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Worsening Chest Pains

Forum: The Heart Forum
Topic: Angina
 

From To Post
Jaz
10/12/2000
 		 . HI there,

For several years now I have been experiencing fast/skipped heart beats and occasional pain(every few weeks)which seem to come from the heart, lasting only a few seconds.

Three weeks ago I started to feel an aching\burning sensation in the left hand side of my chest. It usually starts in the morning and lasts the whole day, though it does fade a little during the evening. The pain lasts between a few minute to over an hour. It has got a little worse recently. It doesn't seem to get any worse when I walk or run, in fact that and eating seems to help the pain somewhat! I do also get a little light headed sometimes. I have been to seen my doctor and have had a 24 hour EKG doe which has shown nothing, also the hospital were unable to find anything wrong.


Q. How quickly can heart probelms manifest themselves?
 
CCF CARDIO MD - CRC
10/12/2000
 		 Jaz Dear Jaz,
In response to your question about how quickly heart problems can manifest themselves the answer is very rapidly. The onset of an MI or even sudden death can occur without warning. The real question is whether your symptoms are due to your heart or something else. There are many potential causes of chest pain. The one that doctors worry about the most is cardiac because it has the potential to be life-threatening. Once this is ruled out the work-up can proceed at a more leisurely pace.

Amongst the cardiac causes of chest pain are: ischemia (due to blockages - including both stable and unstable angina and acute heart attack and coronary artery spasm), pericarditis (inflammation of the sack around the heart), myocarditis (inflammation of the heart), cardiomyopathy (heart failure) and rarer causes such as coronary artery dissection, acute rupture of the heart and valves and infections of the pericardium.

Gastrointestinal causes of chest pain include reflux (acid from the stomach washing back into the esophagus), gallstones, esophageal spasm, esophageal rupture, varicose veins of the esophagus, strictures of the esophagus, tumors of the esophagus and other less common GI problems.

Pulmonary (lung) causes include pneumonia, pulmonary embolus, pneumothorax, pleuritis and bleb rupture.

Other potential causes are aortic dissection, back and spine problems and musculoskeletal (muscle strain, rib fracture, etc.).

Psychological causes of chest pain are common and include panic attacks, anxiety, stress and mental duress.

As you can see the list of potential causes in long and may take a little bit of time to determine the precise cause. A good Internal Medicine doctor should be able to work through the potential causes of your symptoms.

I hope you find this information useful. Information provided in the heart forum is for general purposes only. Only your physician can provide specific diagnoses and therapies.
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Heart Health Center

 
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Alcohol May Lower Heart Attack Risk

Moderate Drinking May Lower Risk for Men With High Blood Pressure
By Daniel J. DeNoon
WebMD Medical News
Reviewed by Louise Chang, MD
 

 

Jan. 2, 2007 -- A drink or two a day isn't bad for men with high blood pressure -- and may lower their risk of heart attack, according to new research.

The finding comes from a long-term study of nearly 12,000 male doctors, dentists, and pharmacists with high blood pressure.

Many doctors now warn men with high blood pressure not to drink alcohol, which is known to raise blood pressure.

That recommendation may have to change, say researchers Joline W.J. Beulens, MSc, of the University Medical Center in Utrecht, Netherlands, and colleagues.

Every four years from 1986 to 2002, the men in the Dutch study filled out questionnaires about alcohol use, diet, and health.

Men who drank moderately -- one or two drinks per day -- had a lower risk of heart attack. However, their risk of heart disease and death from any cause was no lower than that of men who did not drink.

"Men with hypertension who drink moderately and safely may not need to change their drinking habits," Beulens and colleagues conclude.

In an editorial accompanying the study, National Cancer Institute researcher Anne C.M. Thiebaut, PhD, and colleagues warn doctors and patients to take the findings with a grain of salt.

Thiebaut and colleagues note that self-report surveys -- particularly those on nutrition -- are notoriously prone to reporting errors. That is, people who actually consume very little of something often overreport their consumption. And those who actually consume a great deal of something often underreport.

This is particularly true of surveys on alcohol use.

"The uncertainties surrounding measurement error should send a strong message to those who formulate recommendations about nutrition," Thiebaut and colleagues suggest. "The discretion of silence may be preferable to the valor of setting recommendations."

The Beulens study and the Thiebaut editorial appear in the January issue of Annals of Internal Medicine.
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Heart Health Center

 
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Blood Test Predicts Heart Attack Risk

Protein Measurement Linked to Risk for Strokes, Heart Attack, and Heart Failure
By Salynn Boyles
WebMD Medical News
Reviewed by Louise Chang, MD
 

 

Jan. 9, 2007 -- A simple blood test may help doctors identify heart patients who are at high risk for having heart attacks, strokes, and heart failure.

The test, which measures blood levels of a protein called NT-proBNP, was found to be highly predictive of such cardiovascular events in a study involving almost 1,000 heart patients thought to have stable coronary heart disease.

Patients with the highest levels of the protein in their blood were eight times as likely as patients with the lowest levels to die or suffer a heart attack, stroke, or heart failure during the study. Even taking into account other risk factors such as sex, age, smoking, and cholesterol levels, there was still an increased rate of such problems.

Pinpointing Patients at Risk

NT-proBNP was found to independently predict cardiovascular risk, suggesting it can be a useful addition to tests already used in heart disease, like echocardiograms (a sonogram of the heart), stress tests, and other protein biomarkers.

The study is published in the Jan. 10 issue of The Journal of the American Medical Association.

"We have known that this marker was predictive, but the question has been, 'Does it really tell us anything that these other tests don't tell us?'" researcher Kirsten Bibbins-Domingo, MD, PhD, tells WebMD. "We found that it does, and the hope is that it can be used with these tests to help physicians pinpoint which patients have the highest risks."

The blood test is already used in hospital emergency departments to help ER doctors identify heart failure in patients who have shortness of breath and other symptoms of the disease. Heart failure occurs when the heart's ability to pump blood is weakened, which can result in a backup of fluid in the lungs and other areas.

Protein Levels vs. Heart Risk

It has not been clear if the test has value for predicting risk in asymptomatic heart patients thought to have stable heart disease.

In an effort to address this issue, Bibbins-Domingo and colleagues from the University of California, San Francisco and the San Francisco VA Medical Center assessed the association between plasma NT-proBNP levels and cardiovascular risk in 987 patients followed for an average of 3.7 years.

During this time, roughly a quarter of the patients either died or had a hospitalization from a nonfatal heart attack, stroke, or heart failure event.

The annual event rate among patients with the highest NT-proBNP levels at study entry was 19.6%, compared with just 2.6% among patients with the lowest levels.

There were four times as many heart attack cases reported among patients with the highest levels of the protein compared with those with the lowest, and four times as many strokes.

But the strongest association was seen for heart failure. Eighty cases of heart failure were reported among patients with the highest NT-proBNP levels, compared with just three cases among patients with the lowest levels.

"After adjusting for all other risk factors, it's clear that this marker is picking up something that we are otherwise unable to detect with standard tests such as echocardiography," says study researcher Mary Whooley, MD.

Value Unknown

While there is some suggestion that the test could prove useful for identifying heart risk in the general public, its most immediate use is for patients with established heart disease.

But even among these patients, its role in disease management is not yet clear, cardiologist Robert Bonow, MD, tells WebMD.

Bonow is chief of cardiology at Northwestern University Medical School and a former president of the American Heart Association.

"We aren't sure at this point what to do with this information once we have it," he says. "We can treat these patients [with elevated NT-proBNP] very aggressively, but we should be doing that anyway."

Bonow adds that while NT-proBNP may prove to be a useful test for asymptomatic patients with heart disease, "we don't really know this yet."

In an editorial accompanying the study, Marvin Konstam, MD, of Tufts University School of Medicine agreed that it remains to be seen if NT-proBNP will prove useful for the management of patients with heart disease.

Konstam tells WebMD that more study is needed to determine the value of such testing.

"The real home run will be when we identify a marker and an intervention to go along with it to lower risk," he says. "The best example of this is LDL, or bad, cholesterol. We not only know that LDL cholesterol is a predictor of heart risk, but we know that we can lower that risk with drugs."
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Heart Health Center

 
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Test IDs Risk of Sudden Cardiac Death

Computer Technology Reveals Patients Who Can Benefit From Implanted Heart Defibrillators
By Salynn Boyles
WebMD Medical News
Reviewed by Louise Chang, MD
 

 

Jan. 5, 2007 -- As many as one-third of heart patients who get implanted heart defibrillators -- like the one Vice President Dick Cheney has -- might not benefit from them; a simple heart-rhythm test may help identify these patients, new research suggests.

The noninvasive test uses computer technology to gauge a person's risk for sudden cardiac death.

Researchers from the University of Michigan Cardiovascular Center, the VA Ann Arbor Healthcare System, and the Ohio Heart and Vascular Center in Cincinnati found that patients who performed well on the test had the same low risk of death whether they had implanted defibrillators or not.

Saving Health Care Costs

If the findings are confirmed, the test could save hundreds of millions of dollars annually in health care costs in the U.S. alone, researchers say.

But a heart specialist who spoke to WebMD says many important questions remain unanswered.

"Over the last 10 years or so we have evaluated a lot of tests and a lot of tests have failed," says Virginia Commonwealth University professor of cardiology Kenneth Ellenbogen, MD. "[The tests] looked promising in smaller studies, but in larger studies they missed a lot of patients who had cardiac arrest."

Sudden cardiac death due to electrical problems of the heart accounts for roughly 300,000 deaths a year in the U.S. People with certain heart conditions are at greater risk.

Sudden cardiac death is due to electrical problems in the heart; it is not a heart attackheart attack. Such conditions can include cardiomyopathycardiomyopathy (heart muscle disease) due to past heart attack, among other things.

How Implanted Defibrillators Work

Implanted cardioverter defibrillators (ICDs) are often recommended for these high-risk patients as a preventive measure. Like pacemakerspacemakers, ICDs are surgically implanted. But while pacemakers deliver mild, continuous electrical impulses to maintain a suitable heart rate and rhythm, defibrillators can deliver a bigger shock of electricity when they detect an abnormal heart rhythm that can lead to sudden cardiac arrest.

The devices work so well that the U.S. government recently expanded coverage for high-risk patients. It is now estimated that 50,000 MedicareMedicare recipients qualify for them annually, at a lifetime cost of roughly $90,000 per recipient.

The problem has been that the strategies for determining who will benefit from ICDs have been inadequate, University of Michigan researcher Paul S. Chan, MD, tells WebMD.

"There is no doubt that these devices are extremely effective for the right patient, but they are also very expensive and not everyone benefits," he says.

The MTWA Test

In their study involving 768 heart patients considered candidates for ICDs based on conventional testing, Chan and colleagues evaluated the usefulness of a test called microvolt T-wave alternans (MTWA) for predicting who would benefit from the device.

All of the patients had survived heart attacks and had permanent damage to the heart muscle as a result.

Roughly two-thirds had either positive or inconclusive MTWA test results. During up to three years of follow-up, these patients were 70% less likely to die from an abnormal heart rhythm if they had ICDs.

In the remaining one-third of patients with negative MTWA tests, no significant reduction in cardiac arrest-related deaths was seen among patients with the implanted defibrillators.

The study is published in the Jan. 2/9 issue of the Journal of the American College of Cardiology.

Less Impressive Findings

Ellenbogen acknowledges that the latest MTWA findings are impressive. But he points out that in another recent study the test did not perform as well.

In that trial, reported last November at the annual meeting of the American Heart Association (AHA), MTWA testing was compared with a more invasive and expensive screening method.

The best results were obtained when the two tests were used together.

"That study definitely did not show [MTWA] to be as useful as a single measure of risk as this trial did," says Ellenbogen, a spokesman for the AHA
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Lifestyle Vital to New Heart Diet

Learn about the benefits of leading a healthy lifestyle.
By Daniel J. DeNoon
WebMD Medical News
Reviewed by Robert J Bryg, MD
 

 

June 19, 2006 --The key to a healthy heart is lifestyle, not a strict diet, according to new guidelines from the American Heart Association.

About every five years the AHA updates its diet advice. This year, for the first time, the guidelines emphasize lifestyle as much as diet.

Tufts University researcher Alice Lichtenstein, DSc, chairs the AHA nutritionnutrition committee that wrote the new recommendations.

"We wanted to present recommendations that would be easily adopted by the general public," Lichtenstein tells WebMD. "There is a de-emphasis on numbers, and more on answering basic questions: What can I do? How do I do it? How do I make changes right now?"

The new guidelines don't lay down the law about how much to eat, what to eat, and when to eat. They instead focus on healthy diet and lifestyle patterns. And they offer practical ways for real people to make lifesaving changes, says WebMD's director of nutrition, Kathleen M. Zelman, MPH, RD.

"Eighty percent of heart diseaseheart disease is preventable with healthy lifestyle: good food, fitness, and normal weight," Zelman says. "Dietary patterns are what it's all about. The AHA says, 'This is the gold standard.' But you don't have to get there overnight. It is not about perfection -- it is about making progress toward the healthier lifestyle. And the payoff is huge."

The guidelines appear in the July 4 issue of the AHA journal Circulation.

In Balance: Food and Activity

Lichtenstein says it's all about balancing the food one takes in with the energy one puts out.

"If you have the best diet, but get no physical activity or if you smoke, it is going to impact your heart health," she says. "When one makes decisions about food choices and activity patterns, it is important to make sure they are balanced."

In a nutshell, the AHA says you can avoid heart diseaseheart disease if you:

  • Eat a healthy overall diet.
  • Balance calories consumed with calories burned.
  • Get at least 30 minutes of physical activity each day.
  • Eat lots of fruits and vegetables.
  • Choose whole-grain, high-fiber foods.
  • Eat fish -- especially oily fish such as salmon -- at least twice a week.
  • As much as you can, avoid saturated fats and trans fats.
  • Cut back on cholesterol by choosing lean meats and fat-free or low-fat dairy foods.
  • Cut back on beverages and foods with added sugars.
  • Cut back on salt added to food -- especially if you're middle aged or older, African-American, or have high blood pressurehigh blood pressure.
  • If you drink alcohol, drink in moderation.
  • Make healthy choices when dining in restaurants.

Don't let this list overwhelm you, Lichtenstein and Zelman say. The idea isn't to burn out after two weeks of strenuous effort, but to gradually adopt healthy habits for the rest of your life.

"We're talking about making small, incremental, permanent changes in your habits," Lichtenstein says. "This is the only way to make enough of a change, for a long enough time, to accrue benefits."
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Eat Your Veggies, Help Your Arteries

Vegetable-Rich Diet Tied to Less Artery-Clogging Plaque
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD
 

 

June 19, 2006 -- Scientists are serving up yet another reason to put vegetables on your plate: It might discourage plaque from accumulating in your arteries.

So says Michael Adams, DVM. He's a professor in Wake Forest University's pathology/comparative medicine department in Winston-Salem, N.C.

Adams and colleagues recently studied nearly 100 young male mice at high genetic risk for artery-clogging plaque. For four months, the researchers fed half of the mice a vegetable-free diet.

The other mice got the same number of calories, but 30% of those calories came from equal parts of freeze-dried corn, carrots, green beans, broccoli, and peas. Adams' team chose those vegetables because they're five of the most common vegetables in the U.S. diet, not counting potatoes.

Why not include potatoes? Because in the U.S., they're typically served drenched in fat from frying, the scientists note in The Journal of Nutrition's July issue.

Less Plaque

After four months, the scientists checked the mice's arteries. They found 38% less plaque in the arteries of mice that had eaten the vegetable-rich diet, compared with mice that had eaten no vegetables.

Mice fed the vegetable-rich diet also had modestly better cholesterol levels -- including a slight drop in LDL ("bad") cholesterol -- and had gained 7% less weight.

How do vegetables help tame plaque? That's still uncertain, write Adams and colleagues.

Adams' team checked the data to look for clues. They concluded that the differences in weight and cholesterol between the two groups of mice didn't totally account for the plaque gap.

But the researchers found another clue related to inflammation, which is associated with hardening of the arteries (atherosclerosis). Adams and colleagues found lower levels of an inflammatory marker in blood from the mice on the vegetable-rich diet, compared with those lacking vegetables.

The study was funded by the General Mills Company, which supplied the vegetables.

SOURCES: Adams, M. The Journal of Nutrition, July 2006; vol 136: pp 1886-1889. News release, Wake Forest University Baptist Medical Center.
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The content below was selected by the WebMD Editorial staff and is solely under WebMD's editorial control.
 
 

Diabetes Medications & Diet: Synergistic Success

Reviewed By Brunilda Nazario, MD
By Jeanie Lerche Davis
WebMD Feature
 

 

It's a tricky balancing act using diabetes medications to keep blood sugar at just the right level.

You're coasting along, trying to "eat right," when suddenly you're confronted with a crisis -- sharing a very large pizza. It's so difficult turning away from pizza -- yet you face the inevitable blood sugar spike, with your diabetes drugs faltering under the carb load. If you're taking insulin, the mealtime dosage will need lots of attention.

There's also the weight gain issue: Too many calories pack on the pounds, which worsens blood sugar control.

It's serious business, keeping blood sugar and diabetes under control. There are too many health complications at stake to take it lightly. Over time, those blood sugar spikes take a toll on all your major organs and nerves throughout your body. It's nothing to take lightly. But good blood sugar control can prevent the worst complications of diabetes.

In recent years, new drugs that treat diabetes and various types of insulin have helped improve the management of diabetes and greatly improve blood sugar control. Some medication used to treat diabetes help drop weight and reduce blood cholesterol levels. But they can't do the work alone, diabetes experts say.

Lifestyle changes are essential -- a healthy diet, regular exercise, and weight loss -- in letting diabetes medications do their job, says David Nathan, MD, chief of the Diabetes Center at Massachusetts General Hospital and a professor of medicine at Harvard Medical School.

"If you have type 2 diabetes, your pancreas is still trying to release insulin," Nathan explains. "But if you have a rapid rise in blood sugar, it just can't keep up with the demand. With diabetes medicines, it's the same thing. They will work better if you don't challenge the pancreas -- if you don't have spikes in blood sugar."

Bottom line:

  • You've got to watch your diet.
  • Exercise regularly and maintain a normal weight.
  • Test blood sugar often as recommended by your doctor.
  • Follow your doctor's instructions when taking your diabetes medications.

There's no getting around it, if you want to live a good, long life.

Diabetes Diet Avoids Blood Sugar Spikes

A number of factors influence blood sugar levels after meals, but carbohydrates have the biggest impact, so carb counting is essential. You must learn to make wise food choices that won't cause blood sugar spikes -- yet indulge in an occasional pizza slice.

A dietitian or diabetes educator can help you line up a game plan for meals, says Roberta Anding, RD, a diabetes educator at Texas Children's Hospital in Houston. She is also a spokesperson for the American Dietetic Association.

After all, not all carbs are created equal. "A scoop of white rice is different from a scoop of brown rice," Anding tells WebMD. "The calories may be the same, but they act differently when digested."

Processed "white foods" -- white bread, white rice, cakes and cookies (made with white flour) -- are digested quickly, which causes sharp spikes in blood sugar. Even an apple -- highly nutritious and high in fiber in its natural form -- is done a disservice in processing. When an apple is made into applesauce or apple juice, it loses its fiber content.

"You see remarkable differences in the effect on blood sugar levels," Nathan explains. "The more processed the fruit, the faster the glucose level goes up -- and the higher it goes up. Getting more high-fiber carbohydrates in your diet will naturally slow the absorption rate, and will help the pancreas keep up with the insulin demand."

What are high-fiber carbohydrates? Everything your mother ever advised: vegetables, fruits, whole-grain breads, and cereals. Every colorful fruit and vegetable in your grocery's produce section -- broccoli, spinach, red bell peppers, fruits and berries of all types. Oatmeal is another great source of fiber!

Weight Gain vs. Diabetes Drugs

Weight gain poses its own problems for people with diabetes. The fight against weight gain has always been tough, as many older diabetes drugs may cause weight gain -- which further interferes with blood sugar control.

"The heavier you get, the more you're fighting a losing battle," Nathan tells WebMD. "If you're gaining weight, diabetes medications won't work as well, so you need more of the medicines -- which only makes your weight go up more."

Newer drugs like Byetta and Symlin have made weight control a bit easier. Both drugs stimulate the body's natural insulin-producing capability, plus patients may experience a decrease in appetite leading to weight loss.

Diabetes specialists typically prescribe these newer diabetes medications in combination with older diabetes drugs to get optimal blood sugar control. "It helps minimize the difficulties of dieting. ... People can restrict calories, exercise more, have more positive results in losing weight," says Anne Peters, MD, director of the clinical diabetes programs at the University of Southern California and author of the book Conquering Diabetes.

Lose the Weight, Take Less Diabetes Medication

Lifestyle is key to keeping weight off -- and to controlling diabetes in the long run. "There's no way around it, and it's hard work, but you have to address it. You don't have to get skinny, but you do have to lose weight," says Anding.

In fact, research shows that losing just 10% to 15% of body weight -- dropping 20 or 30 pounds, if you weigh 200 -- can have a marked improvement on diabetes control.

These lifestyle changes help preserve the body's insulin-producing function, explains Hermes Florez, MD, director of the Diabetes Prevention Program at the University of Miami Miller School of Medicine. "With weight loss, patients are able to nearly get off insulin. Some patients are able to come off insulin completely."

An NIH-funded clinical trial, the Diabetes Prevention Program, helped show the positive effects of healthy lifestyle changes. A significant number of patients in the study were able to reduce their diabetes risk with a healthy diet and regular exercise like brisk walking -- about 150 minutes a week.

In the early stages of diabetes, weight loss can also help reduce the dosage of diabetes medications you're taking, Peters tells WebMD. "I can't guarantee you will get completely off pills if you lose weight. But it's likely you will need less medicine. It depends on where you are in the disease process, because diabetes gets worse over the years."

Diabetes Diet and Insulin: Better Mealtime Control

Sticking with your diabetes diet makes it easier to calculate mealtime insulin. With new forms of insulin -- including small "pens" to give injections -- even taking your insulin is hassle-free. If you're out with friends, no one needs to know you're doing it.

Today's rapid-acting insulin can be given with a meal or immediately afterward. "You need to make sure you eat within 10 minutes of taking insulin. These insulins act very quickly, so if you don't eat right away you'll have a low blood sugar reaction. The insulin will start working before food is absorbed," Nathan explains.

Insulin pens are nothing like the needles and insulin vials used in the past. The pens are small, and operate like fountain pens with cartridges -- an easy way to give yourself an injection to keep blood sugar under control. For people who simply won't or cannot use needles, inhaled insulin has been shown to work just as well as injections.

Insulin pumps are another advance -- delivering a constant, computerized trickle of rapid-acting insulin into your bloodstream. At mealtime, you calculate the extra insulin dose you need to match carbs in the meal.

"A patient with an insulin pump often ends up needing less insulin overall," Peters tells WebMD. "It allows us to fine-tune insulin doses, so there's more flexibility and success in general. But to do it right, the patient needs a dietitian and diabetes educator. It takes a lot of education."

Diabetes Diet and Exercise Basics

Be sure to tell your doctor if you're starting a diet and exercise plan. "We can adjust insulin doses for your exercise," Peters tells WebMD. "Let's say you get an insulin shot before breakfast, but you're going to start exercising after breakfast. I might have you take half the dose before breakfast, so you're not too low while you exercise."

The mantra from diabetes experts:

Eat healthy: Get plenty of vegetables, fruits, whole grains, lean protein, and low-fat dairy.

Focus on fiber: Eat "real food," not processed food. Spinach, broccoli, and other colorful veggies should be staples. Feast on berries -- they're highly nutritious, high-fiber, and won't really affect your blood sugar despite their sweetness. Choose brown rice, whole-wheat tortillas, whole-grain bread, oatmeal. If you buy canned fruits or veggies, read labels closely to make sure there's no added sodium or sugar.

Curb the sweets: Ice cream, cookies, candy, and cake should be special-occasion treats only. They contain too much fat, sugar and calories. If you indulge, make sure you keep track in your total carb count.

Watch portions: Your meal plan is your guide. Excess calories only cause trouble -- blood sugar spikes and weight gain. Stop eating so much!

Exercise: Get your feet checked by a doctor, to ensure that you don't have injuries or signs of infection. People with diabetes are prone to foot problems caused by nerve damage, which can become very serious. Then get walking -- 20 to 40 minutes a day. Walk briskly to get maximum benefit!

Published April 27, 2007.

SOURCES: David Nathan, MD, chief of the Diabetes Center at Massachusetts General Hospital and a professor of medicine at Harvard Medical School. Anne Peters, MD, director of the clinical diabetes programs at the University of Southern California. Roberta Anding, RD, a diabetes educator at Texas Children's Hospital in Houston. Hermes Florez, MD, director of the Diabetes Prevention Program at the University of Miami Miller School of Medicine. WebMD Medical Reference provided in collaboration with Cleveland Clinic: "Diabetes: Healthy Diet Basics," "Diabetes: The Insulin Pump," and "Managing Your Diabetes." WebMD Feature: "Diabetic Diet: 6 Foods That May Help Control Blood Sugar." WebMD Medical Reference from MedicineNet: "What Is Diabetes" and "Diabetes Treatment." WebMD Medical News: "Inhaled Insulin Effective for Diabetes."

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Heart Disease Health Center

 
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Heart Attack and Unstable Angina - Overview

 

 

What is a heart attack?

A heart attack occurs when blood flow to the heart is blocked. Without blood and the oxygen it carries, part of the heart starts to die. A heart attack doesn't have to be deadly. Quick treatment can restore blood flow to the heart and save your life.

Your doctor might call a heart attack a myocardial infarction, or MI.

What is angina, and why is unstable angina a concern?

Angina (say “ANN-juh-nuh” or “ann-JY-nuh”) is a type of chest pain or discomfort that occurs when there is not enough blood flow to the heart. Angina can be dangerous, so it is important to pay attention to chest pain, know what is typical for you, learn how to control it, and understand when you need to get treatment.

There are two types of angina:

  • Stable angina is chest pain that has a typical pattern. It happens when your heart is working harder and needs more oxygen, such as during exercise. The pain goes away when you rest.
  • Unstable angina is chest pain that is unexpected, and resting or taking nitroglycerin may not help. Your doctor will probably diagnose unstable angina if you are having chest pain for the first time or if your pain is getting worse, lasting longer, or happening more often.

Unstable angina is a warning sign that a heart attack may happen soon, so it requires treatment right away. But if you have any type of chest pain, see your doctor.

What causes a heart attack?

Heart attacks happen when blood flow to the heart is blocked. This usually occurs because fatty deposits called plaque have built up inside the coronary arteries, which supply blood to the heart. If a plaque breaks open, the body tries to fix it by forming a clot around it. The clot can block the artery, preventing the flow of blood and oxygen to the heart. See a picture of how plaque causes a heart attack.

This process of plaque buildup in the coronary arteries is called coronary artery disease, or CAD. In many people, plaque begins to form in childhood and gradually builds up over a lifetime. Plaque deposits may limit blood flow to the heart and cause angina. But too often, a heart attack is the first sign of CAD.

Things like intense exercise, sudden strong emotion, or illegal drug use can trigger a heart attack. But in many cases, there is no clear reason why heart attacks occur when they do.

What are the symptoms?

The most common symptom of a heart attack is severe chest pain.

  • Many people describe the pain as discomfort, pressure, squeezing, or heaviness in the chest.
  • People often put their fist to their chest when they describe the pain.
  • The pain may spread down the left shoulder and arm and to other areas, such as the back, jaw, neck, or right arm.

Many people also have at least one other symptom, such as:

  • Pain in the upper belly, often mistaken for heartburn.
  • Sweating.
  • Nausea and vomiting.
  • Trouble breathing.
  • A feeling that their heart is racing or pounding (palpitations).
  • Feeling weak or very tired.
  • Feeling dizzy or fainting.

Not everyone has the classic symptom of severe chest pain during a heart attack. Women, older adults, and people with diabetes are less likely to have severe chest pain and more likely to have shortness of breath, dizziness, weakness or fainting, and belly pain.

What should you do if you think you are having a heart attack?

If you have symptoms of a heart attack, act fast. Each year, 4 out of 10 people who have a heart attack die, many of them before they reach the hospital.1 Quick treatment could save your life.

If you are having chest pain and your doctor has prescribed nitroglycerin for angina:

  1. Take 1 dose of nitroglycerin and wait 5 minutes.
  2. If the chest pain doesn't improve or it gets worse, call 911 or other emergency services. Describe your symptoms, and say that you could be having a heart attack.
  3. Stay on the phone. The emergency operator will tell you what to do.

If you are having chest pain and you do not have nitroglycerin:

  1. Call 911 or other emergency services now. Describe your symptoms, and say that you could be having a heart attack.
  2. Stay on the phone. The emergency operator will tell you what to do
  3. After calling for help, chew 1 regular-strength aspirin. Aspirin helps keep blood from clotting, so it may help you survive a heart attack.

The best choice is to go to the hospital in an ambulance. The paramedics can begin lifesaving treatments even before you arrive at the hospital. If you cannot reach emergency services, have someone drive you to the hospital right away. Do not drive yourself unless you have absolutely no other choice.

If you think you are having unstable angina but you are not sure, follow the steps listed above. Unstable angina can lead to a heart attack or death, so you need to have it checked right away.

How is a heart attack treated?

If you go to the hospital in an ambulance, treatment will be started right away to restore blood flow and limit damage to the heart. You may be given medicines, including:

  • Aspirin (if you have not already taken some) and other medicines to prevent blood clots.
  • Medicines that break up blood clots (thrombolytics). To work, these must be given within a few hours of the start of the heart attack.
  • Medicines to decrease the heart's workload, ease pain, and prevent abnormal heart rhythms, which can be life-threatening.

At the hospital, you will have tests, such as:

  • Electrocardiogram (EKG or ECG). An EKG can detect signs of poor blood flow, heart muscle damage, abnormal heartbeats, and other heart problems.
  • Blood tests, including tests to see whether cardiac enzymes are high. Having these enzymes in the blood is usually a sign that the heart has been damaged.

If these tests show that you may be having or have had a heart attack, you may have a cardiac catheterization. For this test, the doctor puts a thin, flexible tube (called a catheter) through an artery in the groin or arm and carefully guides it into the heart. (See a picture of catheter placement.) A dye is injected that makes the coronary arteries show up on a computer screen. The doctor then can see if the coronary arteries are blocked and how your heart is working.

If cardiac catheterization shows that an artery is blocked, the doctor can do angioplasty right away. The doctor guides the catheter into the narrowed artery, and a small balloon at the end of it is inflated. This widens the artery to help restore blood flow. Often a small wire-mesh tube called a stent is placed to keep the artery open. See a picture of angioplasty with stent placement.

Angioplasty, with or without a stent, is the preferred treatment for a heart attack. But if angioplasty is not available or cannot be done for some reason, “clot-busting” thrombolytic medicines may be used. Or the doctor may do emergency bypass surgery to redirect blood around the blocked artery.

After these treatments, medicines are given to prevent clots, reduce the heart’s workload, and lower cholesterol. These can help prevent another heart attack and heart failure. Most people who have had a heart attack take these and sometimes other medicines for the rest of their lives.

Once you have had a heart attack, the chance that you will have another one is higher. Taking part in a cardiac rehab program helps lower this risk. A cardiac rehab program is designed for you and supervised by doctors and other specialists. It can help you learn how to eat a balanced diet and exercise safely to reduce your risk of more heart problems.

It is common to feel worried and afraid after a heart attack. But if you are feeling very sad or hopeless, ask your doctor about treatment. Getting treatment for depression may help you recover from a heart attack.

Can you prevent a heart attack?

Heart attacks are usually the result of heart disease, so taking steps to delay or reverse coronary artery disease can help prevent a heart attack. Since heart disease is the number one killer of both men and women in the United States, these steps are important for everyone.

To improve your heart health:

  • Don't smoke. Quitting smoking can quickly reduce the risk of another heart attack or death.
  • Eat a heart-healthy diet that includes plenty of fish, fruits, vegetables, beans, high-fiber grains and breads, and olive oil.
  • Get regular exercise-3 to 5 times a week is best. Your doctor can suggest a safe level of exercise for you.
  • Control your cholesterol and blood pressure. If you have diabetes, keep your blood sugar in your target range.
  • Lower your stress level. Stress can damage your heart.
  • Take a daily aspirin if your doctor advises it.
More information

For more information about heart disease, see the topic Coronary Artery Disease.
9 

Heart Disease Health Center

 
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Heart Attack and Unstable Angina - Symptoms

 

 

The most common symptom of a heart attack is severe chest pain, although this sensation is not always present. In a recent review of 700 people treated for heart attack, 47% came to the emergency room because they had symptoms other than chest pain, including shortness of breath, dizziness, weakness or fainting, and abdominal pain.2Women, older adults, and people with diabetes are less likely to have chest pain during a heart attack and more likely to have other symptoms.

It is possible to have a "silent heart attack" without any symptoms, but this is rare. Most people have chest pain and at least one other symptom, such as:

  • A feeling of choking or a "tight throat," a lump in the throat, or a need to keep swallowing.
  • A cold sweat.
  • Nausea.
  • A sense of impending doom.
  • Difficulty breathing or breathlessness.
  • Palpitations, or feeling your heart beat rapidly or irregularly. (Palpitations are very common and are usually harmless in a healthy heart, but they may signal coronary artery disease if brought on by exertion.)
  • Numbness or discomfort in either arm or hand.
  • Weakness.

People who are having a heart attack often describe their chest pain in various ways. The pain:

  • May feel like pressure, heaviness, weight, tightness, squeezing, discomfort, burning, a sharp ache (less common), or a dull ache. People often put their fist to their chest when describing the pain.
  • May radiate from the chest down the left shoulder and arm (the most common site) and also to other areas, including the left shoulder, middle of the back, upper portion of the abdomen, right arm, neck, and jaw. See an illustration of the areas where you might have pain during a heart attack.
  • May be diffuse; the exact location of the pain is usually difficult to point out.
  • Is not made worse by taking a deep breath or pressing on the chest.
  • Usually begins at a low level, then gradually increases over several minutes to a peak. The discomfort may come and go. Chest pain that reaches its maximum intensity within seconds may represent another serious problem, such as an aortic aneurysm.

Call 911 or your local emergency services if:

  • Your chest pain gets worse or lasts more than 5 minutes, especially if you are short of breath or feel weak, nauseated, or lightheaded.
  • Your chest pain doesn't improve or gets worse within 5 minutes after taking 1 nitroglycerin.

It may not always be possible to tell the difference between unstable angina and a heart attack. Often the symptoms are similar. Both conditions require immediate emergency care.

People who have unstable angina often describe their pain as:

  • Starting within the past 2 months and becoming more severe.
  • Limiting their physical activity.
  • Suddenly becoming more frequent, severe, or longer-lasting or being brought on by less exertion than before.
  • Occurring at rest with no obvious exertion or stress; it may wake the person up.
  • Not responding to rest or nitroglycerin.

The symptoms of stable angina are different from those of unstable angina. Stable angina occurs at predictable times with a specific amount of exertion or activity and may continue without much change for years. It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than 20 to 30 minutes.

More information
10 

Heart Disease Health Center

 
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Heart Attack and Unstable Angina - What Increases Your Risk

 

 

Coronary artery disease (CAD) is the underlying cause of heart attacks in almost every case. Therefore, the more risk factors you have for CAD, the greater your risk for developing unstable angina or having a heart attack. Smoking, diabetes, high cholesterol, high blood pressure, and a family history of heart disease are all strong risk factors for coronary artery disease. For more information, see the What Increases Your Risk section of the topic Coronary Artery Disease.

Use the heart attack risk calculator to estimate your risk of having a heart attack over 10 years. This tool is designed to estimate risk in adults age 20 and older who do not have heart disease or diabetes.

Even if you already have coronary artery disease or have had a heart attack, you can still lower your risk of another heart attack. To lower your risk:

  • Stop smoking. Quitting smoking is probably the most important step to decrease your chance of a heart attack.
  • Reduce high cholesterol. High cholesterol can lead to a buildup of cholesterol inside your arteries.
  • Lower high blood pressure. High blood pressure damages the coronary arteries and increases the heart's workload.
  • Manage diabetes. People who have diabetes develop hardening and narrowing of the arteries more frequently and at a younger age than those not affected by diabetes. Keeping blood sugar at normal levels can slow this development.
  • Maintain a healthy weight. Weight loss frequently improves blood pressure and cholesterol levels and may also help control diabetes.
  • Be physically active. Regular exercise can help reduce your risk of heart attack by helping you to control cholesterol and blood pressure, regulate blood sugar (important for people with diabetes), and lose weight.
  • Manage depression and emotions. Treating depression and treating anger problems are important steps in improving cardiac and overall health and quality of life.
  • Reduce stress. Stress causes increased blood pressure and heart rate and causes your arteries to narrow, increasing your risk for heart attack.
  • Evaluate birth control pill and hormone replacement therapy use. Hormone replacement therapy (estrogen and progestin) increases the risk for heart disease. Birth control pills are more likely to increase a woman's risk if she is older than 35 and smokes cigarettes.
  • Take an aspirin every day (check with your doctor first to make sure you have no medical reasons for not taking it).

Some risk factors are beyond your control. These include:

Elevated homocysteine levels and mutations of a specific gene (MTHFR) may also indicate an increased risk of heart attack, although more study is needed to fully understand their role in heart disease. Tests for these factors may be indicated for some people, such as those who have had a heart attack at a young age, but are not recommended for the general population.

Elevated levels of C-reactive protein (CRP), a substance found in blood that indicates inflammation, may better predict your risk for having a heart attack than cholesterol levels. Two new studies on CRP levels and statin treatment show that testing CRP levels may help predict heart attack risk even when a person has a normal or low level of LDL cholesterol. The studies suggest that testing people for both C-reactive protein and cholesterol levels could prevent more heart attacks by identifying who is at risk.3, 4

Tests for C-reactive protein are now available in many hospitals. If you have any CAD risk factors, ask your doctor if CRP testing would be helpful in guiding your treatment.

Most nonsteroidal anti-inflammatory drugs (NSAIDs), which are used to relieve pain and fever and reduce swelling and inflammation, may increase the risk of heart attack. This risk is greater if you take NSAIDs at higher doses or for long periods of time. People who are older than 65 or who have existing heart, stomach, or intestinal disease are more likely to have problems.

Aspirin, unlike other NSAIDs, has been shown to reduce the risk of heart attack and stroke. But it also carries the risks of serious stomach and intestinal bleeding as well as skin reactions. Regular use of other NSAIDs can make aspirin less effective in preventing heart attack and stroke.
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Heart Disease Health Center

 
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Heart Attack and Unstable Angina - When to Call a Doctor

 

 

Call 911 or other emergency services immediately if you have any of the following symptoms of a heart attack:

  • You have chest pain that has not improved or that gets worse within 5 minutes after taking 1 nitroglycerin and/or resting. After calling 911 , continue to stay on the phone with the emergency operator; he or she will give you further instructions. See how to take nitroglycerin.
  • You have chest pain or discomfort that is crushing or squeezing, feels like pressure on the chest, and gets worse or lasts more than 5 minutes, especially if it occurs with any of the following symptoms:
    • Sweating
    • Shortness of breath
    • Nausea or vomiting
    • Pain that spreads from the chest to the neck, the jaw, or one or both shoulders or arms
    • Dizziness or lightheadedness
    • A fast or irregular pulse
    • Signs of shock

After calling 911 or other emergency services, you should chew 1 regular-strength aspirin (325 mg) unless you cannot take aspirin because of allergy or some other reason. By calling 911 and taking an ambulance to the hospital, you may be able to start treatment before you arrive at the hospital. If any complications occur along the way, ambulance personnel are trained to evaluate and treat them.

If an ambulance is not readily available, have someone else drive you to the emergency room. Do not drive yourself to the hospital unless that is the only option.

If you witness a person become unconscious, call 911 or other emergency services and start CPR (cardiopulmonary resuscitation). The emergency operator can coach you on how to perform CPR. To learn more about CPR, see the Rescue Breathing and Cardiopulmonary Resuscitation (CPR) section of the topic Dealing With Emergencies.

Never wait if you have symptoms of a heart attack. Many people are unsure if they are having a heart attack and take a "wait and see" approach. Heart attack symptoms can vary. People often discount their symptoms if they do not fit into the expected "extreme chest pain" scenario. Some people are embarrassed or don't want to bother others by calling for help if they think it may not be a heart attack. Even if you're not sure it's a heart attack, you should still have it checked out. Rapid treatment can save your life.

Who to See

You will be evaluated and treated by an emergency medicine specialist in the emergency room. For ongoing care, you will likely see a cardiologist. If surgery is needed, you will be referred to a cardiovascular surgeon.

More information
12
 

Heart Disease Health Center

 
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Heart Attack and Unstable Angina - What Increases Your Risk

 

 

Coronary artery disease (CAD) is the underlying cause of heart attacks in almost every case. Therefore, the more risk factors you have for CAD, the greater your risk for developing unstable angina or having a heart attack. Smoking, diabetes, high cholesterol, high blood pressure, and a family history of heart disease are all strong risk factors for coronary artery disease. For more information, see the What Increases Your Risk section of the topic Coronary Artery Disease.

Use the heart attack risk calculator to estimate your risk of having a heart attack over 10 years. This tool is designed to estimate risk in adults age 20 and older who do not have heart disease or diabetes.

Even if you already have coronary artery disease or have had a heart attack, you can still lower your risk of another heart attack. To lower your risk:

  • Stop smoking. Quitting smoking is probably the most important step to decrease your chance of a heart attack.
  • Reduce high cholesterol. High cholesterol can lead to a buildup of cholesterol inside your arteries.
  • Lower high blood pressure. High blood pressure damages the coronary arteries and increases the heart's workload.
  • Manage diabetes. People who have diabetes develop hardening and narrowing of the arteries more frequently and at a younger age than those not affected by diabetes. Keeping blood sugar at normal levels can slow this development.
  • Maintain a healthy weight. Weight loss frequently improves blood pressure and cholesterol levels and may also help control diabetes.
  • Be physically active. Regular exercise can help reduce your risk of heart attack by helping you to control cholesterol and blood pressure, regulate blood sugar (important for people with diabetes), and lose weight.
  • Manage depression and emotions. Treating depression and treating anger problems are important steps in improving cardiac and overall health and quality of life.
  • Reduce stress. Stress causes increased blood pressure and heart rate and causes your arteries to narrow, increasing your risk for heart attack.
  • Evaluate birth control pill and hormone replacement therapy use. Hormone replacement therapy (estrogen and progestin) increases the risk for heart disease. Birth control pills are more likely to increase a woman's risk if she is older than 35 and smokes cigarettes.
  • Take an aspirin every day (check with your doctor first to make sure you have no medical reasons for not taking it).

Some risk factors are beyond your control. These include:

Elevated homocysteine levels and mutations of a specific gene (MTHFR) may also indicate an increased risk of heart attack, although more study is needed to fully understand their role in heart disease. Tests for these factors may be indicated for some people, such as those who have had a heart attack at a young age, but are not recommended for the general population.

Elevated levels of C-reactive protein (CRP), a substance found in blood that indicates inflammation, may better predict your risk for having a heart attack than cholesterol levels. Two new studies on CRP levels and statin treatment show that testing CRP levels may help predict heart attack risk even when a person has a normal or low level of LDL cholesterol. The studies suggest that testing people for both C-reactive protein and cholesterol levels could prevent more heart attacks by identifying who is at risk.3, 4

Tests for C-reactive protein are now available in many hospitals. If you have any CAD risk factors, ask your doctor if CRP testing would be helpful in guiding your treatment.

Most nonsteroidal anti-inflammatory drugs (NSAIDs), which are used to relieve pain and fever and reduce swelling and inflammation, may increase the risk of heart attack. This risk is greater if you take NSAIDs at higher doses or for long periods of time. People who are older than 65 or who have existing heart, stomach, or intestinal disease are more likely to have problems.

Aspirin, unlike other NSAIDs, has been shown to reduce the risk of heart attack and stroke. But it also carries the risks of serious stomach and intestinal bleeding as well as skin reactions. Regular use of other NSAIDs can make aspirin less effective in preventing heart attack and stroke.
13

Heart Disease Health Center

 
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Heart Attack and Unstable Angina - Exams and Tests

 

 

Emergency evaluation for a heart attack

After you call 911 for a heart attack, paramedics will quickly assess your heart rate, blood pressure, and breathing rate and place electrodes on your chest for an electrocardiogram (EKG, ECG). An electrocardiogram is a graphic record of the heart's electrical activity as it contracts and relaxes. The ECG's jagged-line image appears on a portable monitor, and in some areas this image can be transmitted to the hospital emergency room so a doctor there can assess your condition before you arrive.

When you arrive at the hospital, the emergency room doctor will take your history and perform a physical exam, and a more complete ECG will be done. An ECG can detect signs of insufficient blood flow, heart muscle damage, abnormal heartbeats, and other heart problems. A technician will draw blood to test for cardiac enzymes, which are released into the bloodstream when heart cells die. The presence of the enzyme troponin in the blood usually means that there has been heart damage.

Results of these tests are usually available quickly. If your tests indicate that you are at risk of having or are having a heart attack, your doctor will probably recommend that you have cardiac catheterization. During a cardiac catheterization, a fine tube (called a catheter) is threaded through an artery in your arm or leg and up into the heart. Then a dye that contains iodine is injected, which makes the coronary arteries visible on a digital X-ray screen. The doctor can then see whether your coronary arteries are blocked and how your heart functions.

If an artery appears blocked, angioplasty with stent placement, a procedure to open up clogged arteries, may be done during the catheterization, or you will be referred to a cardiovascular surgeon for coronary artery bypass graft surgery.

If your tests do not clearly indicate a heart attack or unstable angina and you do not have other high-risk indicators (such as a previous heart attack), you will probably have other tests, such as a myocardial perfusion scan, also called single photon emission computed tomography or SPECT imaging. SPECT is a noninvasive imaging scan that is often done while you are in the emergency department to help determine whether you are at risk of heart attack.5

If your SPECT test is abnormal, you are considered at high risk and may need cardiac catheterization.

If your tests do not indicate a heart attack but your doctor thinks you have unstable angina and may be in danger of having a heart attack, you may be admitted to the hospital.

Testing after a heart attack

From 2 to 3 days after a heart attack or after being admitted to the hospital for unstable angina, you may have additional tests to assess how well your heart is working and to determine whether undamaged areas of the heart are still receiving adequate blood flow.

These tests may include:

  • Echocardiogram (echo). An echo is an ultrasound exam used to evaluate the size, thickness, shape, and movement of the heart muscle. It also evaluates blood flow and the heart valves.
  • Stress electrocardiogram (such as treadmill testing). A stress test compares your ECG while you rest to your ECG after your heart has been stressed, either through physical exercise (treadmill or bike) or by using a medicine. A stress test can detect ischemia, which is reduced blood flow to the heart muscle.
  • Stress echocardiogram. A stress echocardiogram can determine whether you may have reduced blood flow to the heart.
  • Cardiac perfusion scan. A thallium scan or technetium scan (also called a sestamibi scan) is a test used to estimate the amount of blood reaching the heart muscle during rest and exercise.
  • Angiogram. In this test, a dye (contrast material) is injected into the coronary arteries to evaluate your heart and coronary arteries.
More information
14

Heart Attack, Stroke and Cardiac Arrest Warning Signs

Quick Links:
 Heart Attack Warning Signs
Stroke Warning Signs
Cardiac Arrest Warning Signs

Act in Time
The American Heart Association and the National Heart, Lung, and Blood Institute have launched a new "Act in Time" campaign to increase people's awareness of heart attack and the importance of calling 9-1-1 immediately at the onset of heart attack symptoms. Find the links here.

7648-inter-phot.jpg
 

Dial 9-1-1 Fast
Heart attack and stroke are life-and-death emergencies — every second counts. If you see or have any of the listed symptoms, immediately call 9-1-1. Not all these signs occur in every heart attack or stroke. Sometimes they go away and return. If some occur, get help fast! Today heart attack and stroke victims can benefit from new medications and treatments unavailable to patients in years past. For example, clot-busting drugs can stop some heart attacks and strokes in progress, reducing disability and saving lives. But to be effective, these drugs must be given relatively quickly after heart attack or stroke symptoms first appear. So again, don't delay — get help right away!

 

Statistics 
Coronary heart disease is America's No. 1 killer. Stroke is No. 3 and a leading cause of serious disability. That's why it's so important to reduce your risk factors, know the warning signs, and know how to respond quickly and properly if warning signs occur.

Heart attack warning signs
 

Heart Attack Warning Signs
Some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.   
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.   
  • Shortness of breath with or without chest discomfort.  
  • Other signs may include breaking out in a cold sweat, nausea or lightheadedness       

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Learn the signs, but remember this: Even if you're not sure it's a heart attack, have it checked out. Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1.

Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. The staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

If you can't access the emergency medical services (EMS), have someone drive you to the hospital right away. If you're the one having symptoms, don't drive yourself, unless you have absolutely no other option. 

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warning signs
 

Stroke Warning Signs
The American Stroke Association says these are the warning signs of stroke:

 

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body   
  • Sudden confusion, trouble speaking or understanding   
  • Sudden trouble seeing in one or both eyes   
  • Sudden trouble walking, dizziness, loss of balance or coordination   
  • Sudden, severe headache with no known cause

If you or someone with you has one or more of these signs, don't delay! Immediately call 9-1-1 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

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Cardiac arrest strikes immediately and without warning. Here are the signs:

  • Sudden loss of responsiveness (no response to tapping on shoulders).
  • No normal breathing (the victim does not take a normal breath when you tilt the head up and check for at least five seconds). 

If these signs of cardiac arrest are present, tell someone to call 9-1-1 and get an AED (if one is available) and you begin CPR immediately.  

If you are alone with an adult who has these signs of cardiac arrest, call 9-1-1 and get an AED (if one is available) before you begin CPR. 

Use an AED as soon as it arrives.
15

Heart Attack, Stroke and Cardiac Arrest Warning Signs

Quick Links:
Heart Attack Warning Signs
Stroke Warning Signs
Cardiac Arrest Warning Signs

Act in Time
The American Heart Association and the National Heart, Lung, and Blood Institute have launched a new "Act in Time" campaign to increase people's awareness of heart attack and the importance of calling 9-1-1 immediately at the onset of heart attack symptoms. Find the links here.

7648-inter-phot.jpg
 

Dial 9-1-1 Fast
Heart attack and stroke are life-and-death emergencies — every second counts. If you see or have any of the listed symptoms, immediately call 9-1-1. Not all these signs occur in every heart attack or stroke. Sometimes they go away and return. If some occur, get help fast! Today heart attack and stroke victims can benefit from new medications and treatments unavailable to patients in years past. For example, clot-busting drugs can stop some heart attacks and strokes in progress, reducing disability and saving lives. But to be effective, these drugs must be given relatively quickly after heart attack or stroke symptoms first appear. So again, don't delay — get help right away!

 

Statistics 
Coronary heart disease is America's No. 1 killer. Stroke is No. 3 and a leading cause of serious disability. That's why it's so important to reduce your risk factors, know the warning signs, and know how to respond quickly and properly if warning signs occur.

Heart attack warning signs
 

Heart Attack Warning Signs
Some heart attacks are sudden and intense — the "movie heart attack," where no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren't sure what's wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.   
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.   
  • Shortness of breath with or without chest discomfort.  
  • Other signs may include breaking out in a cold sweat, nausea or lightheadedness       

As with men, women's most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Learn the signs, but remember this: Even if you're not sure it's a heart attack, have it checked out. Minutes matter! Fast action can save lives — maybe your own. Don’t wait more than five minutes to call 9-1-1.

Calling 9-1-1 is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. The staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

If you can't access the emergency medical services (EMS), have someone drive you to the hospital right away. If you're the one having symptoms, don't drive yourself, unless you have absolutely no other option. 

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warning signs
 

Stroke Warning Signs
The American Stroke Association says these are the warning signs of stroke:

 

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body   
  • Sudden confusion, trouble speaking or understanding   
  • Sudden trouble seeing in one or both eyes   
  • Sudden trouble walking, dizziness, loss of balance or coordination   
  • Sudden, severe headache with no known cause

If you or someone with you has one or more of these signs, don't delay! Immediately call 9-1-1 or the emergency medical services (EMS) number so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you'll know when the first symptoms appeared. It's very important to take immediate action. If given within three hours of the start of symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.

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Cardiac arrest strikes immediately and without warning. Here are the signs:

  • Sudden loss of responsiveness (no response to tapping on shoulders).
  • No normal breathing (the victim does not take a normal breath when you tilt the head up and check for at least five seconds). 

If these signs of cardiac arrest are present, tell someone to call 9-1-1 and get an AED (if one is available) and you begin CPR immediately.  

If you are alone with an adult who has these signs of cardiac arrest, call 9-1-1 and get an AED (if one is available) before you begin CPR. 

Use an AED as soon as it arrives.
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Reducing Risk
Common Risk Factors
Risk factors are traits and lifestyle habits that increase the risk of disease. Extensive clinical and statistical studies have identified several factors that increase the risk of stroke. Most of them can be modified, treated or controlled. Some can’t. more
How Cardiovascular & Stroke Risks Relate
Both coronary heart disease and stroke share many of the same risk factors such as cholesterol disorders, high blood pressure, smoking, diabetes, physical inactivity, and being overweight or obese. more
Controlling Risky Conditions
Learn more about how many conditions contributing to the risk of stroke or recurrent stroke can be controlled. more		 image
Know the Facts
Heart disease and stroke are major health risks for all people. But African Americans are at particularly high risk. more
Stroke Among Hispanics
Stroke is the fourth-leading cause of death among Hispanics. One study found that hemorrhagic strokes occurred more commonly in Hispanics than in any other sub-group. more
Hidden Risk Factors for Women
This year, more than 100,000 U.S. women under 65 will have a stroke. Stroke is not a geriatric disease. And it's not confined to elderly overweight smokers who have high blood pressure or high cholesterol. more
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"A Simple Test for Stroke"

The American Stroke Association does not endorse “The Smile Test,” also known as “a simple test for stroke,” which has been widely distributed through e-mails.

The facts: A scientific poster presented at the 2003 International Stroke Conference titled “Untrained Adults Can Identify Symptoms of Stroke by Directed Use of the Cincinnati Prehospital Stroke Scale” suggested that bystanders could identify a stroke by asking a person to:

  1. Smile
  2. Raise both arms 
  3. Speak a simple sentence coherently

This presentation by researchers at the University of North Carolina-Chapel Hill School of Medicine was one of 450 presentations made at the conference hosted by the American Stroke Association.  The poster showed positive results but was a very small study.  The research was funded by a grant from the American Stroke Association.  However, the American Stroke Association has not taken a position on this topic nor endorsed this test.  

Stroke warning signs are:

  • Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
  • Sudden confusion, trouble speaking or understanding
  • Sudden trouble seeing in one or both eyes 
  • Sudden trouble walking, dizziness, loss of balance or coordination
  • Sudden, severe headache with no known cause

Call 9-1-1 immediately if you experience symptoms!
Time lost is brain lost!
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18

Recovering
 

What to Expect in Rehabilitation
Rehabilitation is a critical part of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn or redefine how you live. Stroke rehabilitation helps you return to independent living. more

New & Alternative Therapies
Rehab centers across the country are using innovative advances in rehab science. These therapies can either supplement or replace traditional therapy. more

Common Effects of Stroke
Every stroke is individual, but there are a number of common ways in which stroke can affect someone. more
image Rehab & Regaining Independence
Learn about what to expect in rehab, new and alternative therapies and tips for regaining as much independence as possible. more
Tips for Daily Living
Whether you need advice about chopping vegetables with one hand, getting behind the wheel again or reducing stress, this section has something for you. more		 image
image Getting Support
Stroke can be an isolating experience. But you're not alone, and there's no one who knows what you are going through better than another survivor or caregiver. more
Personal Stories
Stroke survivors do amazing things. Read stories from and about stroke survivors all over the country as they share their personal insights and experiences. more		 image
image Receiving Quality Care
Accreditation and recognition programs that help identify hospitals, rehabilitation facilities and healthcare professionals providing quality care for stroke patients. more
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Stroke Support Groups
Find a Stroke Support Group in Your Area
Use our Stroke Group Finder by entering your ZIP code and a mileage radius to find registered stroke groups near you.

Register Your Group
Do you lead, or know of, a group in your area that isn't listed in our registry? Download our Stroke Group Registration Form (PDF) and get listed today! Check out the benefits of registering.
Successful Stroke Support Groups
Download this comprehensive 30-page booklet that guides you through starting and maintaining a viable stroke support group. more
Online Support
Maybe there's not a support group in your area, or perhaps mobility or time restrictions make it difficult to make it to group. These are groups you can attend on your schedule, without leaving the comfort of home. more

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20

Signs and Symptoms of Heart Failure
 

If you haven't been diagnosed, here's an interactive way to learn the signs and symptoms. Take a second to find the symptoms.


Once a person has been diagnosed with heart failure, it's important for them to keep track of symptoms and report any sudden changes to their physician. This table lists the most common signs and symptoms, explains why they occur and describes how to recognize them.

 

Sign or Symptom Why It Happens People with Heart
Failure May Experience...
Shortness of breath (also called dyspnea) Blood "backs up" in the pulmonary veins (the vessels that return blood from the lungs to the heart) because the heart can't keep up with the supply. This causes fluid to leak into the lungs. . . . breathlessness during activity (most commonly), at rest, or while sleeping, which may come on suddenly and wake them up. They often have difficulty breathing while lying flat and may need to prop up the upper body and head on two pillows. They often complain of waking up tired or feeling anxious and restless.
Persistent coughing or wheezing Fluid builds up in the lungs (see above). . . . coughing that produces white or pink blood-tinged mucus.
Buildup of excess fluid in body tissues (edema) As blood flow out of the heart slows, blood returning to the heart through the veins backs up, causing fluid to build up in the tissues. The kidneys are less able to dispose of sodium and water, also causing fluid retention in the tissues. . . . swelling in the feet, ankles, legs or abdomen or weight gain. They may find that their shoes feel tight.
Tiredness, fatigue The heart can't pump enough blood to meet the needs of body tissues. The body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain. . . . a tired feeling all the time and difficulty with everyday activities, such as shopping, climbing stairs, carrying groceries or walking.
Lack of appetite, nausea The digestive system receives less blood, causing problems with digestion. . . . a feeling of being full or sick to their stomach.
Confusion, impaired thinking Changing levels of certain substances in the blood, such as sodium, can cause confusion. . . . memory loss and feelings of disorientation. A caregiver or relative may notice this first.
Increased heart rate To "make up for" the loss in pumping capacity, the heart beats faster. . . . heart palpitations, which feel like the heart is racing or throbbing

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