The following symptoms and complaints may indicate an acute myocardial infarction (heart attack). These are particularly common during the morning hours, but in principle a myocardial infarction can occur at any time of day or night. Often, the infarction occurs during or after physical or emotional stress.
- Thoracic pain (chest wall pain/chest pain): radiating chest pain – especially in the areas of the left shoulder, left arm (about 50% of cases) and left hand; also possible are sore throat and jaw pain.
- Feeling of pressure behind the sternum (breastbone).
- Angina pectoris (“chest tightness”; sudden pain in the heart area).
- Cold sweat or sweating
- Anxiety
- Paleness
- Nausea
- Pain of annihilation, fear of death
- Dyspnea (shortness of breath) – especially in the elderly.
- Frequently lowered blood pressure
- Rarely vomiting
Other indications
- Myocardial infarction (heart attack) can rarely occur without the above symptoms (circa 20%). It is then called a “silent infarction”. This type occurs particularly in diabetics, the elderly and in men.
- Heart attack symptoms and age:
- Thoracic pain (chest pain): age group 55-64: 83% vs. age group > 85: 45%.
- Atypical symptoms in age group > 85: shortness of breath (20%), weakness/fatigue (10%).
CONCLUSION: In elderly patients (> 75 years), more than 40% are leading nonspecific symptoms.
- A 33-year follow-up study of 12,745 subjects showed that xanthelasmata (yellowish plaques formed by deposition of cholesterol in the tissues of the upper and lower eyelids) are an important skin marker for atherosclerosis (arteriosclerosis, hardening of the arteries), independent of lipid levels. Individuals with this skin marker have an additional risk factor for myocardial infarction (heart attack) and ischemic heart disease (coronary artery disease, CAD).
Gender differences (gender medicine)
- Men are more likely to have an alarming annihilation pain in the left chest that radiates to the upper arms, shoulders, and neck. This is accompanied by palpitations, anxiety, sweating, or indigestion.Chest pain (chest pain) and sweating are more common in men.Silent myocardial infarction (SMI) is more common in men than in women, according to a US study.
- Women are more likely to have atypical, vague symptoms (Eva infarction): they complain of weakness and fatigue (sometimes several days before the infarction), shortness of breath, abdominal pain, nausea and vomiting, sweating, and pain in the neck or throat. Pain between the shoulder blades (occur twice as often in female patients)Nausea and shortness of breath is more common in women.In women, the prognostic impact of “silent infarction” (silent myocardial infarction (SMI)) is less favorable, according to a US study.
- Note: In women, spontaneous coronary artery dissection (SCAD) or spasm of the coronary arteries (cramping of the coronary arteries) are more common causes of myocardial infarction than in men. Furthermore, infarction manifests more often as non-ST elevation myocardial infarction (NSTEMI) and nonobstructive CAD.
Acute coronary syndrome
The term acute coronary syndrome (ACS; acute coronary syndrome) is used to describe the stages of coronary artery disease (CAD) that are immediately life-threatening. These include:
- Unstable angina (UA) – unstable angina is when the symptoms have increased in intensity or duration compared with previous attacks of angina.
- Acute myocardial infarction (heart attack):
- Non-ST-segment-elevation myocardial infarction (NSTEMI; English : non-ST-segment-elevation myocardial infarction).
- ST-elevation myocardial infarction (STEMI; ST-segment-elevation myocardial infarction).
- Sudden cardiac death
The distinction between unstable angina/NSTEMI and STEMI is difficult because their transitions are fluid. For ST-segment elevation myocardial infarction is characterized by prolonged (> 20 min) and nitrorefractory pain symptoms (no response to nitroglycerin)! Prodromal symptoms (precursor symptoms) for acute coronary syndrome (ACS) (median age of study participants was 49 years).
- 85% of women and 72% of men, reported prodromal symptoms in terms of nonspecific complaints:
- Unusual fatigue (60% of women, 42% of men).
- Sleep disturbances
- Anxiety
- Arm weakness or pain
- Thoracic pain (chest pain; = leading symptom of ACS) occurred in only 24% of patients in both sexes before ACS.
Leading symptom of ACS
- Thoracic pain: acute onset retrosternal feeling of pressure or heaviness (“stone on the chest”); pain radiates to the left arm the neck or jaws, or to the lower abdomen; furthermore, pain between the shoulder blades (occur twice as often in female patients)Male: Thoracic pain (chest pain) and sweating are more common in men. Woman: pain between the shoulder blades (occur twice as often in female patients)Note: Pain radiation to the right arm or both arms is possible but rare.Duration of thoracic pain: intermittent for several minutes or persistent.
Possible accompanying symptoms
- Dyspnea* (shortness of breath)
- Nausea* (nausea)/vomiting
- Palpitations (heart palpitations)
- Sweating
- Syncope – brief loss of consciousness caused by reduced blood flow to the brain, usually accompanied by a loss of muscle tone.
* Nausea and shortness of breath is more common in women. Notice:
- In one study, the so-called typical chest pain (chest pain) for the diagnosis of acute coronary syndrome was shown to have only a 0.54 area under the curve in terms of its discriminatory ability: experienced physicians were 65.8% and novice physicians were 55.4%. After completion of treatment, only 15-20% of patients with chest pain were diagnosed with acute coronary syndrome.
- Silent infarcts: nearly half of all myocardial infarctions are detected by ECG changes alone. The prognosis in this was almost as unfavorable as in symptomatic myocardial infarction!
- S. u. Laboratory diagnostics: Clinical Chemistry Score (CCS) to calculate the probability of myocardial infarction.
