There can be a whole set of other signs. Chest discomfort is the most common. Most people don’t describe it as pain, but as chest pressure or unusual chest discomfort. Other signs include nausea, vomiting, profuse sweating, neck discomfort, arm discomfort or heaviness, and back discomfort.
How are the symptoms different for women?
Women can present with non-specific symptoms. They say, “I don’t feel well.” “Something is wrong, I’m short of breath.” Those kinds of symptoms. An ER physician has to be suspicious and say, “This is a woman. She might be having a heart attack.”
If you suspect you are having a heart attack, what should you do — or ask others to do?
If you think there is a precipitating event, like snow shoveling, stop. Go inside to someplace warm. Ask for help. Some individuals will drive themselves to the ER department — that is not a good thing to do. Instead, sit down, rest, and relax. Call 911. If you have a history of heart disease, such as bypass or stenting, you probably have nitroglycerin available. Also, use aspirin unless you have an aspirin sensitivity. Chew four baby aspirin if you suspect a heart attack.
The other risk is a sedentary lifestyle. Individuals who are sedentary have a significantly increased risk of heart attack precipitated by activity. It’s linked to the degree of activity. For someone who exercises once a week or not at all, the risk is higher than someone who exercises four times a week.
What steps can we all take to prevent or lower the risk of heart attack?
Obviously, exercise regularly. Be careful with your weight. Obesity is associated with a sedentary lifestyle. Treat the risk factors. If you have high blood pressure or diabetes, make sure the condition is treated aggressively. If you smoke, stop smoking. You can’t change your genes but you can modify every other risk factor.
In winter, there’s a risk for heart attack related to shoveling snow. What’s the connection?
There are studies that looked at geographic areas. Who gets a lot of snow? New England, the Upper Midwest. They’ve also looked at the timing of heart attacks. During the 1978 blizzard, there was an increase in heart attacks. It’s thought to be related to a number of factors. We go out in the morning and shovel snow. That is the time of day that people are at the highest risk for heart attack. And that is thought to be related to a rise in blood pressure and to an increase in blood viscosity and platelets being more likely to aggregate (stick together) in the morning.
Then there is the type of exercise. When you shovel show, you’re using your arms and lifting heavy, often wet, snow — things you may not be used to doing. Lifting heavy snow is very taxing to the heart, causing a marked rise in heart rate and blood pressure. In studies researchers have put young men on treadmills and compared it to shoveling snow, and showed that snow shoveling after two minutes led to the same heart rate increase as very vigorous treadmill activity. The risk of dying of heart attacks with shoveling snow is much greater in males. It’s reported to be three times greater in males than in females.