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Are you having a heart attack?

February 21, 2019 | UCI Health
man holding his chest

How do you know if you’re having a heart attack? First, it’s important to distinguish between angina and heart attack.

UCI Health cardiologist Dr. Ihab Alomari says angina is caused by a reduction of blood flow to the heart; an acute heart attack occurs when the blood flow to the heart is blocked.

Angina and heart attack share many common symptoms:

  • Chest pain, pressure, heaviness, squeezing, typically on the left side and radiating to the left shoulder or arm, jaw or back
  • Shortness of breath
  • Sweating
  • Fatigue
  • Lightheadedness
  • Nausea

Do symptoms improve with rest?

Stable angina gets worse with exertion or emotional stress, and lasts for 5 to 10 minutes then improves with rest.

“Angina is the step before having a heart attack,” explains Alomari, an interventional cardiologist with the UCI Health Cardiovascular Center. “Suspect a heart attack when your symptoms come on suddenly and very strongly and do not resolve with rest.”

In this case, he advises:

  • Call 9-1-1 immediately
  • Chew four baby aspirins or one regular aspirin
  • Take nitroglycerin, if it has already been prescribed for you
  • Rest and wait for help to arrive

Help during a heart attack

If you’re with someone who you believe is having a heart attack, help that person with all the above steps and locate the closest Automated External Defibrillator (AED), which are used if a person goes into cardiac arrest. AEDs are located many places such as airports, parks, schools and gyms.

If the person is not breathing and there is no pulse, begin CPR immediately and, if possible, attach the AED, which will determine if a shock is necessary to restart the heart.

Heart attacks without chest pain

However, people can experience both angina and heart attacks without the typical symptom of chest pain. Instead, the patient may have:

  • Back pain
  • Pain in the upper abdominal area
  • Shortness of breath
  • Jaw pain
  • Arm pain

These occur primarily among women, the elderly and diabetics.

“Many patients come in a day or two late because they don’t recognize the symptoms,” says Alomari, who is an assistant professor of medicine and associate director of the interventional cardiology fellowship program with UCI School of Medicine.

“When someone is having a heart attack, we need to get them in the ER as soon as possible, where we’ll perform an angiogram and aim to open the artery within 90 minutes.”

Patients who experience angina that subsides with rest should see their doctor or cardiologist as soon as possible to be evaluated with exams that may include a:

  • Stress test
  • EKG
  • Echocardiogram
  • Angiogram

Unstable angina requires quick action

But there is a kind of angina, called unstable angina, which is much more dangerous. Unlike stable angina, it’s not linked to exertion and can last up to 30 minutes. It’s an immediate precursor to a heart attack, and like a heart attack comes on suddenly and gets stronger; it doesn’t go away with rest.

Just as with a suspected heart attack, Alomari advises getting to an emergency department right away.

How to prevent heart disease

Family history can determine whether you have risk factors for heart disease that are out of your control. But there also are many steps people can take to prevent cardiovascular disease, Alomari says.

They include:

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