The features of a heart attack are often obvious and quite straightforward. It is vital that a possible attack be recognized, and that treatment be started immediately. The quicker this can be arranged, and the patient transported to a place where expert attention is available, the greater are the chances of recovery.
Often in smaller heart attacks, the symptoms are not so apparent. However, the same precautions hold. It is far better to assume a heart attack has taken place and see that proper treatment is given, rather than the reverse.
This is the most prominent symptom and occurs in practically every case of heart attack. (The term cardiac infarction is the one most used these days. It is the same as coronary occlusion. It means a narrowed coronary artery has been blocked with a clot or thrombus.)
The pain varies greatly, and it can come on suddenly. It may occur at any time of the day or night, although it is claimed to be a little more common in onset in short, obese men during winter.
It takes place without any apparent exciting cause. Maximum pain is soon reached. It usually is situated over the front of the chest, mostly over the breastbone (sternum). From here it tends to spread into the chest, particularly the left-hand side.
The pain has often been described as a constricting sensation or a pressure, rather than pure pain. It tends to spread into the lower part of the neck, probably the jaws, and into the left arm. The pain may also be present between the shoulder blades, and also in the pit of the stomach (the epigastrium). The distribution of the pain and its nature are very similar to that occurring in angina, but there has not been the exercise- induced cause as usually occurs with angina.
However, as opposed to the pain of angina, an infarct pain gradually or rapidly increases in intensity until a maximum has been reached. In some people this pain is excruciating, and is among the worst a person has ever experienced. Often the discomfort is not as severe as this, however, and the person tends to be active and quite restless.
Many instances have been recorded where patients think they have a bad attack of indigestion. They feel the more they move and exercise, the quicker it will disappear. A multitude of instances are on record of people going outside and digging the garden, doing exercises or attending the local gym and vigorously exercising. Of course, none of these activities can have any beneficial effect, and indeed they may jeopardize the person’s life.
Painless infarction is almost totally unknown. Cases have occurred during sleep, causing the patient’s death, but these are not usual.
Some patients notice brief attacks of chest pain occurring during the 24-72-hour period before the true commencement of symptoms. These are referred to as prodromal symptoms.
There may be a general feeling of malaise, feeling off-color, and generally in indifferent health, often for no outward, obvious reason. Bouts of pain may take place, coming then going.
Patients who have known angina may realize all is not well by the apparent frequency and recurrence of their chest pains. But they may recognize this as something more than their usual anginal attacks. The pains may be more frequent, and persist for longer periods of time. This could herald the onset of an infarct, and a patient is wise to seek medical attention promptly.