Posted by Bill Sandweg on 28 August 2023.

Many times a year we see a case in which someone has a heart attack (known medically as a myocardial infarction), seeks medical attention, and dies when they should not have.  We also know that there are many, many more who have heart attacks at home and, for one reason or another, do not seek treatment and die or are badly damaged.  Almost all of these situations arise from the same cause:  The symptoms of a heart attack were not recognized, either by the person having the heart attack, or by the health care provider to whom the person went for treatment.  With a condition as common and deadly as a  heart attack, how can that happen?

The picture above provides a big clue to how this can happen.  When people, including medical professionals, think about a heart attack, they think about crushing, substernal chest pain.  The proverbial “elephant sitting on my chest.”  Medical professionals know that not all heart attacks present with crushing, substernal chest pain, but they can’t help themselves sometimes when a cardiac patient presents with some other manifestation of a heart attack.  Lay people are less likely to know about all of the different ways a heart attack can present, so it is easier to understand why they may not make a bee line for the hospital when they start to have symptoms.

Here are some of the different ways in which a heart attack can present:

Chest pain.  Crushing, substernal chest pain is the classic presentation.  It is most often on the left but need not be.  As with many other things in medicine, if you have a classic presentation, the doctors are most likely to correctly diagnose your problem.  The rarer your illness or presentation is, the less likely doctors are to correctly recognize it.

Back pain.  This can be anywhere in the back, but is most likely in the upper back.

Abdominal pain.  This is less likely but still one of the ways in which a heart attack might present.  A good rule of thumb is that any discomfort between the belly button and the jaw may be a heart attack and you should seek treatment accordingly.

Pain radiating down the arm (especially the left arm).  This also one of the classic presentations.

Jaw pain.  Another presentation that is likely to be recognized as a possible heart attack.

Indigestion.  Another vague symptom that may easily be due to a heart attack.

Cold sweats.  Usually a sign of a heart attack in conjunction with the symptoms listed below.

Nausea.

Unusual shortness of breath.  Shortness of breath not associated with significant activity.

Dizziness or Lightheadedness.

Unusual fatigue.  Again not associated with significant activity.

A general feeling of being unwell or of impending doom.

While heart attacks can strike suddenly and without warning, most of the time there are warning signs prior to the main event.  Be very alert and concerned if these symptoms appear and you are over 50 years old.  Remember women can have heart attacks too.  Be proactive and get checked out at an emergency department.  Don’t waste your time at Urgent Care.  They won’t treat chest pain patients or patients who may be having a heart attack (or at least they shouldn’t).

Family history plays a big role in heart health.  If you are a male and your father had a heart attack in his 40’s, be very vigilant.  Every time I have seen a young man with a heart attack, his father has also had early onset heart disease.

In the meantime, everyone over 50 ought to be getting regular check ups, which include blood work to check for elevated lipid levels.  Low Density Lipoprotein (LDL), the bad cholesterol is a lipid and can be measured with these blood tests.  Heart attacks are usually the result of fatty deposits in the coronary arteries.  High lipid levels contribute to these deposits.  If your lipid levels are high, the doctor can give you medication to drive the numbers down.

Stop smoking, eat a reasonably healthy diet, drop a few pounds, if you are overweight, and get off the couch and move around.  Take good care of yourself and you may live to a ripe old age.

On the other hand, if you have symptoms, go to the emergency department, and get sent home by mistake, call me.