Heart Attack Symptoms

Heart attackThere is a popular saying that “the heart does not hurt”. However, pain of different intensity levels is a manifestation of various heart diseases. Angina pectoris and acute pericarditis cause chest pain.

When we read information on heart attack (myocardial infarction), always stands out the pain that typically produces. Although pain is absent in some patients with myocardial infarction, especially the elderly and those with diabetes mellitus, pain usually dominates the picture. In addition, patients with heart attack may have other symptoms.

The pain of the heart attack and the circumstances surrounding it usually have characteristics that allow differentiate it of the pain of another origin. In many patients suffering a heart attack can be found a trigger.

The situations that increase the heart rate, such as physical exercise, psychological stress, infections, fever, anemia, hypotension, surgery, trauma, pulmonary embolism, hypoglycemia or tachyarrhythmias, can increase the oxygen demand in the heart and lead to myocardial infarction

In addition, those processes in which occurs an increase of vasomotor coronary tone, or a real vasospasm, as may occur by the consumption of vasoconstrictors, amphetamines or cocaine, or an allergic reaction, can reduce decisively the coronary flow and lead to heart attack.

Patients with heart attack usually show one or more cardiovascular risk factors such as smoking, hypertension, hypercholesterolemia, diabetes mellitus, advanced age, menopause or family history of premature coronary disease.

Several epidemiologic studies have demonstrated circadian variation in the onset of acute myocardial infarction, with an increased incidence in the morning (between 6 AM and 12 noon). This is probably due to higher levels of catecholamines and cortisol and increased platelet aggregation observed at the morning. There is also seasonal (winter) and weekly (Monday) peaks of higher incidence of heart attack.

The most patients suffering an acute myocardial infarction have a history of chest discomfort, generally suggestive of typical angina, from hours until days before the pain becomes more intense.

Some complain of nonspecific chest discomfort, shortness of breath, and general weakness in the hours or days before the infarction. In a few, however, the pain appears abruptly, without warning symptoms.

When the heart attack occurs, patients often seek medical attention complaining of constant chest pain or discomfort of variable intensity from case to case and usually of more than 30 minutes duration.

Very often, the discomfort has a character of oppression or compression and some patients report it as stinging or burning. The pain typically is located in the center of the chest, in the sternal region. It often radiates to the left shoulder and arm and in some cases to the left forearm and hand.



Sometimes it radiates to the neck, jaw, and / or back. Less frequently, pain is also directed at the right shoulder and arm. Some patients complain of pain in the stomach area, which is more common when the infarction affects the underside of the heart.

Heart attackChest discomfort secondary to myocardial infarction is often associated with sweating, and many patients clearly describe the onset of symptoms as cold sweat.

Sometimes gastrointestinal symptoms occur, such as abdominal meteorism, nausea, and vomiting, especially in inferior infarctions. Patients may also report dizziness, sometimes severe, and even loss of consciousness, which may be secondary to hypotension, decreased heart rate, blocks, or arrhythmias.

They can also complain palpitations, what to do suspect the presence of an arrhythmia. In some patients, particularly in the elderly, heart attack may present with atypical manifestations, such as difficulty breathing, confusion or loss of consciousness, rather than chest pain as the initial symptom.

Up to 25% of heart attacks occur without symptoms and are detected by changes in the electrocardiogram and analysis. Patients with silent infarcts may also have silent ischemia, and interrogation can not find a history of chest pain; this occurs more often in diabetic patients and in the elderly.

The presence of chest pain is not by itself sufficient for diagnosis of myocardial infarction. Many episodes of chest pain are due to angina or noncardiac diseases. The first thing to be evaluated are the characteristic features of chest pain, which increases the diagnostic accuracy.

Chest pain described as tightness or burning is most frequently associated with myocardial infarction, while a pricking pain, which changes with the position of the body, chest or arms, or reproduced by palpation is rarely seen in myocardial infarction. To confirm the diagnosis requires an electrocardiogram and the troponin determination.


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