HealthHints

Heart Attack & Stroke –
Will you know when it happens?

March 2010 – Vol. 14, No. 3

Editor: Janet M. Pollard, MPH

How would you know if you were having a heart attack or stroke? Would you know if your loved one was exhibiting the signs of heart attack or stroke? Should you call for help or wait and see if these are the true symptoms? What if it’s only heartburn or a headache? How can you know the difference? Do men and women exhibit the same symptoms? Will you know when it happens?

We’d all like to think “it won’t happen to me.” The truth is, heart disease and stroke are the number 1 and number 3 causes of death in America, respectively.1 (Cancer is number 2.) And, although stroke is number 3, it is a leading cause of serious long-term disability.2 “About every 34 seconds, an American will suffer a heart attack…On average, every 40 seconds someone in the United States has a stroke.”3 “Stroke will affect 4 out of 5 families over the course of a lifetime.”4 The truth is, most of us don’t go untouched by heart disease or stroke – if it is not us, it is a loved one or friend.

We can all work to be healthier and reduce risk factors. We can work to quit tobacco use, exercise regularly, eat healthier, and try to maintain a healthy weight. For healthy adults, regular screenings at your doctor’s office beginning at age 20 should include checks of blood pressure, cholesterol and triglycerides, and BMI and waist circumference checks, as well as blood sugar levels (beginning at age 45). If any of these levels are in an unhealthy range, we can be at greater risk for heart disease and stroke. Talk with your doctor about how to manage these conditions most effectively.

Even with the best of care, however, there are factors we cannot control (like genetics, heredity, and aging). It is so important to know what it looks like – and feels like – when someone is suffering a heart attack or stroke. Too often, we are deceived by the images we have seen on TV or movies…someone dramatically clutches their chest and that’s it, yet this is rarely the case.5 Although chest pain is one sign of heart attack, it is not the only indicator; such images do not fully portray the signs of heart attack or represent the signs of stroke.

Heart Attack & Stroke: Why you need to get help – fast

It is important to seek treatment for both heart attack and stroke immediately to have the best chances for life and the least chances for damage or disability. Here’s why:

Heart attack

“A heart attack, also called a myocardial infarction, occurs when a section of the heart muscle dies or gets damaged because of reduced blood supply. Coronary Artery Disease (CAD) is the main cause of heart attack. A less common cause is a severe spasm of a coronary artery, which also can prevent blood supply from reaching the heart.”6 If immediate treatment is not sought, “further damage to the heart muscle can occur, and an irregular heart rhythm may develop.”6

“Sudden cardiac arrest – the stopping of the heart – occurs when the heart stops completely.”6 Sudden “cardiac arrest usually occurs when your heart’s electrical activity becomes disrupted and the heartbeat gets dangerously fast or chaotic.”7 Sudden cardiac arrest is not a heart attack, but it can occur during a heart attack. This sudden loss of heart function, breathing, and consciousness usually results from an electrical system malfunction in the heart that disrupts the pumping action and causes blood to stop flowing to the rest of the body.8,9 “Unless treated, a person whose heart has stopped will die within minutes.”6

“People who experience a heart attack need emergency care such as cardiopulmonary resuscitation (CPR) or electrical shock (defibrillation). That’s why you need to act quickly once you notice the signs and symptoms of heart attack…. The chances of surviving a heart attack are greater when emergency treatment begins quickly.”6

Stroke

“A stroke, sometimes called a brain attack, occurs when a clot blocks the blood supply to the brain (called an ischemic stroke) or when a blood vessel in or around the brain bursts (called a hemorrhagic stroke).”10 About 85 percent of all strokes are ischemic strokes.11 “In either case, parts of the brain become damaged or die.”10

“Stroke can cause death or significant disability, such as paralysis, speech difficulties, and emotional problems. Some new treatments can reduce stroke damage if patients get medical care soon after symptoms begin.”12 “Two million brain cells die every minute during stroke, increasing risk of permanent damage, disability, or death. Recognizing symptoms and acting fast to get medical attention can save a life and limit disabilities.”13

“When a stroke happens, it is important to recognize the symptoms, call 9-1-1 right away, and get to a hospital quickly.”12

Signs & Symptoms: Differences in men & women

Both men and women can experience similar signs of heart attack or stroke. Women, however, are more likely to experience some other common symptoms. It is important to know all possible signs – “women are less likely to survive heart attacks than men,”14 and “more women than men die from strokes.”15 If both men and women cannot identify the signs, how will they protect and help themselves or each other?

Heart attack warning signs

“Some heart attacks are sudden and intense – the ‘movie heart attack,’ where no one doubts what’s happening. But most heart attacks start slowly, with mild pain or discomfort. Often, people affected aren’t sure what’s wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
  • Shortness of breath with or without chest discomfort.”16
  • Feeling faint, woozy, or lightheaded.16,17
  • Breaking out in a cold sweat.16,17
  • Nausea (feeling sick to your stomach) or vomiting.16,17

“As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.”16

“Women are also more likely to have less common signs of a heart attack, including:

  • heartburn,
  • loss of appetite,
  • feeling tired or weak,
  • coughing, or
  • heart flutters.

Sometimes the signs of a heart attack happen suddenly, but they can also develop slowly, over hours, days, and even weeks before a heart attack occurs.

The more heart attack signs that you have, the more likely it is that you are having a heart attack. Also, if you’ve already had a heart attack, your symptoms may not be the same for another one. Even if you’re not sure you’re having a heart attack, you should still have it checked out.

If you think you, or someone else, may be having a heart attack, wait no more than a few minutes – five at most – before calling 911.17

“Learn the signs, but remember this: Even if you’re not sure it’s a heart attack, have it checked out (tell a doctor about your symptoms). Minutes matter! Fast action can save lives – maybe your own. Don’t wait more than five minutes to call 9-1-1 or your emergency response number.”16

Stroke warning signs

It is important to understand that stroke is an emergency. “The first three hours are the most important. Once you pass three hours after the first sign of stroke, doctors are limited in how or if they can treat your stroke.”15 “If you get to the hospital within three hours of the first symptoms of an ischemic stroke, a doctor may give you medications, called thrombolytics, to break up blood clots. Unfortunately, if you have had a hemorrhagic stroke, few medications can treat it, but surgery may stop the bleeding.”11 “Typically, patients arrive 12 to 24 hours after the first stroke symptom.”15 “The chance that you will survive and recover from a stroke is higher if you get emergency treatment right away.”10

Think F.A.S.T.18 to identify signs of stroke:

  • F – Face: Ask the person to smile. Does one side of the face droop?
  • A – Arms: Ask the person to raise both arms. Does one arm drift downward?
  • S – Speech: Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?
  • T – Time: If the person shows any of these symptoms, time is important. Call 911, or get to the hospital fast.18

“Common stroke symptoms seen in both men and women:

  • sudden numbness or weakness of face, arm or leg – especially on one side of the body;
  • sudden confusion, trouble speaking or understanding;
  • sudden trouble seeing in one or both eyes;
  • sudden trouble walking, dizziness, loss of balance or coordination; or
  • sudden severe headache with no known cause.

Women may report unique stroke symptoms:

  • sudden face and limb pain,
  • sudden hiccups,
  • sudden nausea,
  • sudden general weakness,
  • sudden chest pain,
  • sudden shortness of breath,
  • sudden palpitations.”18

A stroke is an emergency. Make sure you can identify the signs so that you can get help and get your loved one to the hospital in time for the best possible outcome.

The Importance of Emergency Care: EMS help

Both heart attack and stroke require immediate action. If you think you or someone you know is having a heart attack or stroke, call 9-1-1 immediately.6 Patients who arrive at the hospital in an ambulance usually receive faster treatment for heart attack and stroke symptoms than someone who arrives by car.16 Emergency personnel may give you some instructions over the phone, such as telling a potential heart attack victim to chew an aspirin if there is no medical reason to avoid it (aspirin should not be taken by a person experiencing symptoms of a stroke21). Follow the instructions of emergency personnel, and try to remain calm. “Bystanders who have been trained to perform CPR or use a defibrillator may be able to help”6 as well, but be sure you have called 9-1-1 and that help is on the way.

“Emergency medical services (EMS) staff can begin treatment when they arrive – up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. …It is best to call EMS for rapid transport to the emergency room.”16

Your Role…Now

Your role now may or may not be that of someone touched by heart attack or stroke, but either way, with heart disease and stroke being the number 1 and number 3 causes of death in the U.S., respectively, we should all learn the signs. Now is the time – not when it is too late. Knowing the signs and symptoms of heart attack and stroke and how to act fast could be the difference between life and death or health and permanent damage or disability. There is a lot that can be done, in most cases, if we act fast. In the meantime, learn the signs, and make healthy lifestyle choices (don’t smoke, exercise regularly, eat healthfully, maintain a healthy weight, and have your blood pressure, blood lipids, and blood sugar levels checked regularly).


Transient Ischemic Attack (TIA): A mini-stroke

“It may not be a full-blown stroke, but a transient ischemic attack (TIA) – also called a mini-stroke – is your warning that one could be just around the corner. TIAs produce symptoms similar to strokes, but they usually only last a few minutes and don’t cause damage. About a third of people will subsequently have a stroke, and about half of them will have it within a year.”19 A TIA lasts for less than 24 hours (it may only last for a few minutes), but a TIA is a serious warning sign of stroke that should not be ignored.20 According to the National Stroke Association, “up to 40 percent of all people who have experienced a TIA will go on to have an actual stroke…and nearly half of all strokes occur within the first two days after a TIA.”20 If you have stroke symptoms, or see them in someone else, even for a short time, call 911 or have someone take you to the hospital immediately. The goal of TIA management is to prevent future stroke. Talk with a doctor about the best stroke prevention options for you.20 For more information on TIAs, their symptoms and causes, see the full article, What is TIA?, from the National Stroke Association.


This document is meant for educational purposes only and is not intended to replace the advice of your doctor or other health care provider.


References:

  1. Centers for Disease Control and Prevention (2009). Leading causes of death [online]. Retrieved February 8, 2010. From http://www.cdc.gov/nchs/fastats/lcod.htm.
  2. American Heart Association (2007). Let’s talk about stroke, TIA, and warning signs [online]. Retrieved January 5, 2010. From http://www.americanheart.org/downloadable/heartsmart/118582358042250-0066%20ASA%20TIAWrngSigns_4-07.pdf.
  3. American Heart Association (2009). Heart disease and stroke statistics 2009 update at-a-glance [online]. Retrieved January 5, 2010. From http://www.americanheart.org/downloadable/heart/1240250946756LS-1982%20Heart%20and%20Stroke%20Update.042009.pdf.
  4. National Stroke Association (2009). Women and stroke: Women are caregivers [online]. Retrieved February 15, 2010. From http://www.stroke.org/site/PageServer?pagename=WOMCOMP#care.
  5. Cleveland Clinic (2009). Call 911 – before it’s too late [online]. Retrieved December 18, 2009. From http://my.clevelandclinic.org/heart/disorders/cad/call911.aspx.
  6. Centers for Disease Control and Prevention (2009). Heart Attack [online]. Retrieved February 16, 2010. From http://www.cdc.gov/HeartDisease/heart_attack.htm.
  7. Mayo Clinic (2009). Automated external defibrillators: Do you need an AED? [online]. Retrieved February 24, 2010. From http://mayoclinic.com/health/automated-external-defibrillators/HB00053.
  8. Mayo Clinic (2008). Sudden cardiac arrest [online]. Retrieved December 17, 2009. From http://mayoclinic.com/health/sudden-cardiac-arrest/DS00764.
  9. WebMD (2009). Heart disease and sudden cardiac death [online]. Retrieved January 6, 2010. From http://www.webmd.com/heart-disease/guide/sudden-cardiac-death.
  10. Centers for Disease Control and Prevention (2010). About stroke [online]. Retrieved February 16, 2010. From http://www.cdc.gov/stroke/about.htm.
  11. Centers for Disease Control and Prevention (2010). Types of stroke [online]. Retrieved February 16, 2010. From http://www.cdc.gov/Stroke/types_of_stroke.htm.
  12. Centers for Disease Control and Prevention (2010). Stroke [online]. Retrieved February 16, 2010. From http://www.cdc.gov/Stroke/indexc.htm.
  13. National Stroke Association (2009). Stroke 101 [online]. Retrieved February 16, 2010. From http://www.stroke.org/site/DocServer/STROKE_101_Fact_Sheet.pdf?docID=4541.
  14. American Academy of Family Physicians (2010). Heart disease and heart attacks: What women need to know [online]. Retrieved January 5, 2010. From http://familydoctor.org/online/famdocen/home/common/heartdisease/risk/287.html.
  15. National Stroke Association (2008). Women in your life [online]. Retrieved February 15, 2010. From http://www.stroke.org/site/DocServer/women05.pdf?docID=881.
  16. American Heart Association (2010). Heart attack, stroke, and cardiac arrest warning signs [online]. Retrieved December 17, 2009. From http://www.americanheart.org/presenter.jhtml?identifier=3053.
  17. Office of Women’s Health (2009). Heart disease: Frequently asked questions [online]. Retrieved December 18, 2009. http://womenshealth.gov/faq/heart-disease.cfm.
  18. National Stroke Association (2009). Unique symptoms in women [online]. Retrieved February 15, 2010. From http://www.stroke.org/site/PageServer?pagename=WOMSYMP.
  19. College Station Medical Center (2010). MedLife and Health: Mini strokes – heed the warning [online]. Retrieved February 24, 2010. From http://www.csmedcenter.com/Community%20Relations/Documents/CollegeSt_Win10.pdf.
  20. National Stroke Association (2009). What is TIA? [online]. Retrieved February 15, 2010. From http://www.stroke.org/site/PageServer?pagename=TIA.
  21. Cleveland Clinic (2009). Aspirin therapy in heart disease [online]. Retrieved February 24, 2010. From http://my.clevelandclinic.org/disorders/coronary_artery_disease/
    hic_aspirin_therapy_in_heart_disease.aspx.

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Last updated: 31 October, 2013

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