Actor and director Kevin Smith had just wrapped up the first of two comedy shows on a Sunday night when he realized something was wrong and he needed an ambulance.
At the time, he thought it was nothing more than some “spoiled milk.” There was little pain. He just couldn’t seem to catch his breath.
He went to the hospital anyway—and it was a good thing he did.
It turned out that Smith had suffered a heart attack resulting from a blockage in his left anterior descending (LAD) artery.
If the paramedics hadn’t gotten to him in time, he would probably be dead.
At the time I am writing this, the story about Kevin Smith’s near-silent heart attack is recent news.
Thankfully Smith’s instincts saved his life—despite his rational mind trying to assure him that his heart attack was only “spoiled milk.”
Reading this story, you might wonder, “What if I had been in Smith’s shoes? Would I have thought I was having a heart attack? Would I have called the ambulance, or would I have tried to perform my second show?”
Smith’s close brush with mortality is a reminder to all of us to look after our health—and educate ourselves so that we too may make the right move at a critical life-and-death juncture in our own lives.
What Are the Risk Factors for Heart Attacks?
First of all, what predisposes you to getting a heart attack? Are you in a high risk category?
Anyone can theoretically get a heart attack (also known as a “myocardial infarction”)—but your chances are significantly higher if any of the following are true:
You are a man who is 45 or older, or you are a woman who is 55 or older.
You have high LDL (“bad”) cholesterol, and/or low HDL (“good”) cholesterol.
Your triglyceride levels are high.
Your blood pressure is high.
You have been diagnosed with metabolic syndrome (which is a combination of high risk factors).
You are overweight, particularly in the abdomen.
You smoke or live with secondhand smoke.
You do not get regular aerobic exercise.
Heart attacks are common in your family history.
You have been under extreme stress.
You have been using amphetamines or other stimulants.
You have or have had other health conditions which can increase the risk of heart attack. Some examples include preeclampsia, or autoimmune diseases like lupus.
The more risk factors you have, the more prone you will be to heart attacks. If you know you are in a high risk category, you should be extra vigilant of the symptoms of heart attacks.
What Happens During a Heart Attack?
To understand what a heart attack feels like, it helps to first understand physiologically what is taking place in the body during the course of one.
Your heart is responsible for pumping blood through your veins and arteries. To do this effectively, those vessels need to be relatively unobstructed.
If substances like cholesterol and fat are allowed to build up inside your arteries, they can turn into a substance called “plaque.”
This plaque can disrupt the flow of blood to your heart.
There are a few possibilities which may lead to a heart attack:
An atherosclerotic plaque might sometimes break apart. If this happens, a clot may form, cutting off blood flow. This can result in tissue death. Mere minutes may pass between the breakup of the plaque and the formation of the clot.
If there is a spasm in a coronary artery, this might result in blood flow being blocked. An example would be a condition like Prinzmetal’s angina.
It is also possible to experience what is known as “ischemic cascade.” This happens as a result of a severe reduction in the flow of blood reaching the heart. Heart cells are unable to get the oxygen they need, and die. It takes around 15-30 minutes of this kind of deprivation in order for necrosis to set in. Damage begins in the part of the heart called the “endocardium,” and spreads from there. At the lower end, these cascades usually last a couple of hours, but it is possible for this type of heart attack to go on for days.
Being as heart attacks can take different forms, the associated sensations and timeframes can vary tremendously.
How Long Does a Heart Attack Last?
The exact timing for a heart attack depends on the exact physiological factors involved. There are both fast-onset and slow-onset varieties.
Ironically, those who experience fast-onset heart attacks are often more likely to get the help they need on time.
This is because the sudden appearance of symptoms is abrupt enough to make an impression. When nothing seemed wrong a moment ago and something is clearly wrong now, we tend to take action. This is what we expect a heart attack to feel like.
With slow-onset heart attacks, symptoms may become noticeable more gradually over a period of hours or days. Since they can be subtle, we might tell ourselves, “It’s okay—it is only heartburn. Or spoiled milk.”
As a result, we resist getting the help we need, especially if we do not want to upset those around us.
It is actually possible in some situations to experience the first signs of a heart attack weeks in advance.
Even though this may not fit with the image of a heart attack you have inside your head, it is important to seek help if you believe your symptoms might point toward one.
Are Heart Attacks Painful?
This is another area where expectation and reality may sometimes clash. You would think that the cells in your heart dying off rapidly would result in tremendous pain—but sometimes it doesn’t.
The American Heart Association states that, “Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or then goes away and comes back.”
“Discomfort” is certainly not a very dramatic description. The American Heart Association goes on to further describe this discomfort as “uncomfortable pressure, squeezing, fullness or pain. “
Note the “or” in front of “pain.” In other words, you might not feel what you perceive of as “pain” at all. You could just feel pressure, fullness or squeezing.
If you check the link, you will see some cool graphics which illustrate ways in which heart attack patients have described their symptoms through metaphor. Most emphasize pressure, but some point toward squeezing or burning.
The pain of a heart attack is not necessarily going to be confined to the chest either. You can actually have pain or other forms of “discomfort” elsewhere in your body. Along with the chest, common sites of discomfort include:
Either or both arms
There are other symptoms which you can experience as well. For example, you could feel like you are suffering from a flu, or like you are sick to your stomach. You might be dizzy and lightheaded, or you could start sweating profusely.
What is a “Silent” Heart Attack?
When a heart attack presents without chest pain, it is referred to as a “silent heart attack.”
Silent heart attacks are particularly disturbing because they may also present with few other recognizable symptoms, or sometimes none at all.
For this reason, patients are less likely to seek treatment for them. This can increase the risk of mortality associated with them.
Can You Have a Heart Attack and Not Know It?
Sometimes patients can have heart attacks, survive, and not realize what happened until later, as described by cardiologist Deborah Ekery, M.D. in this article.
According to Ekery, patients sometimes will experience fatigue and other cardiovascular symptoms, and then find out later through a diagnostic that they had a heart attack weeks or even months in the past.
Still, Ekery has noticed patterns in common silent heart attack symptoms. If you think you may be at-risk and you experience one or more of the following symptoms inexplicably, it may be worth seeing your doctor:
A feeling in your upper back or chest like you have pulled a muscle
Unusual neck or jaw pain or discomfort
Pain or discomfort in the arms
Ongoing extreme fatigue
Some patients may go to the doctor complaining that their “left arm feels numb,” or hurts in some way.
Pain or discomfort in either arm can mean a heart attack, but it happens more often with the left because of how the nerves in the body refer pain.
Of course, pain in the left arm may also come from some other source, such as a strained muscle or ligament. A pinched nerve could be responsible as well.
But if the pain cannot easily be explained through another more innocuous cause, and/or other heart attack symptoms are present, it could be a cause for concern.
In general, it is always best to play it safe. If you are unsure whether you are having a heart attack or not, going to the doctor and finding out you wasted an hour of your day is far better than skipping it only to lose your life.
Are Symptoms Different for Men vs. Women?
There are a wide range of symptoms for heart attacks in both men and women, but here too there are some identifiable patterns.
Actually, there is a lot of confusion in this area—probably in part to the differences being exaggerated or placed out context.
There is a widespread misconception that women do not experience chest pain like men often do.
Actually, the Harvard Medical School reports that, “men and women experience similar forms of discomfort when having a coronary blockage. Women, however, are more likely to have a ‘silent’ heart attack, which has no overt symptoms at all. This variation may be due to women being older when the heart attack occurs, and also may be more likely if they have diabetes.”
In other words, both men and women tend to experience “classic” chest pain. Chest pains in women do happen. Silent heart attacks however are more common among women.
This does not mean that if you are a man, you can never have a silent heart attack. It is just statistically less likely.
WebMD has shared some insightful data collected by the nursing school at the University of Rochester. They conducted a study to see whether men or women were more likely to report certain symptoms. Here were their findings:
These symptoms were more likely to be reported by men:
Discomfort on the right side of the chest: 4.7 times more likely
Generalized discomfort: 2.7 times more likely
Dull ache: 3.8 times more likely
Indigestion: 3.7 times more likely
Additionally, it was found that it was five times more probable that men would associate their symptoms with heart issues. Women were significantly more likely to miss the connection.
These symptoms were more likely to be reported by women:
Discomfort in the throat: 12 times more likely
Pressing on the chest: 7.3 times more likely
Vomiting: 3.9 times more likely
It is quite fascinating that women were significantly more likely to report “pressing on the chest,” considering the common myth that women do not experience chest discomfort during heart attacks.
These symptoms were reported equally by both men and women:
Shortness of breath
So this gives you an idea of what you can be on the lookout for. But you should keep in mind some limitations:
All of this is based on reported symptoms, not necessarily symptoms that were present. It is possible that other factors could play into reporting, like the expectations held by men and women concerning their symptoms.
Just because a man is more likely than a woman to report a certain symptom or vice versa, that does not mean you should discount symptoms based on your sex. Vomiting in a man could relate to a heart attack, and so could discomfort on the right side of the chest in a woman.
What you should walk away from this discussion with is the understanding that even though reported heart attack symptoms statistically differ for the sexes, there are a lot of commonalities, and no rules on what you can expect whether you are male or female.
What Should You Do If You Think You May Be Having a Heart Attack?
If you believe you are having a heart attack, you should take the following steps immediately:
Get yourself to the emergency room. Call 911 if possible. If for whatever reason that is not an option, get someone else to drive you. If you absolutely must drive yourself, that is an option, but it should be avoided if at all possible, since it endangers the lives of others on the road.
Take an aspirin. Do not just swallow it whole. Chew it up and then swallow it. The exception is of course if aspirin is not safe for you to take.
If you have a prescription for nitroglycerin, take it. If you do not, make sure you don’t take any.
If someone else is having the heart attack, you should respond the same way. If that person falls unconscious, you should perform CPR, or allow someone with training to do it.
If no one with training is present, call 911 and talk to a dispatcher. The dispatcher can walk you through the steps.
If there happens to be an automated external defibrillator (AED) nearby, use it.
What Steps Can You Take to Prevent Heart Attacks?
Whatever is going on in your life right now, you do not have to simply wait for a heart attack to happen. You can take proactive steps to prevent one. That is true no matter how young or old you are.
Here are some healthy lifestyle choices which will reduce your chances of heart attack, stroke, and other cardiovascular health issues:
Accept that your health is your responsibility. Doctors are there to try and help us when we cannot help ourselves. But their effectiveness is limited, and ultimately each day, it is up to us to make healthy decisions. A doctor cannot eat right or exercise for you. Only you can do that.
Eat a healthy diet. Research backs up a diet low in carbohydrates as an excellent choice for heart health. That means steering clear of grains and focusing mainly on meats, vegetables and healthy fats. When you do eat grains, make sure they are healthy whole grains. Stay away from sugar.
Avoid over-indulging in alcohol. Drinking excessively can damage many parts of your body, including your heart. It can also raise cardiovascular risk markers like blood pressure.
Do not smoke. Smoking is a risk factor for heart disease, and also can cause a range of other serious health problems. If you live in an environment with secondhand smoke and can do something about that, you should. Consider asking the person you live with to only smoke outdoors or in certain parts of the house—or think about moving somewhere else.
Get plenty of regular exercise. Ideally, you should be getting at least 2-3 hours of exercise over the course of a week. If you just take a short walk once a day, that can add up to the aerobic activity you need to protect your heart.
Maintain a healthy weight. That may require that you make adjustments to your exercise and diet throughout your life.
Monitor your markers. Keep an eye on your blood pressure, blood sugar, cholesterol and triglycerides. Work with your doctor on a plan to keep these numbers in a healthy range.
Know your family history. If heart disease runs in your family, you will know to be extra mindful of your markers and any signs or symptoms you might detect. This information will also be helpful for providing context for your doctor.
Regulate your stress as effectively as you can. Stress can raise your blood pressure, and excessive stress over a prolonged time period raises your chance for serious health conditions as a result. You should look for ways to reduce your stress. If there are stressors in your life which you are able to liberate yourself from, remove them. For those you cannot avoid, you will need to develop coping techniques. You can try exercise, meditation, relaxing activities, cognitive reframing of events, and so forth. If necessary, you may want to talk to a therapist.
Keep up with the latest science. Researchers are learning more about heart health every year. The science that was on the cutting edge 10 years ago may be out of date in some respects today. So continue to keep up with the latest developments. Always look closely at any studies you are relying on to make healthcare decisions. Make sure that they are free of conflicts of interest.
Conclusion: The Signs and Symptoms of Heart Attacks Can Vary Radically
Because heart attacks can be caused by a few different physiological processes, their symptoms, durations, and outcomes can vary. For some, they are intensely painful with a sudden onset. For others, they may present with few or no symptoms, and might even unfold slowly and subtly. While certain symptoms are more likely to be reported by men or women, there are no symptoms which are exclusive to either sex.
Because of this, the best thing you can do is be aware of your risk level, do your best to reduce it, and stay vigilant to any possible symptoms you do detect. If you think you may be having a heart attack, get yourself to the doctor right away, even if you think it is just “spoiled milk.” When it comes to your health, it is always better to be safe than sorry.