Heart attack

Alternative Names

Symptoms

Chest pain is a major symptom of heart attack. However, some people may have little or no chest pain, especially the elderly and those with diabetes. This is called a silent heart attack.

The pain may be felt in only one part of the body or move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back.

The pain can be severe or mild. It can feel like:

• Squeezing or heavy pressure
• A tight band around the chest
• Something heavy sitting on your chest
• Bad indigestion

Pain usually lasts longer than 20 minutes. Rest and a medicine called nitroglycerine do not completely relieve the pain of a heart attack.

Other symptoms of a heart attack include:

• Shortness of breath
• Nausea or vomiting
• Anxiety
• Cough
• Fainting
• Lightheadedness - dizziness
• Palpitations (feeling like your heart is beating too fast)
• Sweating, which may be extreme

Exams and Tests

A heart attack is a medical emergency. If you have symptoms of a heart attack, seek immediate medical help.

The health care provider will perform a physical exam and listen to your chest using a stethoscope. The doctor may hear abnormal sounds in your lungs (called crackles), a heart murmur, or other abnormal sounds.

You may have a rapid pulse. Blood pressure may be normal, high, or low.

Tests to look at your heart include:

• Coronary angiography
• CT scan
• Echocardiography
• Electrocardiogram (ECG) -- once or repeated over several hours
• MRI
• Nuclear ventriculography

Blood tests can help show if you have substances produced by heart tissue damage or a high risk for heart attack. These include:

• Troponin I and troponin T
• CPK and CPK-MB
• Serum myoglobin

References

Mosca L, Banka CL, Benjamin EJ, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women: 2007 Update. Circulation. 2007; Published online before print February 19, 2007.

Pollack CV Jr. 2004 American College of Cardiology/American Heart Association guidelines for the management of patients with ST-elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med. 2005; 45(4): 363-76.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Clinical Guidelines/Evidence Reports. 2003 May; 3(5233); 1.

Boden WE, O'rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med. 2007 Mar 26; [Epub ahead of print].