I personally always wanted to joke around with people by responding to the “Are you serious?” question with “As serious as a heart attack!” I now realize that it may have been for the best that I never got the chance to come across as an insensitive person. Nevertheless heart attacks really are serious and it is quite alarming that many people have few if any information when medical attention is needed. Heart attacks (or myocardial infarctions are caused by a sudden occlusion of the arteries supplying the heart muscle with blood. Heart muscle as opposed to skeletal muscle uses about 80% of the oxygen transported by red blood cells (skeletal muscle about 20-25%) and is therefore highly sensitive to oxygen deficiency. If left untreated, the ischemia can cause the death of myocardial muscle cells. And because myocardial infarction is the number one diagnosis in hospitalized patients in industrialized countries it should come as a necessity that the population be made aware of the warning signs.
This is by far the most common symptom of an infarction: and patients experience visceral, deep, pressing pain, described as heavy, squeezing, crushing or even burning located in the central chest region. The characteristics of the pain may vary but more often than not the pain radiates alongside the left arm up to the fourth and fifth finger or in the jaw.
Pain is not always present in patients with myocardial infarction and for this reason a sudden onset of breathlessness is considered a pain equivalent. This can be the only presenting symptom, where patients have an acute difficulty breathing that can even progress to pulmonary edema.
Pressure, heaviness or tightness in other areas
Not only the chest can be a warning sign: tightness in chest, neck, arms, jaw, back and/or shoulders can be a sign of concern because every patient is different and therefore presentation may vary.
Heart attacks can disrupt the normal electrical excitation and transmission within the heart and thus generate arrhythmias (which are an abnormal heart rhythm) such as atrial fibrillation or atrial flutter. This can be perceived by patients as palpitations or heart skipping beats.
The proper function of the brain is ensured by many factors, the most important being blood flow. In case of a heart attack this normal blood flow may be disrupted either by atrial fibrillation or flutter or just by the decreased pump function of the heart as myocardial muscle that is under oxygenated cannot contract correctly.
Sudden loss of consciousness
This can be in most cases the result of an arrhythmia with a high frequency like atrial fibrillation but in some cases where the infarcted area is large, serious complications may arise that can lead to cardiogenic shock. Simply put, papillary muscles can rupture (these are the muscles that connect to the heart valves and ensure their proper function) or even the ventricular septum may tear which leads to a sudden decrease in blood pressure and loss of consciousness.
Or heavy sweating is a symptom caused by the excessive firing of the sympathetic nervous system and is commonly associated with myocardial infarction.
This symptom is likely induced by cathecolamines (epinephrine, norepinephrine and dopamine) that are massively secreted during a heart attack and can go as far as right out vomiting.
Anxiousness, restlessness and an impending death sensation
As curious as this may seem it is recognized that many patients experiencing heart attacks have the fear that they will die soon and this is acknowledged by doctors and regarded as a symptom.
This is a symptom often present in women with myocardial infarction that together with sleep disturbances and difficulty breathing frequently precede the actual clinically manifest event by as much as a month.
So even if you yourself are a thriving 25-year-old with the certainty that this is not going to be likely to happen to you for at least 25 years to come, you still can find yourself in the proximity of someone who is experiencing symptoms of a life-threatening condition. And at least now you know when and why to call 911. And as a quick tip: if you or someone near you is having a heart attack, encourage them to cough (the increased pressure pumps blood through the body) and do not hesitate to perform CPR if needed.