Heart Attack Symptoms, Treating Heart Disease

by Food and Drug Administration (FDA)

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Heart Attack Symptoms

Research has shown that people typically wait two hours or more before seeking emergency care for heart attack symptoms. It could be because they are uncertain about their symptoms or concerned that it might be a false alarm. But clot-busting medications and other effective treatments that restore blood flow and save heart muscle are most effective in the first hour following a heart attack.

Symptoms of heart attack include chest discomfort or pain, discomfort in the arm(s), back, neck, jaw, or stomach, shortness of breath, breaking out in a cold sweat, nausea, and lightheadedness. Most heart attacks don't involve someone clutching the chest and dropping to the floor like you might see on TV. It's also important to know that heart attack symptoms for men can be different than symptoms for women.

"The classic sign is when someone comes into the emergency room, puts their fist on their chest, and says it feels like a squeezing pressure," says Cynthia Tracy, M.D., chief of cardiology at Georgetown University Hospital in Washington, D.C. "But it's not always like that. For women, it may present as back pain, flu-like symptoms, or a sense of impending doom."

"We need women to be aware of their symptoms, and we need doctors to put the pieces together and say, 'This woman is postmenopausal and her mother died of a heart attack at 47. So even though her symptoms don't sound classic, I need to investigate her for coronary disease.'"

When Bonnie Brown, 50, of Baltimore, felt a sharp pain in the middle of her chest in 1997, she thought it was indigestion and assumed the feeling would pass. But something made her tell her sister, Joan Hamilton, 53, who lived with her at the time. Joan noticed how pale Bonnie looked and insisted they call an ambulance. Soon after, doctors confirmed that she was having a heart attack.

Then, amazingly enough, Joan also had a heart attack — two weeks after Bonnie did. For Joan, her main symptom was persistent pain in the left arm. "I thought it was from lifting boxes," Joan says, "but I don't tolerate pain too well so I checked it out."

Both Bonnie and Joan used to think heart disease was only for men. Both women are part of the Red Dress Project, the centerpiece of the Heart Truth campaign, sponsored by the National Institutes of Health. The Red Dress Project features a collection of 19 red dresses from America's most prestigious designers, with the dresses symbolizing the fact that heart disease is a women's issue too.

Treating Heart Disease

Once doctors determine that you have clogged coronary arteries, the treatment plan typically involves a combination of drugs, lifestyle changes, and procedures that open up the arteries.

Drugs: Thrombolytic drugs, also referred to as "clot-busting drugs," are given during a heart attack to dissolve blood clots in coronary arteries and restore blood flow to the heart.

Because of its anti-clotting abilities, aspirin is recognized by the Food and Drug Administration as safe and effective to help lower the risk of having a second heart attack.

Other drugs commonly used to treat people with heart disease include drugs that lower blood pressure, angiotensin-converting enzyme (ACE) inhibitors, which help the heart pump blood better, and beta blockers, which slow the heart down. Nitrates and calcium channel blockers relax blood vessels and relieve chest pain. Diuretics decrease fluid in the body. Blood cholesterol-lowering drugs reduce levels of low-density lipoproteins (LDL), the "bad cholesterol," in the blood and increase high-density lipoproteins (HDL), the "good cholesterol."

Catheter-based treatments: Angioplasty is a procedure in which a thin tube called a catheter is put into an artery in the groin and threaded up to the narrowed artery in the heart. The catheter, which has a balloon at the tip, is used to widen the artery. Routinely, tiny mesh wire tubes called stents are then inserted into the artery to hold it open permanently. But a major challenge is restenosis, which is the reclogging or renarrowing of an artery after angioplasty or stenting.

Maureen Magoon, 67, of Blairsville, Ga., who was diagnosed with heart disease in 1999, has experienced problems with restenosis since receiving angioplasty. So when her doctors at the Emory Heart Center in Atlanta recently discovered that another one of her arteries was clogged, they determined that she was a good candidate to receive the Cypher Stent from Cordis Corp., the first drug-eluting stent.

The new stent, approved by the FDA in May 2003, releases the drug sirolimus, which reduces the risk that the artery will reclog. As part of its conditions for approving the Cypher Stent, the FDA is requiring Cordis to conduct a post-approval study of 2,000 patients to assess the long-term safety and effectiveness of the new device. The agency is monitoring reports of problems with the stent, as it does with all medical devices.

A process called intravascular radiation therapy, which uses radiation to kill cells that are clogging an artery, is sometimes used during angioplasty procedures. Also known as brachytherapy, this treatment is not approved for use with the placement of a stent for a vessel that has never been treated, says Jonette Foy, Ph.D., a biomedical engineer in the FDA's Center for Devices and Radiological Health. "Brachytherapy is approved for vessels that have been previously stented, but reoccluded over time."

Coronary bypass surgery: In cases of severe blockages or when someone is unresponsive to medications or not a candidate for angioplasty, doctors may perform coronary bypass surgery. This involves taking a blood vessel from the leg or chest and grafting it onto the blocked artery to bypass the blockage.

In the last few years, the FDA has approved several devices that improve heart disease diagnosis and treatment. For example, after a person has received coronary bypass surgery, devices are used to catch loose particles that could potentially float downstream and clog another artery. This process is known as embolic protection.

C-reactive Protein: A New Risk Factor

Among the new risk factors that may be linked to increased risk of cardiovascular disease is C-reactive protein (CRP). It's produced by the liver as a response to injury or infection and is a sign of inflammation in the body. Research correlates high levels of CRP with an increased risk of heart attack and stroke. Though the evidence is conflicting, some researchers believe that CRP itself is not a risk factor, but elevated levels of CRP could mean that some part of the cardiovascular system is inflamed, which can lead to stroke or heart attack. Information about CRP and other new risk factors is still emerging.

About the Author

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