ComplaintsSymptoms
Only about forty percent of those affected by heart attacks show typical symptoms. The leading symptom, the most common symptom, of a heart attack is chest pain (unstable angina pectoris, also known as “tightness on the chest“). This is very pronounced, is usually described as lying behind the sternum and has a “devastating” character for many patients.
In comparison to the stable angina pectoris attack (moderate lack of oxygen to the heart muscle cells), the unstable angina pain in myocardial infarction does not improve with the administration of nitro preparations (drugs to promote blood circulation in the heart). In addition, it lasts longer (over 20 minutes) and does not subside when the patient is physically calm, so that patients often suffer from mortal fear. The pain mostly radiates into the arms (more often on the left), the upper abdomen or lower jaw and into the shoulder joint and occurs in more than half of the patients before a heart attack.
Women, diabetics and elderly patients often report upper abdominal pain in the event of a heart attack, so that in the case of such pain not only a cause in the stomach and intestines, but also a posterior wall infarction as a trigger for the pain must be considered. In addition to the main symptom of angina pectoris, many patients experience a feeling of weakness, increased sweating, pale skin, cardiac arrhythmia, shortness of breath, nausea and vomiting. In 20-30% of patients, a so-called “silent” heart attack is present, i.e. it does not cause any pain to the patient.
This is often the case with diabetics (diabetes mellitus) or very old patients who have a nerve alteration (neuropathy) and can hardly or no longer feel any pain.In the case of a heart attack, these patients suffer superficially from shortness of breath, physical weakness or faint and suddenly lose consciousness. In these patients, the heart attack is the first clinical manifestation (initial manifestation) of coronary artery disease. 95% of patients have cardiac arrhythmias during the infarction, which can extend to ventricular fibrillation (ventricular tachycardia).
Here, the heart’s actions are so fast that blood is no longer being transported. In the final analysis, this means the same as cardiac arrest (asystole) without any cardiac action of the muscle cells. Shortness of breath or rales when listening to the lungs with a stethoscope are signs of left heart weakness (left heart failure), i.e. weakened and inadequate function of the left half of the heart, which can be detected in about 1/3 of patients.
In the course of left heart insufficiency, the lungs become congested with the typical damp rales. At the cellular level, the symptoms have the following causes: The undersupplied and dying heart muscle cells lose their function during a heart attack. They can no longer contribute to the pumping function of the heart, which maintains blood pressure and blood flow in the circulatory system.
As a result, signs (symptoms) of illness such as a drop in blood pressure, shortness of breath due to restricted blood circulation and oxygen supply to the organs, mainly due to an undersupply to the brain, and a feeling of physical weakness develop. In short, one can say that the picture of a heart attack is very variable. From an unimpaired patient to an unconscious person, anything is possible.
A typical overall impression is a pale, anxious, painful patient who is cold sweaty and possibly vomiting. Pain radiating from the chest into the left arm can be symptoms of a heart attack. Especially in women, isolated pain in the left arm can also occur, which is initially independent of pain in the heart area.
The pain is basically caused by the fact that the heart muscle cells are not supplied with sufficient oxygen and other nutrients. This is often the case when vessels that supply the heart with blood are blocked. The lack of blood flow leads to the destruction of the heart muscle cells, which often causes very severe pain, which also presents itself as burning or stinging.
The fact that the pain is not limited to the heart region is due to the interconnection of the nerve cells that conduct the pain stimulus to the brain. Pain fibers from the heart and from the left arm are brought together at one point and from there they move on to the brain. Due to the common final distance, the brain sometimes cannot distinguish where exactly the pain is coming from.
Therefore, the brain projects the sensation not only onto the heart but also into the left arm. Sometimes the stabbing pain of a heart attack is not felt directly on the chest. Instead of causing pain in the heart, the infarction can also cause back pain, which most often radiates between the shoulder blades.
The fact that the pain is felt in the back is due to the interconnection of the pain-conducting nerve fibers. The pain fibers from the back and those from the heart area are conducted together to the next nerve fiber at a nerve plexus and therefore arrive at the brain in a bundle. The brain is therefore often no longer able to “calculate” from which region the pain actually comes and therefore interprets the pain of the heart attack as back pain.
The typical symptom of a heart attack, namely the strong stabbing pain or the feeling of pressure in the heart area, is also found in women, but heart attacks in women often show very unspecific signs. Thus, a heart attack in women often presents itself with pain in the stomach area. This can be accompanied by nausea and vomiting, in some cases also diarrhoea.
Furthermore, women often show signs such as shortness of breath and shortness of breath. This often includes a general weakness in performance and increased fatigue. In addition to chest pain, women often feel a twinge in the left arm or one that extends into the back between the shoulder blades.
Pain in the area of the neck up to the jaw can also indicate a heart attack in women. Likewise, dizziness and fainting fits are not untypical signs in women. Overall, heart attacks occur more frequently in women over the age of 50.Diseases that promote heart attacks can also occur at a younger age.
In men, the heart attack usually follows the “typical” pattern. There is a sudden stabbing pain in the heart. This is often accompanied by a feeling of tightness and pressure on the chest.
The sudden occurrence in combination with the strong feeling of tightness can lead to anxiety symptoms up to the fear of death. Even before the heart attack, signs such as a drop in performance and reduced physical resilience can be seen. Likewise, in case of shortness of breath and increased fatigue, a possible subsequent heart attack should be considered.
Most frequently, heart attacks occur in men between the ages of 65 and 75. However, the risk of suffering a heart attack is already increased from the age of 40. If diseases are present, which favor a heart attack, also already in younger years increased attention should be paid to a possibly forthcoming heart attack.
These diseases include disturbances of the balance of blood lipids. High blood pressure or atherosclerosis (calcification of the vessels) can also be involved in the development of a heart attack. The same applies to diseases like diabetes mellitus (“diabetes”).
There are several unspecific symptoms that can herald a heart attack a long time in advance. These include increased fatigue, reduced performance and reduced resilience. These are the first signs that the heart is no longer as efficient.
The underlying problem may be blocked coronary arteries, which are also involved in the development of heart attacks. Stinging pains can also occur long before the actual heart attack, because these too are caused by a reduced supply to the heart muscle cells. These pains can occur particularly during physical exertion.
Some people have had these symptoms for months without suffering a heart attack. The actual symptoms of a myocardial infarction should be taken seriously if they last only a few minutes. Depending on the severity of the heart attack, they can also last longer than half an hour. However, an emergency doctor should have arrived by then at the latest, provide first aid and alleviate the symptoms with medication.
