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Heart Attack and Acute Coronary Syndrome


An in-depth report on the causes, diagnosis, treatment, and prevention of heart attack.

Alternative Names

Beta Blockers



In people with known heart disease, any unusual chest pain or other symptoms of heart attack that do not clear up with medications are signals to go to the hospital. The degree of pain and the specific symptoms before a heart attack vary greatly among individuals. Onset can be abrupt, gradual, or intermittent.

Heart Attack Symptoms

Chest Pain. People with heart disease or risk factors should be concerned about any chest pain, usually precipitated by exercise or stress, that interrupts normal activities and does not clear up after resting or taking angina medications. Chest symptoms might be experienced as follows:

  • Pain is typically as a crushing weight against the chest, which is accompanied by profuse sweating. The pain may radiate to the left shoulder and arm, the neck or jaw, and even infrequently to the right arm. The arm may be tingling or numb.
  • Some people may only have a tingling sensation or a sense of fullness, squeezing, or pressure in the chest.
  • In some patients with a history of heart disease, chest pain is mild. Such patients may have experienced unexplained fatigue, depression, and ill health within a month of a heart attack.

Of note: Although chest pain is the classic symptom, it occurs in only about half of patients with a heart attack.

Other Common Symptoms. Other common symptoms of a heart attack include the following:

  • Nausea, vomiting, and cold sweats.
  • A feeling of indigestion or heartburn.
  • Fainting.
  • A great fear of impending death, a phenomena known as angor animi.

Atypical Symptoms. Some studies suggest that nearly half of patients with heart attack do not have chest pain as the primary symptom. Common atypical symptoms of a heart attack include the following:

  • Shortness of breath
  • Cardiac arrest
  • Dizziness, weakness, and fainting.
  • Abdominal pain.

Patients most likely to have atypical symptoms are women and the very elderly (although they can certainly have classic heart attack symptoms as well.)

  • In one study, 52% of elderly people with acute coronary syndrome had atypical symptoms that included shortness of breath, nausea, profuse sweating, pain in the arms, and fainting. Such symptoms were more likely to occur in people with personal or family history of heart disease.
  • Before a heart attack, women are more likely than men to be nauseous and experience pain high in the abdomen or chest. Their first symptom may be extreme fatigue after physical activity rather than chest pain. (Chest pain in women is also more likely to be caused by non-heart problems than in men.)

Symptoms That Are Less Likely to Indicate a Heart Attack. The following are symptoms that are more likely to be due to causes other than a heart event:

  • Sharp pain brought on by lung movements or coughing.
  • Pain that is mainly or only in the middle or lower abdomen
  • Pain that can be pinpointed with the top of one finger.
  • Pain that can be reproduced by moving or pressing on the chest wall or arms
  • Pain that is constant and lasts for hours (although no one should wait hours if they suspect they are having a heart attack).
  • Pain that is very brief and last for a few seconds.
  • Pain that spreads to the legs.

The presence of these symptoms, however, does not always rule out a serious heart event.

Ruling Out Other Causes of Symptoms

Chest pain is a very common symptom in the emergency room, but heart problems account for only 10% to a third of all episodes. High on the list of other causes of chest pain are the following:

  • The most common causes of chest pain are muscular and bone problems. Problems affecting the ribs and chest muscles include injured muscles, fractures, arthritis, spasms, and infections.
  • Anxiety attacks.
  • Gastrointestinal disorders (gallstone attacks, peptic ulcer disease, hiatal hernia, heartburn).
  • Asthma.
  • Spasm in the coronary artery.
  • Abnormalities of the heart muscle itself.
  • Rupture of the aorta, collapsed lung, acute inflammation of the heart, or a blood clot in the lung.
  • Hyperthyroidism.
  • Anemia.
  • Vasculitis (a group of disorders that cause inflammation of the blood vessels).
  • Exposure to high altitudes (rare).

Actions Taken at the Onset of Symptoms

Individuals who experience symptoms of a heart attack should take the following actions:

For angina patients, take one nitroglycerin dose either as an under-the-tongue tablet or in spray form at the onset of symptoms. Take another dose every five minutes up to three doses or when the pain is relieved, whichever comes first.

Call 911 or the local emergency number. This should be the first action taken if angina patients continue to experience chest pain after taking the full three doses of nitroglycerin. It should be noted, however, that only 20% of heart attacks occur in patients with long-standing angina. Therefore, anyone who has heart disease or risk factors for it and experiences heart attack symptoms should contact emergency services.

The patient should chew an aspirin (250 to 500 mg)and be sure that emergency health providers are informed of this so an additional dose isn't given.

Chest pain sufferers should go immediately to the nearest emergency room, preferably traveling by ambulance. They should not drive themselves.


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