The acute myocardial infarction, commonly known as a heart attack, is a potentially serious framework, which arises when the flow of blood that irrigates the heart through the coronary arteries is insufficient, leading to necrosis of part of the heart muscle.
The main and most classic symptom of heart attack is a typical painful tightness in the left chest, radiating to the arm. However, infarction can be a tricky event, with atypical symptoms, such as pain in the stomach, nausea and vomiting or pain in the neck. In addition, dozens of other diseases can cause pain in the chest area, mimicking a heart attack.
Chest pain is the symptom that most frightens us and that leads patients to seek emergency services. The fear of having a heart attack is so great that even young people without any risk factors for coronary disease usually look for a hospital because of chest discomfort.
The fact is that there are dozens of diseases that can cause chest pain, some of them simple, such as muscle pain, and other more serious, as the infarct or an aortic aneurysm.
But just as knowing the symptoms does chest pain mean a heart attack?
In fact, there is no definitive answer to the question above. What doctors do is evaluate several clinical variables, such as characteristics of pain, patient's age, risk factors, etc. to decide whether the pain is at high or low risk. The same diagnosis can only be confirmed with blood work and an EKG.
As has been mentioned above, various diseases that are not of cardiac origin may present as chest pain. Among them we can mention:
The cause of angina and heart attack is chest pain with quite similar characteristics because both originate from an inadequate blood flow in the coronary arteries. The difference is that in angina the flow is reduced but not enough to cause necrosis of a heart muscle. Angina is a sign that the heart is at its limit, working with a stream of blood that is just enough to meet their basic demands.
Imagine a patient having a partial blockage in one or more coronary arteries. When this patient is at rest he/she feels nothing because the demand for cardiac blood is low at the moment. However, when the patient makes a physical effort, the heartbeat accelerates and there is a need to increase the blood supply to the heart. Since there is an obstruction to the flow, this extra blood does not reach the destination in the necessary amount, causing ischemia of a heart muscle, called angina. After some minutes of rest the demand for heart rate and blood from the heart will return to baseline, making ischemia and angina pain disappear.
So while the infarction is a severe lack of blood to the heart, causing the death of a heart tissue, angina is an earlier stage, where there is reduced blood flow in the coronary arteries, but there is still sufficient perfusion to the heart muscle not to undergo necrosis.
The cardiac ischemia can be divided into three stages: stable angina, unstable angina and myocardial infarction. Let us summarize them:
Stable angina is cardiac ischemia caused by physical exertion, stress or any other situation that temporarily increases the demand for blood to the heart muscle. There are one or more blockages in the coronary arteries, but they are not large enough to cause pain at rest. When making an effort a person feels pain, but it is short lived and disappears after a few minutes of rest.
Unstable angina, cardiac ischemia is occurring at rest or with minimal exertion just like combing your hair or bathing. The obstruction is large enough so that blood flow is lower than required in basal conditions. Unstable angina may be considered a pre-infarction, being classified as an acute coronary syndrome. Only the symptoms cannot distinguish unstable angina with a heart attack.
Acute myocardial infarction is a severe cardiac ischemia leading to necrosis of part of the heart muscle tissue. Fulminating infarcts are those that occur due to extensive necrosis heart area, making the heart unable to continue its work of pumping blood.
Typically the symptoms of heart attack are a pain in the middle or in the left chest, of a squeeze type, pressure or weight, often radiating to the left arm, jaw and / or back. The pain may be triggered by physical exertion, emotional stress or after an exaggerated meal, but can also come suddenly at rest.
The pain shows gradual worsening of infarction and is usually accompanied by sweating, shortness of breath, pallor, restlessness and often nausea and vomiting. Unlike stable angina, myocardial pain lasts several minutes and there is no relief with rest.
It's curious that the patients often report pain in their chest like a tightening, closing their fist and touching their hand to the chest to try to describe this pain as oppressive.
When infarction presents with its just described classic symptoms, the patient can suspect that the pain originates in the heart. In these cases, the patient usually quickly seeks medical attention.
Infarctions presenting atypical symptoms cause more problems, as is relatively common in the elderly, women or diabetics. There is often chest pain and symptoms are restricted to tiredness, nausea and / or discomfort in the chest or abdomen. There are many cases when patients have infarction and are not told about it. If the necrotic area is small and there are atypical symptoms, the patient usually can only find out to have an infarction through an EKG or an echocardiogram routine.
Besides the characteristics of pain, another very important factor in evaluating a possible heart attack is to know the risk factors of the patient. The more risk factors for coronary disease a patient has, the more importance should be given to their complaints, even though they did not initially seem to indicate a history of infarction. Diabetic patients, obese men of more than 45 years, people with high cholesterol, patients with renal problems and hypertension or smokers have a higher risk of a heart attack. In these individuals any pain or discomfort in the chest region should raise suspicions.
A young patient with no risk factors for coronary heart disease, which arrives at the hospital complaining of chest pain should worry less than a 55-year-old individual, obese, and a diabetic smoker who complains of nausea and just a mild discomfort in the chest region.
All chest pain should be viewed as potentially serious, but some characteristics make us think about other causes besides the myocardial infarction. We call all that atypical pain that does not display the classic characteristics of infarct-like pain in the center oppressive and / or left side of the chest, with or without radiation to the left arm.
The atypical chest pain usually indicates diseases other than a heart attack. Let's illustrate some cases of atypical pain that does not suggest infarction:
1. A chest pain that worsened when touched or local compression, rotation of the trunk or the mobilization of arms often suggest musculoskeletal pathologies. The pain of angina or myocardial infarction does not usually worsen when pressing somewhere when we move the breast or chest.
2. Chest pain that does not present intimate relationship with physical effort, or does not worse while running, climbing stairs or carrying some weight is also usually not of ischemic origin.
3. Burning pain associated with heartburn and belching, usually being present for several weeks and is mild / moderate, usually indicates problems of gastroesophageal origin.
4. The presence of fever, cough, wheezing or worsening of pain when taking a deep breath, suggests pathology of the lung.
5. Young people without risk factors, especially women, may be followed by anxiety presenting as chest pain. They are usually people with chronic or recent personal problems, history of depression, who cry easily, exhibit nervousness, hand tremors and many other complaints besides chest pain.
Typically, the patient complains only of chest pain. They may have other symptoms, but give much more importance to chest pain. On the other hand, patients with anxiety attack which they think is important usually complain of pain in the heart, but also refer to a range of other nonspecific symptoms, such as dizziness, blurred vision, tingling in the mouth, leg weakness, pain in the arms, stomachache, etc.
Obviously, nothing can prevent people from a heart attack. The ideal is to always let the doctor decide if the chest pain is angina / myocardial infarction or not. This is especially true in people who have risk factors.
