Signs of a heart attack

introduction

The heart attack is probably one of the best known acute life-threatening conditions.

Almost everyone knows someone who has had a heart attack. Some people may have even seen a friend or stranger suffer a heart attack.

But what exactly are the signs, symptoms and harbingers of such a heart attack? How do I know that I, or someone else, is at risk of having a heart attack? And what is the difference between heart attacks in men and women?

The following section examines these questions in detail and provides an overview of the most important signs of a heart attack, which is also known as myocardial infarction.

General signs of a heart attack

A heart attack rarely comes suddenly. There are a number of important harbingers that can indicate an impending myocardial infarction. However, the longer you let time pass and the signs are incorrectly interpreted, the lower the chances of survival. The harbingers of a heart attack can be mistakenly associated with another ailment and therefore very often go unnoticed.

Such harbingers include, for example, nausea and dizziness or unspecific upper abdominal pain.

They can be weeks ahead of the heart attack. People who belong to the risk group for heart attacks, for example people with arterial occlusive disease, should therefore pay more attention to such symptoms. These harbingers are easy to confuse with a gastrointestinal infection.

You can find more information on the topic here: Risk factors for a heart attack

Another harbinger of myocardial infarction can be angina pectoris, the tightness of the chest.
This tightness in the chest can go away after a few minutes. A frequent occurrence can be a sign of an impending heart attack and should not be ignored.
Such frequent angina pectoris can be caused by stress or, for example, obesity, old age is also a risk factor.

What are the typical acute signs of myocardial infarction? Again, there are some differences and no general rule of thumb. In general, the image of the pale, sweaty patient who suffers from severe pain and fear dominates. However, the patient can also be asymptomatic. Complete cardiac arrest with loss of consciousness is also possible.

The strong pressure pain in the chest, which is accompanied by a feeling of tightness in the chest, is well known. However, a heart attack can only be noticeable by pulling in the left chest or not at all. The latter is known as "silent infarction".

The pain can lead to shortness of breath and shortness of breath. Those affected have the feeling, "someone would be sitting on her chest". As a result of the breathing difficulties, patients can panic and get cold sweats. If the symptoms persist, the affected person turns pale and begins to tremble as a result of the high exertion. It can cause nausea and the so-called Annihilation pain come. The annihilation pain is a very strong pain that is characterized by a feeling of fear of death and helplessness. This also occurs, for example, in pulmonary embolisms. The chest pain is localized just behind the sternum.
Also typical are pain in the right shoulder and a radiating pain in the left arm as a sign of a heart attack. About half of the patients complain of such pain. The pain can also radiate to the neck, upper abdomen and back. The lower jaw can also be affected.

Read more on the topic: Pain in the region of the heart

Left arm pain

A common sign of a heart attack are Pain felt in the left arm. In general, pain stimuli are conducted from the point of origin to the spine via certain nerves and transported to the brain via the spinal cord running there. From there they are perceived by us as pain. However, several pathways of pain occur at the same level in the spinal cord, so the location of origin cannot sometimes be precisely assigned. Since pain in the limbs is generally more common than in internal organs, pain in the heart is often felt as pain in the left arm.

Read more about this under: Pain in the left arm- What do I have?

Deaf arm

Also a numb arm can be a sign of a heart attack. This is due to the fact that the nerve pathways that are responsible for the perception of the arms and the heart take a similar route to the brain. There can be confusion with such severe illnesses as a heart attack.

However, a numb arm is not necessarily associated with a heart attack.

Back pain

Like pain in the left arm, back pain, especially in the upper back between the shoulder blades, can indicate a heart attack. This pain also arises from the fact that the pain paths from the back partly have the same course as the pain paths from the heart and for this reason cannot be differentiated in perception. You should try to rule out other causes of the back pain and, if a heart attack is suspected, pay particular attention to a sudden occurrence.

Also read more on the topic: Tension in the chest

High blood pressure

A heart attack limits the pumping function of the heart and less blood can be transported through the body. This causes the blood pressure to drop. In contrast is high blood pressure is usually not the result of a heart attack, rather more of a risk factor having a heart attack. Among other things, the blood vessels that supply the heart are damaged by high blood pressure and so-called coronary artery disease, which is colloquially understood as calcification of the heart vessels, can develop. This leads to deposits in the vessel wall. If these loosen, they can clog a vessel and cause a heart attack. The risk of such coronary artery disease increases very sharply at blood pressure values ​​of 130/85 mmHg.

heartburn

The most common and usually strongest sign of a heart attack is pain that can be felt in the chest. These pains are perceived in very different ways. For example, one can feel a feeling of tightness or pressure or a burning sensation. This burning sensation is often difficult to tell apart from heartburn. However, heartburn comes from a gastrointestinal cause. In contrast to the burning pain in the chest during a heart attack, which is usually felt suddenly and extremely intensely, heartburn usually occurs depending on meals, more often when lying down and in a weaker form.

to cough

Normally, the oxygen-poor blood flows from the small circulation of the lungs, in which it is supplied with oxygen, through the left part of the heart into the large body circulation and thus supplies all organs with oxygen. Due to the restricted pumping function of the heart during a heart attack, blood can build up in the lungs. This causes fluid to leak out of the vessels and collect in the lungs. So the Oxygen absorption through the lungs is made more difficult and coughing and shortness of breath can occur.

Signs of a silent heart attack

A silent heart attack, i.e. a heart attack without the typical accompanying pain symptoms, occurs particularly as one of the consequences of diabetes mellitus or in older people. This is due to the fact that in these patients the nerves in the heart that are responsible for the conduction of pain have lost their function through age or illness. Thus the pain perception is limited and the severe pain of the heart attack goes unnoticed. However, in these patients a heart attack is usually noticeable through the other signs, such as sudden shortness of breath. A rapid drop in blood pressure, weakness, confusion, or loss of consciousness can also be signs of a silent heart attack.

Read more on the subject at: Silent heart attack

How do the signs differ in men and women?

In general, there are different signs that both women and men can experience when having a heart attack. Above all, this is extremely severe chest pain, which often leads to fear of death. This pain is more often felt as a feeling of pressure or tightness in the chest in women than in men.
In addition, the pain can radiate into different regions, such as the arms, around the brook navel or in the back. In men, only the left arm is usually affected. With women partly also the rights. All of these signs are known as specific symptoms.

However, there are some signs that are more common in women. Above all, this includes pain in the upper abdomen and nausea, sometimes with vomiting. The pain is also more common in the neck and lower jaw. Women are also more likely to have difficulty breathing when they have heart attacks. These signs are called unspecific symptoms because they are less common with heart attacks than with other conditions. The danger here is that women often do not recognize these symptoms as such, but rather associate them with an upset stomach, for example. However, if these symptoms appear for the first time and suddenly, a heart attack, especially in women, should not be ruled out. Heart attacks in women can sometimes be announced weeks in advance with unclear symptoms. Sleep disturbances and a general state of exhaustion can be signs of an impending heart attack in women and elderly patients.

What are the signs in young people?

In general, the signs of a heart attack in young people are the same as in older people. However, there are a few Differences in perception of signs. With young people it is Pain perception even more intensethan with older people. You can feel more pain, which in older people is more weakly transmitted due to possible damage to the nerve pathways.
On the other hand, young people mostly still have a very good blood supply and heart pumping capacity. For this reason, they can better compensate for the occlusion of a vessel and thus poorer supply. The symptoms and signs of a heart attack occur through these compensation mechanisms only in the event of major damage to the heart that can no longer be balanced.

In summary, one can say that the signs of a heart attack appear later in young people, but then are usually very intense and usually there is already severe damage to the heart.

Also read: Cause of heart attack in young people

How do the signs of a heart attack differ from a stroke?

Both in the case of a heart attack and a stroke, there is a reduced blood flow to the respective organ. Since the supply of certain parts of the heart or the brain is interrupted, the cells there die and functional failures occur.

With a stroke, the blood supply in the brain is initially reduced and some functions can no longer be fully performed. As a result, signs of a stroke are mainly paralysis of the face on one side, speech disorders or difficulties in understanding spoken language. You may also experience a sudden severe headache, coordination problems, dizziness, blurred vision, confusion, or reduced awareness.

In contrast, the heart's pumping function is restricted in the event of a heart attack. The first signs of a heart attack are extremely severe pain in the chest region or the pain spreading to the arms, upper abdomen, back or lower jaw. Sometimes shortness of breath occurs because the restricted pumping function means that not enough blood can be pumped and therefore not enough oxygen can be transported through the body. You have the feeling that you are not getting enough air and you may feel dizzy.

Read more on the subject at: Stroke - What Are The Signs?

Clinical signs of the heart attack

Further signs of a myocardial infarction emerge during the physical examination by the doctor. There are often irregularities in the pulse caused by so-called extrasystoles. Extrasystoles are heartbeats that occur in addition to the normal heart rhythm. They can be harmless, but they can also be accompanied by a heart attack.

Other signs may indicate damage that has already occurred in connection with the heart attack. These findings include, for example, a pulse that is too fast and additional heart tones or heart murmurs. These indicate the onset of cardiac insufficiency.
Signs of this may include congestion of the neck veins and rattling noises over the lungs.

Mitral valve regurgitation (damage to the mitral valve), an inflammation of the pericardium, or a ruptured ventricle can be clinical signs of myocardial infarction.In addition, other damage that has already occurred, such as tachycardia, ventricular fibrillation or asystole, also indicates a heart attack.

You can see that the clinical signs are more than complex and diverse. Ultimately, technical findings provide certainty.

Technical findings

The most important method to gain certainty in the event of a suspected myocardial infarction is the electrocardiogram, or ECG for short, in which the excitation of the heart muscles is measured using electrodes. There are typical changes in the EKG that characterize a myocardial infarction.

After the acute stage, further circulatory disorders or chronic cardiac arrhythmias are revealed by means of stress ECG and long-term ECG.

Signs in the EKG

The EKG depicts the electrical excitation in the heart, which is, so to speak, the pacemaker for the beating of the heart. Depending on which cells are excited and thus activated, there are rashes in the EKG. The time in which all cells in the heart chambers are activated is shown in the ECG as a so-called ST segment visible. Since heart muscle cells die in a heart attack and can no longer be activated, a change occurs that is reflected in an ST segment elevation, i.e. a higher deflection of the line than usual in the ECG. This can be detected directly after the onset of the heart attack and, through the various points at which the electrical excitation on the body is measured, it can provide conclusions about the location of the heart attack.

A change in the QRS indicates tissue that has already died, that is, tissue that has already died as a result of insufficient blood flow. Such a change always remains visible as a so-called infarct scar.
In the acute stage of myocardial infarction, the ECG can also make accompanying complications such as cardiac arrhythmias or ventricular fibrillation visible.
However, in approx. 20% of the infarct patients no typical signs are visible in the EKG and the infarct must be detected by means of a blood sample.

Imaging procedures

If a heart attack is suspected, imaging procedures such as angiography or echocardiography also show signs of such. Tears in the chamber wall, incapacity of the mitral valve or even fluid in the pericardium (pericardial effusion) can be detected there. Angiography allows direct detection of occlusions and constrictions using a cardiac catheter.

Laboratory examination

Finally, signs of a myocardial infarction also emerge in a laboratory test. The following circumstance is made use of: dying heart muscle cells, which are typical of a myocardial infarction, release a so-called biomarker.
A biomarker can be an enzyme or another protein. These heart biomarkers include:

• Creatine kinase
• Troponin
• Myoglobin
• Lactate dehydrogenase
• Aspartate aminotransferase

The concentration of these markers in the blood is measured over a longer period of time. A very high concentration can be a sign of a heart attack occurring. In this way, conclusions can be drawn about the start, intensity and end of a heart attack, which can later become important for precise diagnosis and therapy.

Troponin test

Different proteins are present in the different cells of the body depending on their function. For example lies the protein troponin only in the heart muscle cells in front. During a heart attack, heart muscle cells die due to impaired blood flow. This removes the proteins from inside the cell, including troponin, free and are present in increased amounts in the blood. From two hours after the start of the heart attack is a increased levels of troponin in the blood verifiable. This is and can be sure proof of the diagnosis of the heart attack by means of a rapid test with blood drops or a blood test in the laboratory be detected.

Summary

As you can see, the signs of a heart attack are very different and often not as typical as you might think.
A distinction is made between the typical picture of the pale, sweaty and anxious patient, with pain in the chest and left arm, from the rather atypical picture. The atypical symptoms manifest themselves, for example, in abdominal pain and nausea, back pain and dizziness and thus occur more often in women and older people. It is also important that these atypical signs can often indicate a heart attack weeks in advance. Ultimately, clinical examinations provide precise information and make physical signs visible.