Am I having a heart attack?

Published Jul 29, 2018 at 9:00am

Symptoms of a heart attack usually include chest discomfort, shortness of breath, abdominal pain, anxiety and or palpitations.

Symptoms may be sudden and dramatic. On the other hand, they may come on slowly. If you, or a loved one, has these symptoms, you should call 911 and tell them you think you are having a heart attack.

Heart attacks are caused when material builds up in arteries of the heart, causing blockage. If blood cannot get to heart muscle, the muscle will die. This type of muscle death is called ischemia. A heart attack is called myocardial ischemia or MI. If a heart attack is happening, it is important to immediately go to an emergency room.

The chances of having a heart attack increase with age, they are more common in men than women, and may run in families. These three risk factors: age, sex and family history, cannot be modified. Other risk factors can be modified, including cigarette smoking, diabetes, inadequately treated high blood pressure, high blood cholesterol, being overweight and being inactive. Problems such as stress and excessive alcohol use are also causative factors.

If you have sudden onset of chest pain or shortness of breath, you may be having a heart attack. If it seems significant or you just aren’t sure, call 911 and have an ambulance take you to an emergency room. When you arrive, the ER staff can, and will, quickly evaluate you. The tests they will do are blood pressure, pulse, oxygen in the blood, an electrocardiogram (EKG) and a troponin level. A chest X-ray will also be done. Troponin is a cardiac enzyme in the blood, and the test takes 10 minutes. If the enzyme is elevated, the ER doctors should immediately call a heart specialist. 

Doctors may determine that the EKG is normal and troponin levels are normal. They will obtain the other tests and put you on a continuous monitor. If no further symptoms or problems occur, the troponin test will be done again in several hours. At that point, you may have further tests, or you may be sent home. 

If EKG indicates a heart attack and troponin levels are elevated arrangements are made to do a cardiac catheterization. Current standards say that the test should be done within 90 minutes of your arrival at the hospital. You might need an ambulance ride to a hospital that does cardiac catheterization, or the ambulance may have brought you to a hospital that does this. 

Catheterization is now usually done through an artery in the wrist. A thin tube is passed up into the vessels of the heart and dye is used to look for obstruction. If there is significant obstruction you will probably have “stents” placed. Stents are tiny wire cages that are installed in the vessel, after the clot is pushed aside. When stents are placed, blood flows again to heart muscle – the heart attack is over and the pain goes away. After stenting you will stay in the hospital for another day or two, monitoring your condition, and starting blood thinners and other medications.

Some patients have severe blockage in multiple vessels, old damage to heart muscle, or damaged valves that need repair. These patients need bypass surgery, rather than stents. That will also be arranged quickly. Blood vessels will be taken from elsewhere in the body and place near the heart, allowing blood to flow to heart muscle, bypassing the obstructed coronary arteries. This is a major operation and you may need time to recover in the hospital or in a rehab facility. 

There are many approaches to maintaining a health heart. These involve working closely with your primary care doctor and your cardiologist to maintain appropriate medications, have regular tests done, and make necessary lifestyle changes. Getting lots of exercise can help keep you healthy.