Q: We read it's essential to get immediate medical attention at the first sign of a heart attack. It would be easier to follow this advice if I knew what to expect if I have a heart attack.
A: A heart attack or myocardial infarction occurs when one of the blood vessels to the heart (coronary arteries) becomes completely blocked. Many heart attack victims have a history of chest pain (angina) that may worsen or occur more often in days before an attack. Others have ill-defined warning symptoms, or experience a heart attack suddenly, without any premonition.
Heart attack symptoms are quite variable. The most common are uncomfortable pressure, tightness, fullness, squeezing or burning pain in the center of the chest that lasts for more than a few minutes. The initial pain is often intense, sometimes described as a crushing feeling or pressure, but in other cases may be merely a persistent dull ache. The pain may also closely resemble a more severe version of the chest pain that angina patients have experienced in the past. Such individuals should consider that a heart attack is likely if the episode lasts for more than 10 to 15 minutes and is not relieved by taking as many as three nitroglycerin tablets. The pain may spread to the shoulders, arms (especially the left arm), neck and jaws. Other common symptoms are sweating, nausea, vomiting, shortness of breath, lightheadedness, fainting and extreme anxiety.
There is an understandable desire to wait to see if the chest pain is due to heartburn or some other harmless problem that will soon go away. It is essential, however, to get medical help immediately when symptoms suggest a heart attack. Half the deaths from a heart attack occur within the first hour, before the victim gets to a hospital. Prompt treatment not only greatly enhances the chance of survival but can also minimize the amount of damage done to the heart.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.