A heart attack is when one or more of the arteries supplying the heart muscle becomes severely narrowed or blocked. This results in damage to the heart muscle. Patients may experience chest pains or may not have any symptoms at all. Heart attacks are one of the commonest heart conditions treated in the United Kingdom and one of the commonest heart conditions in the Western World.
Can you have a heart attack and not know about it?
Some people who have a heart attack don’t realise it at the time. This is called a ‘silent heart attack’ and is often diagnosed after the event. Heart tests such as an ECG or Echocardiogram may provide clues to the presence of heart damage although it may not tell the cardiologist when the heart attack occurred.
When a person has a heart attack typical symptoms are those of severe central chest pains (often described as ‘tight’ or ‘crushing’). The chest pain may travel to the neck, arm or back. Patients may also complain of feeling sick or sweating.
Patients may mistake the pain of a heart attack for indigestion or muscular pain. Other patients may simply notice increased breathlessness upon exertion eventually seeking the help of a local cardiologist who is able to make the diagnosis.
Why do some patients not experience pain during a heart attack?
Older patients and those with diabetes are more likely to not have symptoms of chest pains indicating a possible heart attack. People with diabetes may be less sensitive to pain because diabetes can deaden the nerves (a condition called diabetic neuropathy). Elderly people (usually those over the age of 80) may also have a less sensitive perception of pain or may not remember the pain due to problems with memory.
| Typical (usual) symptoms | Non-typical symptoms |
| Pressure, aching, or tightness in the centre of the chest
Pain or discomfort that radiates to the upper body, especially shoulders or neck and arms Sweating |
Shortness of breath
Weakness Nausea or vomiting Dizziness Back or jaw pain Unexplained fatigue |
Diagnosing a heart attack
A heart attack is commonly diagnosed by looking for changes on an ECG. The ECG can also tell the cardiologist whether the heart attack is recent or old and which part of the heart has been damaged by the heart attack. However, for a definite diagnosis, other heart tests may be required. An echocardiogram (heart ultrasound scan) is a way of looking at the heart function and assessing for any damaged areas. A heart attack usually affects a certain part of the heart muscle and causes that part to stop working. This area is called an ‘infarct’ and is dead heart muscle that is not able to contract. Other heart tests that can be used to diagnose a heart attack is a cardiac MRI scan – this can show the area affected by the heart attack and can also indicate how old the heart attack is. One other test to diagnose a heart attack is a coronary angiogram. Compared to an echocardiogram or cardiac MRI scan a coronary angiogram is an invasive test that involves positioning a catheter into the heart and injecting dye into the heart arteries. If a heart attack has happened one or more of the heart arteries will be narrowed or completely blocked. An angiogram may also be able to diagnose whether the heart attack is recent (acute) or occurred in the past. If a heart attack is old the heart arteries are able to form other channels to negotiate past the blockage. The cardiology term for this is ‘collateralisation’. In a recent heart attack (occurring within days or hours) there hasn’t been sufficient time to form these extra pathways.
What to do if you think you are having a heart attack
For any patient who thinks they are experiencing a heart attack the only sensible advice is to call for an ambulance. The paramedics are trained to assess heart attacks and this is important because ideally this should be treated immediately at a heart attack centre.
For patients who think they may have had a heart attack in the past, or a silent heart attack and not aware of the symptoms it is worth seeking the help of a local, experienced cardiologist who will need to assess this using some of the heart tests mentioned.
