As we highlighted in an earlier post on heart health, data from a recent study show that heart attack deaths in the United States have dropped dramatically since the 1970s. Why is that? Everything from technological advances in CPR and portable defibrillators to better cardiac imaging and cardiac care units in hospitals, to better treatment protocols, including the use of statins, aspirin, and newer diabetes and cholesterol treatments. Moreover, we now recognize the need for emergency care to better ensure someone survives a heart attack, and to get someone treated within 90 minutes of entering a hospital if possible. As one expert notes, “Time is muscle” when it comes to preserving cardiac function following a heart attack. Yet with all of this progress, there are still over 800,000 heart attacks in the US each year, and about 12% of them result in death. That suggests that much more can and should be done both to prevent heart attacks from occurring in the first place and to increase our understanding of early symptoms so that, as best as possible, a good outcome can be achieved. 

When it comes to prevention, a brand new study suggests 4 fundamental risk factors that should ring alarm bells for anyone with a family history of cardiac disease or anyone experiencing possible symptoms. According to new research published in The Journal of the American College of Cardiology, nearly every new heart attack (along with new strokes and cases of heart failure) is preceded by the presence of at least one of 4 basic risk factors: high blood pressure, high cholesterol, elevated blood sugar levels, or smoking (currently or previously). Looking at data from millions of South Koreans and thousands of American patients, researchers found that in 93% of cases, 2 or more of these risk factors were present. Following these patients for almost 20 years, researchers were able to determine that these risks didn’t even need to be severely present- just a borderline level of high blood pressure or high sugar level could still increase your risk of a heart attack. So schedule that doctor’s appointment and read more here. In essence, for most, having a heart attack should not come as a complete surprise if one of these risk factors is part of your medical record.

Even with these risk factors in your health profile, how do you know when you’re actually having a heart attack and should seek emergency care?  An undeniable sign that both men and women may experience is the crushing chest pressure that has sometimes been described as an “elephant sitting on your chest.” But that kind of obvious symptom is often not present, and, in fact, early warning signs several weeks before an actual heart attack may be subtle and new for you. Especially if you have any of the 4 risk factors, these early warning signs should be taken seriously. Several weeks before a heart attack, you might experience such symptoms as unusual fatigue, shortness of breath, dizziness or lightheadedness, sleep disturbances, and abnormal indigestion. Especially if these symptoms come on suddenly, they may suggest a partial blockage of blood flow to the heart before a full-blown heart attack occurs.  Other early warning signs to take seriously? Jaw pain, nausea and vomiting, and even a sense of impending doom. In fact, one cardiologist described his own early warning signs. Feeling chest pressure but not having any of the aforementioned risk factors, he thought it unlikely he was experiencing a heart attack. But then he started to sweat like never before and had an “unmistakable” feeling that he was going to die, along with an intense urge to use the bathroom (a heart attack can affect parts of the nervous system that control bodily functions). Moral of his story? Even without those risk factors, sudden symptoms can be a warning that you are about to have a heart attack. And one sign that almost everyone (92% of patients) ignores? Difficulty breathing while lying down (known as orthopnea).

Women may also experience somewhat different symptoms from men, leaving women vulnerable to misdiagnosis or a late diagnosis. In fact, data show that heart attack outcomes tend to be worse in women. While chest pain may happen, it may not feel like the elephant on your chest. There may also – or instead- be pain in the left arm, neck, back, or abdomen.  Women may also be more reluctant to seek out immediate care and instead, take a wait-and-see approach, which puts them at a disadvantage when it comes to timely intervention. While it’s normal that you might be concerned that you’re making a proverbial mountain out of a molehill, experts implore you to seek out immediate emergency help (don’t drive yourself to the ER) if you have suspicions you may be having a heart attack. 

And for those of you who have survived a heart attack, take note: A new statement from the American Heart Association makes clear that post-heart attack, up to ½ of survivors suffer from mental health or psychological distress concerns that can double their risk of future cardiac events. So just as you should stay on top of pre-heart attack symptoms, you also need to pay attention to your mental health post-heart attack, and understand that your emotional recovery is as important as your physical recovery. You can read more about this important recovery strategy here.