Most of us know the classic warning signs of a heart attack — a sudden onset of chest pain, restricted breathing or loss of consciousness. If any of those symptoms occur, we know a call to 911 is the next step.
But sometimes, the warning signs of a heart attack don't happen the way we see in the movies. Symptoms might come on gradually or mimic other health problems, making it difficult to connect what you're feeling to a heart-related emergency.
"The heart muscle is very hungry for blood," says Miguel Quiñones, a cardiologist at Houston Methodist. "It needs blood all the time to be able to survive and continue to work. If the heart muscle starts dying, it has a little time to survive. If we get to it in time, we can do a lot of things to minimize that damage."
Responding quickly to the warning signs of a heart attack can mean the difference between life and death.
Fact #1: 90 minutes can save your life
Your best chance of survival happens when you get emergency treatment within 90 minutes after the first signs of a heart attack. Call 911 if you have any symptoms, so life-saving treatment can begin as soon as possible.
When a patient arrives at the ER with heart attack symptoms, a specialized care team immediately takes over, bypassing the typical ER check-in and assessments. A lot of coordinated activity happens very quickly with the goal of saving vital heart tissue.
"We have to move very quickly to minimize the impact on the heart muscle," explains Dr. Quiñones. "There will still be some damage, but it will be a fraction of what it would have been if treatment were delayed."
Diagnosis begins with an electrocardiogram (EKG) and other cardiac marker testing. From there, doctors can give a medication to dissolve a blood clot, or an interventional cardiologist can perform a procedure to reopen the artery.
Fact #2: Unusual symptoms may need emergency treatment
Classic heart attack symptoms are sudden and intense chest pain and difficulty breathing. The symptoms appear without warning, and the patient is immediately debilitated. But it doesn't always happen that way.
What we don't see in movies is that acute symptoms like these occur in only half of heart attacks. Many other important warning signs can be overlooked as indigestion, stress or flu-like symptoms.
"You might throw up or start sweating profusely, or you might feel pain in your arm but not your chest," says Dr. Quiñones. "Some people go to the dentist because they're having pain around their jawline and think it's a tooth infection. They might stay home from work because their stomach is upset."
Recognizing the symptoms can be especially tricky for women, who often attribute heart palpitations or a racing pulse to hormones or stress. Those living with a chronic disease can also have different symptoms. For example, studies have shown that people with diabetes tend to experience less chest pain and more fatigue and shortness of breath than those without.
"It might be just a sensation of not feeling well or not being able to get enough air, of just feeling 'off' and not knowing why," Dr. Quiñones says. "Most people don't get that immediate onset of pain that we might expect."
Fact #3: Prevention really does save lives
Symptoms of a heart attack may develop over time. While significant pain or breathing problems may happen suddenly, the blockage of blood flow — and thus, symptoms — may also occur gradually, over the course of a few hours or even a few days, giving patients an opportunity to seek help in time for an intervention.
Most heart attacks originate in what cardiologists call a plaque — a growth inside the lining of the artery caused by a buildup of cholesterol and other substances. If the plaque breaks apart inside an artery, it can cause a blood clot that grows large enough to disrupt the flow of blood to your heart.
"No one develops a plaque overnight," says Dr. Quiñones. "A plaque in your artery might take 20 years or more to develop, and that's why prevention is so important."
Dr. Quiñones encourages his patients to keep in mind that it's never too late to take control of your heart health risk factors. Those who quit smoking see significant improvements in just one year. Blood pressure, cholesterol lowering and weight loss medications are also known to reduce the risk of heart attack.
Talk with your healthcare provider about your risk of heart attack and how to improve your outlook for a healthy life. When it comes to surviving a heart attack, the saying "better safe than sorry" really does make a difference.
"Time is precious, and recognizing the symptoms is so important," Dr. Quiñones says. "Don't be reluctant to make that call."
