The only way to know for sure if you’re having — or have had — a heart attack is to get yourself to a medical professional as quickly as possible. But there are signs and symptoms that could give you a heads up.
“The most common symptom for both men and women is chest pain or discomfort,” said Patel.
But there are other signs. Patel tells her patients to pay attention to their own bodies when doing any form of exercise.
Muchnik explained that symptoms can vary not just between men and women, but from person to person.
“Some people have mild symptoms and some are more severe and some people have no symptoms at all,” she said. “That’s called a silent heart attack.”
With a silent heart attack, Muchnik said diabetics are at a higher risk.
“Diabetic patients tend to have abnormalities in their pain receptors and so they often don’t feel those classic symptoms,” Muchnik explained.
Classic symptoms for men include, but are not limited to, chest pressure or a heaviness in the chest, shortness of breath with activities as simple as walking up a flight of stairs, and heart burn.
“When it comes to a heart attack, if you see a movie or show where someone has a heart attack, they’re clutching their chest, are having nausea and generally the person looks dreadful,” said Ogunsakin.
“Those are very much symptoms of a heart attack — feeling a pressure in the center of the chest that usually goes to the arm, neck, or jaw.”
These are “very significant, stops-you-in-your track kind of pain,” she said.
Women often have more atypical symptoms.
“Women can have chest pain and the sweats, but they can also have other symptoms that are not as clear such as unusual fatigue, shortness of breath, neck and jaw pain, back pain, and even flu-like symptoms,” said Ogunsakin. “With women, the symptoms don’t scream ‘heart attack,’ and unfortunately women aren’t diagnosed as quickly as men.”
Patel agreed and continued by explaining that women can experience brief sharp pains and sometimes symptoms can include sweating, nausea, and fatigue, but some women simply present saying they just feel unwell and it turns out they are presenting with symptoms for coronary disease.
Essentially, said Patel, if symptoms like these come on when you’re pushing yourself physically, but go away with rest, that’s a sign of heart disease.
What to do
If you think you might be experiencing a heart attack — or you are having heart attack-like symptoms — the first thing to do is call 911. If you’ve done that, call a family member, friend or neighbor to be with you while this is happening.
“Taking a baby aspirin is probably the best thing you can do immediately,” explained Patel.”That is a type of medicine that helps keep blood flow going to the heart’s arteries and is an anti-platelet that will help keep arteries open to allow oxygen to continue to your heart.”
What you don’t want to do is drive yourself to the hospital.
“Sometimes it can happen so fast you’ll lose consciousness,” said Muchnik. “In those cases, hopefully a bystander can start CPR and call 911.”
“If someone doesn’t receive treatment immediately, death can happen within minutes ,” she said.
Muchnik noted that between 70-90% of people who experience cardiac arrest outside of a hospital will die, so “it is very serious and important to address it in a timely manner because it happens so quickly.”
Referring back to Hamlin, Ogunsakin pointed out how quick action by medical professionals saved his life.
“I know the world was stunned by Hamlin,” she said. “If you see someone going down, talk to them, check the neck or groin for pulse, if you can’t feel a pulse you will need to start chest compressions — and they need to be very vigorous compressions so that you empty the heart volume, allow it to fill back up and then push again.”
How to avoid heart problems
A healthy lifestyle that includes plenty of exercise and a good diet is the best way to avoid a heart attack.
That means aerobic exercise that gets the heart pumping, said Muchnik.
“Know what’s normal for you and — as soon as you have symptoms — don’t ignore them as many people — especially women — do,” said Muchnik.