Suddenly you are overcome with a feeling of dizziness and a tightness in your chest. How do you know if it’s a heart attack?
First, it’s important to distinguish between angina and an imminent heart attack, says UCI Health cardiologist Dr. Ailin Barseghian El-Farra. Angina is caused by a reduction of blood flow to the heart. An acute heart attack occurs when blood flow to the heart is blocked.
“Angina is the step before having a heart attack,” explains Barseghian, a specialist in interventional cardiology with the UCI Health Cardiovascular Center.
Similar warning signs
Angina and heart attack share many common symptoms:
- Chest pain, pressure, heaviness, a squeezing sensation that typically occurs on the left side and radiates to the left shoulder or arm, jaw or back
- Shortness of breath
- Sweating
- Fatigue
- Lightheadedness
- Nausea
Do symptoms improve with rest?
Stable angina may get worse with exertion or emotional stress, lasts for 5 to 10 minutes, then improves with rest.
"Suspect a heart attack when your symptoms come on suddenly and very strongly and do not resolve with rest,” Barseghian says.
In this case, she advises:
- Call 9-1-1 immediately
- Chew four baby aspirins or one regular aspirin
- Take nitroglycerin if you already have a prescription for it
- Rest and wait for help to arrive
Help during a heart attack
If you’re with someone you believe is having a heart attack, help them with all the above steps and find the closest defibrillator device. Automated External Defibrillators (AED), which are used if a person goes into cardiac arrest, are located many public places such as airports, parks, schools and gyms.
If the person is not breathing and has no pulse, begin CPR immediately and, if possible, attach the AED. The device will determine whether an electrical shock is needed to restart the heart.
Heart attacks without chest pain
People who experience both angina and heart attacks don't always have the typical symptom of chest pain. This occurs primarily in women, older adults and people with diabetes. Instead, they may have:
- Back pain
- Pain in the upper abdominal area
- Shortness of breath
- Jaw pain
- Arm pain
“Many patients come in a day or two late because they don’t recognize the symptoms,” says Barseghian, who is an associate professor in the Mary & Steve Wen Cardiovascular Division in the Department of Medicine at the UC Irvine 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.”
Don't ignore angina
People who experience heart attack symptoms that subside with rest still need to see their doctor or cardiologist as soon as possible. They need to be evaluated for coronary artery disease and other problem with exams that may include a:
- Stress test
- EKG
- Echocardiogram
- Angiogram
Unstable angina requires quick action
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, Barseghian 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. Even so, people can do a lot to prevent or lower their risk for cardiovascular disease, Barseghian says.
These steps include:
- Quitting smoking
- Controlling your blood pressure, cholesterol and diabetes
- Exercising moderately for a minimum of an hour a day, five days a week; or of strenuous exercise for a minimum of 30 minutes five days a week
- Eating a healthy diet that is low in fat and high in vegetables, fruits and whole grains
- Minimizing red meat and avoiding fried and highly processed foods
- Losing weight so that your BMI (Body Mass Index) is less than 25
- Reducing stress
