Nitroglycerin

If you have angina, your doctor is likely to prescribe nitroglycerin, which is a vasodilator, meaning that it expands blood vessels to increase blood supply. Used properly, it relieves angina in as little as 2 minutes by reduc- ing the return of (depleted) blood to the heart and thereby easing its workload, and by relaxing the coronary arteries to allow more oxygen- rich blood to reach your heart. It’s important to remember that angina alone does not mean that you are having a heart
attack or that heart muscle is being damaged it is a temporary decrease in blood to the heart because of restricted supply and increased demand. Nitroglycerin provides a “quick ?x” that allows you to be more active and free of pain.
Nitroglycerin is inexpensive and not at all habit-forming. You can take it several times a day without harm. It works best if you take it at the very earliest sensation of discomfort. Better yet, doctors advise people with stable angina to learn to recognize the conditions (exertion, excitement, or deep emotion) that are likely to lead to the pain and take nitroglycerin preventively. Many people experience angina in predictable circum- stances, such as walking outdoors on a cold, windy, or humid day; carrying parcels or heavy items and hurrying; getting exercise after a heavy meal; working under deadline pressure; speaking in public; engaging in sexual activity; or feeling angry, worried, or tense. Being able to “head off ” angina or keep an episode short is an excellent way to take control of your heart condition.

If your doctor prescribes nitroglycerin, ask for directions about how to take it (see box) and talk to him or her about any concerns you have about using it. If you feel uncertain about it, ask to take a nitroglycerin tablet in your doctor’s presence. You will probably feel a slight tingling sensation under your tongue, your face may ?ush, or you may have a sensation of fullness in your head as the medication works in your blood vessels, but more troublesome side effects (light-headedness or headache) are rare. Once you are accustomed to taking nitroglycerin freely, you can derive the full bene?t of the relief it provides.

Beta-blockers

Beta-blockers (or beta-adrenergic blocking agents) are a group of drugs that reduce the heart’s workload and decrease its need for oxygen. They are commonly prescribed for angina, high blood pressure (see page 62), irregular heartbeat, cardiomyopathy (disease of the heart muscle), and heart failure. (They are also used to treat non-heart-related conditions such as migraine headaches and glaucoma.)
A beta-blocker works by interfering with the body’s natural response to stress. When your body is responding to stress, it releases hormones called catecholamines (norepinephrine and epinephrine) that stimulate an increase in heart rate, heart muscle contraction, and blood pressure. A beta-blocker diminishes the effects of the catecholamines, thereby modifying the heart’s response to stress. Numerous beta-blockers are available that act selectively on different aspects of the action of catecholamines.
If your doctor prescribes beta-blockers for angina, the effects of the drug will enable your heart to work longer during exercise or other stress before the angina occurs. You will need to take the beta-blockers daily, in addition to other drugs such as nitroglycerin. Even if you have no symptoms, doctors will often prescribe beta-blockers, since studies have shown they can reduce the risk of a second heart attack.
If you experience a heart attack, your body will produce high levels of catecholamines that cause your heart to work harder. Doctors may give you a beta-blocker to ease your heart’s activity and limit the injury done to heart tissue. After the heart attack, beta-blockers can help pre- vent another one from occurring. You may take the drugs inde?nitely to reduce your risk of another heart attack.
Although beta-blockers are a well-established remedy for heart con- ditions, some people who take them experience muscle fatigue after exercise, light-headedness, or fainting. If you have a lung condition such as asthma, beta-blockers can cause a spasm of the bronchial muscles and thus interfere with passage of air into the lungs, resulting in shortness of breath or wheezing. Some people with diabetes may have light- headedness if the drug interferes with their recognition of when their blood sugar levels are too low. If you experience any side effects from beta-blockers, notify your doctor immediately. A different beta-blocker or an adjustment in the dosage may resolve the problem. However, do not stop taking the drug suddenly, and try not to miss any doses because that could worsen any cardiac symptoms. If you are taking other medi- cines or herbal remedies, be sure to tell your doctor to avoid a harmful drug interaction.
The following are some commonly prescribed beta-blockers, listed by their generic names: acebutolol, atenolol, betaxolol, bisoprolol, carvedilol, metoprolol, nadolol, pindolol, propranolol, sotalol, and timolol.

Calcium Channel Blockers

A group of drugs called calcium channel blockers, or calcium antagonists, relax the arteries and increase the supply of blood to the heart, while reducing its workload by decreasing blood pressure, heart rate, and muscular contraction. Chemically, calcium channel blockers work by preventing an essential step in the process of muscle contraction the movement of calcium into muscle cells in the heart and blood vessels. As a result, the heart and blood vessels relax. Calcium channel blockers may be prescribed for high blood pressure  or angina and may also be used to prevent migraine headaches. Calcium channel blockers are also very effective for the treatment of coronary spasm and the variant angina it causes.
There are many calcium channel blockers, including both short-acting and longer-acting types. Calcium channel blockers are often used in com- bination with beta-blockers. Possible side effects vary with different types of the drug, but some people experience headache; tenderness, swelling, or bleeding of the gums; drowsiness; constipation; or a slow pulse rate (less than 50 beats per minute). Talk to your doctor immediately about any side effects, but do not stop taking the medication abruptly.
The following are some frequently prescribed calcium channel blockers, listed by their generic names: amlodipine, bipridil, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nisoldipine, and verapamil.

ACE Inhibitors

ACE (angiotensin-converting enzyme) inhibitors are a group of drugs widely prescribed to treat high blood pressure and are now also given to many people after a heart attack to improve heart function. After a heart attack, some heart muscle is damaged and weakened, and it may con- tinue to weaken over time. By lessening the workload of the heart and arteries, ACE inhibitors slow down this weakening.
As antihypertensives (drugs that lower blood pressure), ACE inhibitors reduce the workload on the heart caused by hypertension, and help prevent damage to the blood vessels of the heart, brain, and kidneys. Controlling high blood pressure reduces the likelihood of stroke, heart failure, kidney failure, and heart attack.
ACE inhibitors appear to work by blocking an enzyme (protein) in the body that helps produce angiotensin, a substance that makes the blood vessels contract. By inhibiting this process, the drugs relax blood vessels, the vessels expand, blood pressure goes down, and the workload for the heart decreases.
If your doctor prescribes ACE inhibitors after a heart attack, you will probably take the drugs for the rest of your life. These drugs also control blood pressure and preserve kidney function in people with diabetes.

ACE inhibitors tend to increase the level of potassium in your blood, so it is particularly important that you remind your doctor if you are taking potassium, salt substitutes (which often contain potassium), or low-salt milk (which can increase potassium levels). Talk to your doctor about any other medications you are taking, and check with him or her before using any over-the-counter medications or supplements.
Some people taking ACE inhibitors experience side effects including dizziness, light-headedness, or fainting; skin rash; fever; or joint pain. If you experience any of these effects or others, check with your doctor as soon as possible. A high potassium level often has no symptoms or very nonspeci?c symptoms such as nausea, weakness, malaise (feeling list- less), palpitations, irregular heartbeat, or a slow or weak pulse. Tell your doctor if you experience these symptoms. However, high potassium levels usually cause few symptoms until they are dangerously high, so your doctor may periodically monitor the potassium level in your bloodstream.
The following are commonly prescribed ACE inhibitors, listed by their generic names: benazepril, captopril, enalapril, enalaprilat, fosino- pril, lisinopril, perindopril, quinopril, ramipril, and trandolapril.
Angiotensin-2 receptor blockers (ARBs) may be prescribed. ARBs differ from ACE inhibitors in that ARBs inhibit the effect of angio- tensin, rather than blocking it in the ?rst place .

Ischemic Cardiomyopathy

Cardiomyopathy is a term for disease of the heart muscle  that results from a condition that impairs the muscle tone of the heart and reduces its ability to pump blood. One form of the disease, called

ischemic cardiomyopathy, starts as a result of damage from blockage in a coronary artery supplying a portion of the muscular walls of the heart. This damage leads to the inef?cient pumping that is characteris- tic of cardiomyopathy. Frequently, cardiomyopathy is diagnosed by an echocardiogram (see page 132). The echocardiogram measures the ejection fraction, which is the amount of blood pumped with each heartbeat. In people with cardiomyopathy, this number is low, meaning that not enough blood is being pumped. Often the heart will dilate (widen) to compensate, so people with cardiomyopathy often have an enlarged heart.
Treatment for ischemic cardiomyopathy focuses on restoring the heart’s pumping ability with medications and opening the blocked arter- ies to improve blood supply to the heart. Other types of cardiomyopathy include a viral cardiomyopathy, in which the heart is damaged by a virus, and toxic cardiomyopathy, in which the heart is damaged by some out- side agent—for example, alcohol. If the heart has been severely and irreparably damaged by the disease, doctors may recommend a heart transplant .

Pericarditis

Pericarditis is an inflammation of the pericardium, the membrane surrounding your heart. The pericardium actually has two layers, one of which is attached to the heart’s muscular walls and the other which lines the cavity of the chest in which the heart is located. Fluid between the two layers enables the heart to move as it beats, yet stay in position. When pericarditis inflames the membrane, the amount of fluid increases and the heart’s movement (particularly its ability to ?ll with blood) can become restricted. About 10 percent of people who have had a heart attack develop pericarditis, as a result of the death of tissue. Peri- carditis occurs more often in men than in women. Infection, often due to a virus, is a common cause of pericarditis, especially in young adults. In many cases the causes of pericarditis may be unknown. Other causes of pericarditis include cancer or radiation therapy for cancer, injury to the chest, prior chest surgery, autoimmune disease, kidney failure, or use of medications that suppress the immune system.
The most common symptom of pericarditis is a sharp, stabbing pain in the center or the left side of the chest, and it sometimes radiates to the neck or shoulder. It can easily be mistaken for a symptom of a heart attack. Your doctor can begin to diagnose pericarditis by listening to your description of the pain and how it began. He or she can also listen with a stethoscope for characteristic rubbing sounds in your chest, which sometimes can be heard when the in?amed layers of the pericardium rub against each other as the heart beats. A chest X-ray may show an accumulation of ?uid around your heart, which can be con?rmed by an echocardiogram . An electrocardiogram can show changes that indicate pericarditis. Occasionally, periocardiocentesis—a pro- cedure in which a sample of ?uid is withdrawn and analyzed—is needed to help determine the cause of the pericarditis.
Pericarditis is usually treated with pain relievers and anti-in?ammatory medications such as aspirin or ibuprofen. When the condition is the result of a heart attack, pericardi- tis usually responds well to treatment and you are likely to recover in 1 to 3 weeks.
However, if the condition causes an accumulation of ?uid around your heart that is seriously restricting your heart’s ?lling ability (a rare but life-threatening disorder called cardiac tamponade), your doctor may perform pericardiocentesis (either with a needle or as minor sur- gery) to remove the excess ?uid. Examination of the extracted ?uid can help determine the cause of the cardiac tamponade. Repeated accumu- lations of ?uid may require surgery.
Complications of pericarditis are rare, but the infection can cause arrhythmias or even a heart block (when the electrical impulses triggering heart rhythm fail to perform).
Constrictive pericarditis can also develop, in which the in?ammation causes the pericardium to thicken and develop scar tissue (adhesions) between the pericardium and the heart. The pericardium becomes in?exible, and heart failure can result. In such cases, surgical removal of part or all of the pericardium is the only remedy.
There are other complications after a heart attack, depending on where the damage is located in the heart and how severe it is. The heartbeat may slow markedly, requiring a pacemaker. Arrhythmias or heart failure may also occur.

Considering Your Options

If testing shows that you have blockages in your coronary arteries, if you have angina, or if you have a heart attack, your physician may recom- mend treating your condition with lifestyle changes, medications, or procedures such as angioplasty or bypass surgery. In making a treat- ment recommendation, he or she will consider the overall pumping strength and electrical sta- bility of your heart, as shown by testing, and also the severity of your symptoms. Deciding which treatment or combination of treatments is best for you is complex, but you and your doctor may discuss these strategies:
• Lifestyle changes. Lifestyle changes such as eating a healthy diet, getting regular exercise, and quitting smoking are proven to be beneficial in reducing the risk of heart attack, improving angina, or slowing the progression of disease after a heart attack. These factors are essential to support any other treatments you may receive. Your doctor will provide you with information and support, but only you can follow through.
• Medications. Medications such as beta- blockers, calcium channel blockers, ACE inhibitors, or statins (cholesterol-lowering drugs) can improve your heart’s function and treat contributing factors such as high blood pressure and high cholesterol. They may relieve symptoms such as angina and may play an important role in controlling inflammation and preventing the plaque ruptures that lead to some heart attacks. They also may be prescribed after surgery to support your heart during recovery.
• Angioplasty. If one or more of your arter- ies is substantially blocked, angioplasty  will clear the blockage and restore blood flow. If you are having a heart attack, angioplasty at the time of the heart attack may help minimize heart damage. It is a considerably less invasive, less risky, and less expensive procedure than bypass. But some arteries are not suitable for angio- plasty because they are too small. Other blockages are too dense or too large to pen- etrate with angioplasty. During angioplasty, a stent may be placed in an artery in an attempt to keep it from closing up .
• Bypass. Bypass grafting is the best approach for some people with severe angina or extensive blockages. Your doctor may recommend bypass surgery if your left main coronary artery, which supplies the left ventricle (the major pumping chamber), is significantly blocked, because any problem with angio- plasty could cause serious damage to the heart muscle; if you have several major coronary arteries blocked; or if you have had previous angioplasty procedures. Bypass also may be necessary if you have another condition such as heart failure or diabetes.

What to Do If Symptoms Occur

Many people delay going to a hospital, sometimes for as long as 2 hours after they ?rst notice symptoms. Some people are just hoping the symptoms will disappear, some don’t want to feel embarrassed by a false alarm, some think that a “real” heart attack would be dramatic and unmistakable, and some don’t realize the enor- mous advantage of immediate treatment. Although these feelings are understandable, doctors urge you to seek help at the ?rst signs of a heart attack, so that effective treatment begins as soon as possible.
It’s easier to respond quickly to symptoms—either your own or some- one else’s—if you have thought through the steps you will take before an emergency arises. First, of course, you have to learn the warning signs. Talk to your doctor about your personal risk of a future heart attack and how you should respond—for example, whether you should take aspirin or use nitroglycerin. If you are at risk, talk with your family, friends, and coworkers about the warning signs and the best response. Find out who, if anyone, knows cardiopulmonary resusci- tation (CPR) and alert him or her to the possible need for it. If 911 serv- ices are not available, keep the numbers for your area’s emergency medical services (?re department and ambulance) next to the telephone. Find out which hospitals nearby have 24-hour emergency cardiac care.
When you arrive at the emergency room, a doctor or other staff may ask you questions about your symptoms. If you are able to respond, the information you give them will help guide your treatment. Questions may include:

• When did you ?rst notice symptoms?
• What were you doing at the time?
• Were the symptoms most intense right away, or did they build up gradually?
• Did you notice any symptoms other than the ?rst or most intense ones?
• On a scale of 1 to 10, how would you rate the discomfort you felt?
• What medicines have you taken today?
• What medicines do you usually take?

Chest Pain

Most people would probably name chest pain as the symptom they associate most closely with heart attack. But very often the symptom that a person experiences from a blockage in the coronary arteries is not a sharp or stabbing pain. People who have experienced a heart attack often go to great lengths to say that the sensation they had was not exactly pain, but rather an uncomfortable feeling of squeezing or pressure (angina pectoris; ).
The somewhat confusing fact is that chest pain may be caused by a heart condition other than heart attack, and it can also result from problems having nothing to do with the heart, such as gallbladder dis- ease, a muscular disorder, or a digestive problem. The most important distinguishing feature of pain caused by coronary artery disease is prob- ably a link to some sort of stress, either physical or emotional—an indication that the heart’s increased need for oxygen is not being met. Chest pain at rest deserves immediate medical attention, especially in a person with risk factors for heart attack. The ?rst episode of chest pain in a per- son’s life may be the sign of an impending heart attack, so don’t delay seeking medical help.
For reasons that are not at all clear, women with heart disease are more likely to experience symptoms other than chest pain—such as shortness of breath, indigestion, or fatigue—making diagnosis more complex. People with diabetes also may not experience typical chest pain. Some people may have jaw pain or arm pain that for them is the equivalent of chest pain—a sign of a heart attack. If you have experi- enced symptoms of heart attack before, the important point is to learn to recognize them when they occur so that you can respond without hesitation.
A form of chest pain related to heart disease may also be caused by in?ammation of the outer surface of the heart, the pericardium. Like in?ammation anywhere in the body, an in?amed pericardium swells and causes pressure on nerve endings that may result in pain when you breathe in, when you move in certain ways such as leaning forward, or when you lie down. Even though not all chest pain indicates a heart attack, you should still get medical help if you experience any kind of a chest pain that lasts for as long as 5 minutes. It is de?nitely better to be safe than sorry.

Angina Pectoris

Angina, or angina pectoris, is the term that describes the typical chest discomfort or pain that signals an inadequate ?ow of blood to the heart, most often the result of a blockage in the coronary arteries. Many people who have experienced angina struggle to characterize it, but they often describe it as a constricting pressure or fullness; a squeez- ing, crushing, or burning sensation; or a dull pain in the center of the chest. It may radiate out to the arms, shoulder, back, neck, or jaw. But it may also be con?ned to a small area of the chest, and it can last several minutes. Alternatively, it goes away and returns over a period of minutes. However, pain that lasts less than 30 seconds or more than 30 minutes is usually not anginal pain.
Angina usually occurs when the heart demands more blood for a variety of reasons: physical exertion, such as walking uphill or having sexual intercourse; mental or emo- tional stress, including fright or anxiety; cold temperatures; or even eating a meal that trig- gers digestive activity. When pain brought on by exercise is relieved by rest, angina is suspected by your doctor. Many people have “stable angina”—that is, they have episodes of angina that occur in a fairly predictable pattern. This is the reason behind stress testing as a way to reproduce a person’s chest pain symptoms during exercise: to help diagnose coronary artery disease. Usually, a person with stable angina can relieve the symptom with rest or nitroglycerin, or both.
Unstable angina is a form of chest discomfort that occurs for the ?rst time in that person or occurs when the person is at rest. It can be more severe and prolonged than stable angina. The blockage in the arteries that brings on unstable angina may be atherosclerosis, a blood clot, in?ammation, or infection. The experience of unstable angina is an emergency situation. If you have new, unpredictable, or increasingly severe chest discomfort, go to a hospital emergency department imme- diately for evaluation.
A variant form of angina, sometimes called Prinzmetal’s angina, dif- fers from other types because it is not related to physical or emotional stress. It usually occurs when the person is at rest or asleep, often between midnight and 8 o’clock in the morning. Variant angina is a symptom of coronary artery spasm, which may occur in an open artery or in an artery already blocked by atherosclerosis. The spasm occurs close to the blockage and obstructs blood ?ow to the heart muscle.
Angina can occur more rarely as a symptom of other heart condi- tions such as valve disease, cardiomyopathy (disease of the heart muscle; , or extreme high blood pressure. Angina may be treated with nitroglycerin or other medication .

Shortness of Breath

Shortness of breath is another common symptom of a heart attack that can be dif?cult to differentiate and describe. Dif?culty breathing can take the form of feeling unusually breathless with exertion; experienc- ing rapid or shallow breathing; or feeling short of breath at rest. Some people report that they feel conscious of the need to draw breath.
Of course, it is normal to feel short of breath for a while after stren- uous exercise. Anxiety can cause hyperventilation, a form of rapid or shallow breathing. An overweight person may breathe more heavily just from the exertion of carrying extra weight, or someone who is out of shape may feel short of breath with even limited exercise. You are the best judge of when your shortness of breath feels abnormal.
If you feel short of breath at what for you is a moderate level of exer- cise, or if you become short of breath while at rest, or if your breathless- ness occurs with chest pain, don’t hesitate to get medical help.

Light-headedness and Other Symptoms

Some people feel light-headed—like they might pass out—as a symp- tom of a heart attack. (This sensation is different from dizziness, which makes you feel as if you or your surroundings are whirling.) Light- headedness can also signal other heart conditions, such as heart rhythm problems or problems unrelated to your heart.
Women are more likely than men to have atypical or more vague symptoms of heart attack such as light-headedness, nausea or queezi- ness, or fatigue, rather than chest pain. Researchers have only relatively recently recognized this gender difference, and the reasons for it are not yet clear. Genes, hormones, or lifestyle differences may be at work. Both women and their doctors need to be aware of the nature of a

woman’s symptoms and respond quickly to the possibility of heart attack. It is vital to keep in mind that heart disease is the leading cause of death for women, just as it is for men.

Silent Ischemia

A person can have an episode of ischemia (lack of blood to the heart) without angina or other symptoms, a phenomenon called silent ischemia. If the ischemia is severe or lasts too long, it may cause a heart attack with all the attendant dangers of heart damage or cardiac arrest, even if there is no chest pain. For many people the ?rst sign of heart dis- ease may be a cardiac arrest. Cardiologists estimate that 3 to 4 million Americans have silent ischemia every year. The resulting damage to the heart muscle is a leading cause of heart failure (when the heart’s pump- ing action is inadequate). Most people who have episodes of angina or chest pain are likely to have episodes of silent ischemia, too. Although there is no way to know when silent ischemia occurs, an exercise stress test (see page 125) indicates how the blood ?ow in your coronary arter- ies is affected by exercise, and Holter monitoring (see page 124) records an episode of silent ischemia if it occurs while you wear the monitor.
Treatment for silent ischemia is aimed at improving the ?ow of blood to your heart and reducing your heart’s need for oxygen—just like the treatment for any other symptoms of coronary artery disease. Your doctor will recommend lifestyle changes, medications, or perhaps ulti- mately surgical procedures such as angioplasty to reach these goals.

Coronary Artery Spasm

Chest pain may result from a spasm of the artery. Some people’s coro- nary arteries have a tendency to go into spasm periodically (doctors are not sure why). The spasm, called a vasospasm, temporarily constricts the passageway and blocks blood ?ow to the heart. A spasm usually occurs in a coronary artery that is already blocked by atherosclerosis, but it can occur in an otherwise healthy vessel.
The spasm is temporary, but it can cause a heart attack, irregular heart rhythm (arrhythmia), or even sudden cardiac death. The major symptom of coronary artery spasm is a variant form of angina that is particularly painful and often occurs at the same time each day. To treat coronary artery spasm, your doctor may prescribe a medication called a calcium channel blocker , which relaxes the smooth muscle in the artery walls and eases the discomfort of angina. In some cases, a nitrate may be prescribed also.

Heartburn or Heart Attack?

It’s not always easy to distinguish between the chest discomfort of a heart attack and the burning sensation of heartburn (acid reflux). About one out of ten people who go to an emergency department complain- ing of chest pains has heartburn. Either symptom occurs in the general area of the chest, may have a burning quality, and may occur after a big meal. The location of the pain may be a clue: heart attack pain is likely to radiate from the chest into the shoulder, arm, or neck, especially on the left side, while heartburn usually stays more centered and travels into the neck or throat. But don’t take any chances. Remember that most of the damage done by a heart attack occurs in the first hour or so. Get to an emergency department quickly if you have any doubt about the nature of your discomfort.

What Is a STEMI?

You may hear or read about the danger of a STEMI—an ST elevation myocar- dial infarction. This technical term describes a severe heart attack in which an artery is completely blocked. An ST elevation is a characteristic rise in a partic- ular segment of the waves seen in an ECG reading for a person who is having symptoms of a heart attack. Cardiologists identify certain parts of the wave by the letters of the alphabet from Q through T. Injured heart muscle does not conduct electrical impulses normally. The characteristic wave patterns on an ECG show how the electrical impulses are being affected by the injury, and what part of the heart appears to be affected. Also, problems with the heart’s rhythm can be detected. An ST elevation when you have chest pain is a strong indication of a heart attack. Also, a non-Q-wave heart attack may be indicated by a drop in the pulse rate; this type of attack is called minor but may indicate that a major heart attack is imminent.
What does your doctor want you to know about STEMI? A STEMI is likely to be preceded by chest pain, shortness of breath, or feelings of weakness, nausea, or light-headedness. If you have these symptoms for 5 minutes or more, call 911 or your local emergency number immediately. The sooner you get help, the more likely you are to survive and to return to an active lifestyle. Every minute counts.

Calling for Emergency Help

If you or someone you know might be hav- ing a heart attack, call 911 or the emer- gency services number for your area. More than 90 percent of the United States now has 911 service, but in some communities the emergency number is that of the fire department, police department, or town hall. Keep the number handy at home for all family members. If you call for emer- gency services from a cell phone, be sure to mention the location you’re calling from because the location can’t be traced quickly, as it can from a landline. Also, if you use cable or broadband service for Internet-generated calls, find out whether your service will give you access to a 911 service or to some other administrative service office that does not handle emer- gency calls.

Warning Signs of Heart Attack

Heart attacks may start with relatively mild symptoms. Call 911 or the emergency medical services in your area if you experience any of these symptoms for as much as 5 minutes:
• Chest discomfort. An uncomfortable feeling—such as pressure, squeezing, or a sensation of fullness—in the center of the chest that lasts for a few minutes or that goes away and then comes back. The feel- ing may not be truly painful.
• Discomfort in other parts of the upper body. The uncomfortable feeling or pain may spread to one or both arms, the back, the neck, the jaw, or maybe the stomach.

• Shortness of breath. Difficulty breath- ing often occurs with or just before chest discomfort. It may be the only sign of a heart attack.
• Light-headedness, cold sweats, nau- sea, or indigestion. Some people, par- ticularly women, experience these symptoms, and some report having a sense of impending doom.
If you have heart attack symptoms and for some reason cannot call 911 (or the emergency number for your area), have someone else drive you to the nearest hospital immediately. Never drive yourself unless you have absolutely no other choice.

Signs of Cardiac Arrest
A person in cardiac arrest:
• Loses consciousness
• Stops breathing
• Lacks a pulse
Respond immediately:
• Call 911 or the emergency number for your area.
• If you are trained in CPR, use it to help keep the person alive until emergency help arrives to perform defibrillation.
• Look for automated external defibrillator (AED) equipment to use on the person. See also the box on page 155 on using an AED.

• A coronary artery can temporarily spasm, narrowing the artery and restricting or stopping blood flow. These spasms most commonly occur in a blocked artery but may occur in a normal one.
The most common mechanism begins when a fracture develops within atherosclerotic plaque, exposing the inside of the plaque. This causes platelets to stick to the site of the rupture, triggering a cascade of events resulting in the formation of a blood clot that blocks the artery. This explains why aspirin, which helps reduce stickiness of platelets, is effective in reducing the risk of heart attack.
Every year in the United States, about 1.2 million people have heart attacks, and more than 40 percent of those people die before they reach a hospital. As scary as these numbers may sound, they are substantially lower than the ?gures of 25 years ago. Today, many Americans are doing a better job of reducing their own risk of heart attack. Doctors have made major advances in treatment, so that a person who gets medical help quickly is much more likely to survive a heart attack. A heart attack survivor has a much better chance of getting fully rehabilitated than ever before. The survival rates for men after a heart attack have improved in recent years, but this has not yet occurred for women. See also chapter 16, Women and Heart Disease.