Heart Attack Warning Signs That Are Easy to Miss

The textbook picture is only half the story

Most people picture a heart attack the way films portray it: a man clutching his chest and collapsing. That presentation is real and common, but it accounts for only a portion of cases. A large number of patients arrive at our emergency department having spent hours — sometimes a whole night — assuming they had eaten something wrong.

The heart muscle does not have the kind of precise pain fibres that skin has. When it is starved of blood, the brain often interprets the signal as pressure, heaviness, burning or discomfort in the upper abdomen rather than sharp pain in a specific spot. That is why 'gas trouble' is one of the most dangerous self-diagnoses in Indian households.

Symptoms that should make you think 'heart' first

• Chest heaviness, tightness or pressure lasting more than a few minutes — especially if it comes on with exertion and eases with rest
• Discomfort spreading to the left arm, both arms, jaw, neck, upper back or between the shoulder blades
• Breathlessness that is new, out of proportion to the activity, or wakes you at night
• Cold sweating with nausea or vomiting, with no fever and no diarrhoea
• Sudden unexplained exhaustion — being unable to complete a walk you did easily last week
• Giddiness, near-fainting or palpitations with any of the above

Why women and diabetics are diagnosed late

Women more often present with fatigue, nausea, jaw or back discomfort and breathlessness rather than classic chest pain. Because these symptoms are less dramatic, both patients and families tend to wait — and because women are frequently the household's caregivers, they are used to postponing their own symptoms.

In long-standing diabetes, the nerves that carry pain signals from the heart may be damaged. This produces a 'silent' heart attack, where damage occurs with minimal or no chest pain at all. A diabetic patient with sudden breathlessness, sweating or unexplained collapse needs an ECG regardless of whether the chest hurts.

The first hour decides the outcome

Heart muscle begins to die within twenty to thirty minutes of a coronary artery being completely blocked, and the amount that can be saved falls steadily with every passing hour. Treatment given in the first sixty to ninety minutes — clot-dissolving medication or emergency angioplasty — preserves pumping function that would otherwise be permanently lost.

This is the single reason we ask families not to 'wait and see', not to drive to a clinic first for an opinion, and not to spend an hour looking for the right hospital. Call 108. Ambulance crews can record an ECG, give aspirin and oxygen and alert the hospital so that the cath lab team is ready before you arrive.

What to do while waiting for the ambulance

• Stop all activity and sit or lie down in a half-sitting position — do not walk to the vehicle if it can be avoided
• Loosen tight clothing and open windows for air
• If the person is conscious, not allergic to aspirin and has no active bleeding, give a 300 mg aspirin tablet to chew (not swallow whole)
• Do not give food or water, in case anaesthesia is needed
• Keep previous ECGs, discharge summaries and the current medicine list ready to hand over
• If the person becomes unresponsive and is not breathing normally, begin chest compressions immediately at 100–120 per minute

Reducing your risk before it becomes an emergency

Coronary artery disease is presenting a decade earlier in South India than in Western populations. Diabetes, abdominal obesity, tobacco in any form including gutka and khaini, untreated high blood pressure, and a family history of heart attack before the age of 55 in men or 65 in women are the risk factors we see repeatedly.

None of these are silent to a doctor even though all of them are silent to you. A cardiac screening package — ECG, echocardiography, lipid profile, blood sugar and a treadmill test — takes half a day and finds disease years before it produces symptoms.