InfoMedSearch | Warning Signs Alert

:: 2000 - 2006

Welcome to our Heart Attack Warning Signs Alert!

We have selected articles which provide information on heart attack warning signs. We will continue to add more articles to this alert (from the year 2000).

Highlighted Articles

AHA - Heart Attack Symptoms & Warning Signs "If you think you're having a heart attack, call 9-1-1 or your emergency medical system immediately. 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. May occur with or without chest discomfort. Other signs: These may include breaking out in a cold sweat, nausea or lightheadedness 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."

Diagnosing the Cause of Chest Pain (Am Fam Physician 2005) "Chest pain presents a diagnostic challenge in outpatient family medicine. Noncardiac causes are common, but it is important not to overlook serious conditions such as an acute coronary syndrome, pulmonary embolism, or pneumonia. In addition to a thorough history and physical examination, most patients should have a chest radiograph and an electrocardiogram. Patients with chest pain that is predictably exertional, with electrocardiogram abnormalities, or with cardiac risk factors should be evaluated further with measurement of troponin levels and cardiac stress testing. … Although some patients with chest pain have heart failure, this is unlikely in the absence of dyspnea; a brain natriuretic peptide level measurement can clarify the diagnosis. Pain reproducible by palpation is more likely to be musculoskeletal than ischemic. Chest pain also may be associated with panic disorder … Chest pain is the chief complaint in about 1 to 2 percent of outpatient visits, and although the cause is often noncardiac, heart disease remains the leading cause of death in the United States.2 Thus, distinguishing between serious and benign causes of chest pain is imperative, and diagnostic and prognostic questions are important in making this determination."

[Complications of an unrecognized myocardial infarction] (Ned Tijdschr Geneeskd. 2005) "Patients with an untreated myocardial infarction may present with serious late complications. … Around one-third of patients who have a myocardial infarction do not have chest pain but experience shortness of breath, autonomic nervous symptoms (sweating, nausea, vomiting), extreme and inexplicable tiredness and fainting. These atypical symptoms should suggest myocardial infarction. In order to avoid high morbidity and death from complications such as arrhythmias, heart failure, rupture and aneurysm formation it is important that a patient who has had a myocardial infarction should be treated as soon as possible, preferably by reperfusion therapy."

Anxiety disorder in patients with non-specific chest pain in the emergency setting. (Emerg Med J. 2006) "CONCLUSIONS: Physicians should always consider AD in patients presenting to the ED with chest pain after ruling out organic aetiology. Patients' definition of atypical pain, recurrent admissions to ED, and presence of associated symptoms such as dizziness, chills or hot flushes, and fear of dying could aid in considering AD."

A clinical prediction rule for early discharge of patients with chest pain. (Ann Emerg Med. 2006) "RESULTS: Of 769 patients studied, 77 (10.0%) had acute myocardial infarction and 88 (11.4%) definite unstable angina. We derived a clinical prediction rule that was 98.8% sensitive and 32.5% specific. Patients have very low risk of acute coronary syndrome if they have a normal initial ECG, no previous ischemic chest pain, and age younger than 40 years. In addition, patients at least 40 years old and with a normal ECG result, no previous ischemic chest pain, and low-risk pain characteristics have very low risk if they have an initial creatine kinase-MB (CK-MB) less than 3.0 microg/L or an initial CK-MB greater than or equal to 3.0 microg/L but no ECG or serum-marker increase at 2 hours."

Incidence of recognized and unrecognized myocardial infarction in men and women aged 55 and older: the Rotterdam Study. (Eur Heart J. 2006) "CONCLUSION: A high proportion of incident MIs remains clinically unrecognized. As a history of MI is associated with an increased risk of repeat cardiovascular complications, our data suggest a need for periodical electrocardiographic screening to recognize (prevalent) infarctions and to install effective preventive treatment in those aged 55 and older."

Over 40 pct of mild heart attacks undetected - study "Heart attack is a leading cause of death in industrialized nations. Chest pain is the most common but by no means the only sign that sufferers notice. 'They may sense shoulder pain instead of chest pain, they may think they have severe flu that is taking a long time to recover from,' he told Reuters."

Clinical Guidelines

AHA - Part 3: Overview of CPR (2005)

NGC - Acute chest pain - suspected aortic dissection. (2005)

NGC - Acute chest pain - suspected myocardial ischemia. (2005)

NGC - Acute coronary syndromes: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. (2005)

NGC - Adult basic life support: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. (2005)

NGC - Defibrillation: 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. (2005)

NGC - Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). (2005)

NGC - Heart failure in adults. (2005)

NGC - Inpatient management of heart failure. (2004)

NGC - Myocardial infarction. (2006)

Internet Sites

Featured site

NIH - Heart Attack Warning Signs

Mayo Clinic - Heart attack: Signs and symptoms

NIH Institute and Center Resources - Heart Attack

NIH - Act In Time To Heart Attack Signs - Video

NIH - Frequently Asked Questions About Heart Attack

NIH - Heart Attack Survival Plan

NIH - Heart Attack Tutorial

NIH - Medical Encyclopedia Unstable angina

NIH - What Are the Signs and Symptoms of a Heart Attack?

NIH - What Are the Warning Signs of a Heart Attack? (Women)

NIH - What Is a Heart Attack?

NIH - What Is Angina?

NIH - Women and Heart Attack

In this Warning Signs Alert:

News
Articles
Journal Articles

	News
Heart Attacks Often Go Unrecognized: Some estimates run as high as 43 percent; women frequently under-diagnosed "On one point all agree: Both women and men need to know the warning signs of a heart attack and to seek immediate help if they suspect one. The worst that can happen if you're wrong? You'll be sent home from the emergency room, secure in the knowledge it was a false alarm." Is it heartburn or a heart attack? If there's any question, get help — quickly Many Men Drive to ER During Heart Attack More Than 40 Per Cent of Heart Attacks Go Undiagnosed New CPR guidelines issued for heart attacks: Heart association says to 'push hard, push fast' during chest compressions Shortness of Breath May Be Heart Disease Survival Rises When Hospitals Heed All Heart Attack Guidelines The Claim: You Can Keep Yourself Alive by Coughing During a Heart Attack " … experts say the "cough CPR" claim is largely untrue. It may have started because patients having angiograms are sometimes asked to cough forcefully when they have sudden abnormal heartbeats. Coughing deeply can help a person on the verge of passing out — a sign of cardiac arrest — until treatment can be given. But for someone having a heart attack that does not result in cardiac arrest, coughing can be extremely dangerous. And since most people are not able to tell the difference, coughing during a heart attack is almost always a bad idea, according to the American Heart Association. … THE BOTTOM LINE Coughing during a heart attack can be dangerous."

	Articles
AHA - Heart Attack Symptoms & Warning Signs AHA - What are the Warning Signs of Heart Attack? Chest pain Chest Pain Due To Angina And Other Causes Health Tip: Angina Is Chest Pain "Angina occurs when the heart does not receive enough blood. Angina may feel like pain or discomfort in the chest, including pressure, tightness, indigestion or heartburn. Pain from angina may also be felt in the neck, shoulders, jaw, back and arms. Since angina often is a symptom of coronary artery disease or heart attack, the National Heart, Lung, and Blood Institute recommends that you see your doctor any time you have angina." Health Tip: If Someone Is Having a Heart Attack Heart Attack Heart Attack Symptoms and Warning Signs Heart Attack: Warning Signs and Tips on Prevention Heart Attack, Stroke & Cardiac Arrest Warning Signs Myocardial Infarction MYOCARDIAL INFARCTION Signs And Symptoms Wrong Diagnosis - Symptoms of Heart attack

	Journal Articles
A clinical prediction rule for early discharge of patients with chest pain. (Ann Emerg Med. 2006) A Community Intervention by Firefighters to Increase 911 Calls and Aspirin Use for Chest Pain. (Acad Emerg Med. 2006) "Firefighters delivered a heart attack survival kit (that included an aspirin) and counseled participants on the importance of aspirin and 911 use for chest pain. Main outcome measures were 911 calls for chest pain and aspirin ingestion for a chest pain event…" A critical pathway for patients with acute chest pain and low risk for short-term adverse cardiac events: role of outpatient stress testing. (Ann Emerg Med. 2006) "CONCLUSION: For patients with chest pain and low risk for short-term cardiac events, outpatient stress testing is feasible, safe, and associated with decreased hospital admission rates. With an evidence-based protocol, physicians efficiently identify patients at low risk for clinically significant coronary artery disease and short-term adverse cardiac outcomes." A review of symptoms of coronary artery disease in women. (J Adv Nurs. 2002) [Acute chest pain.] (Med Klin (Munich). 2005) Acute risk factors for myocardial infarction. (Int J Cardiol. 2006) "External triggers, such as heavy physical activity, emotional stress, eating, cold or heat exposure, coffee or alcohol consumption, cocaine or marijuana use and sexual intercourse are recognized as most important acute risk factors. … Lifestyle modifications, regular physical activity and adequate drug regimens may at least prove able to defer the occurrence of coronary thrombosis, thereby providing time for the development of collateral vessels, plaque stabilization or invasive/surgical treatment." Ambulatory oesophageal manometry and pH monitoring for investigation of chest pain: a New Zealand experience. (N Z Med J. 2006) Anxiety disorder in patients with non-specific chest pain in the emergency setting. (Emerg Med J. 2006) Are there gender differences related to symptoms of acute myocardial infarction? A norwegian perspective. (Prog Cardiovasc Nurs. 2006) "The findings demonstrated that the most commonly reported symptom in both genders was chest pain. More than 90% of women and men experienced chest pain, with no difference between the genders. More women than men had nausea as well as pain located in their arms, back, jaw, and throat. More men than women attributed their symptoms to be cardiac in origin. Experiencing pain in the shoulders, attributing symptoms to be noncardiac, consulting a family member, and contacting several medical practitioners increased prehospital delay." Chest pain in general practice: incidence, comorbidity and mortality. (Fam Pract. 2006) [Complications of an unrecognized myocardial infarction] (Ned Tijdschr Geneeskd. 2005) Craniofacial pain as the sole symptom of cardiac ischemia: A prospective multicenter study. (J Am Dent Assoc. 2007) "CONCLUSIONS: Craniofacial pain commonly is induced by cardiac ischemia. This must be considered in differential diagnosis of toothache and orofacial pain. CLINICAL IMPLICATIONS: Because patients who have AMI without chest pain run a higher risk of experiencing a missed diagnosis and death, the dentist's awareness of this symptomatology can be crucial for early diagnosis and timely treatment." Diagnosing the Cause of Chest Pain (Am Fam Physician 2005) Evaluation of noncardiac chest pain: diagnostic approach, coping strategies and quality of life. (Eur J Pain. 2006) How do we define non-cardiac chest pain? (J Gastroenterol Hepatol. 2005) How effective are rapid access chest pain clinics? Prognosis of incident angina and non-cardiac chest pain in 8762 consecutive patients. (Heart. 2006) How Sudden Is Sudden Cardiac Death? (Circulation 2006) "Typical angina was present for a median of 120 minutes in 25% of the 274 patients with witnessed arrest and in 33% with a symptom duration of less than 1 hour. … 'Our data show that 'sudden cardiac death' is not nearly as sudden in most cases as the term may suggest," and symptoms are present for 'a surprisingly long time in many patients' … " Manual Chest Compression vs Use of an Automated Chest Compression Device During Resuscitation Following Out-of-Hospital Cardiac Arrest: A Randomized Trial (JAMA 2006) "Conclusions Use of an automated LDB-CPR device as implemented in this study was associated with worse neurological outcomes and a trend toward worse survival than manual CPR." Risk factors for non-cardiac chest pain in the community. (Aliment Pharmacol Ther. 2005) [Symptoms, risk factors, and etiology of transient ischemic attack and stroke.] (Nervenarzt. 2005) The influence of age on acute myocardial infarction symptoms and patient delay in seeking treatment. (Prog Cardiovasc Nurs. 2006) "Older patients were significantly less likely to report classic pain in the center of the chest and other associated symptoms such as sweating and nausea; they also used fewer words to describe their discomfort compared with younger patients. Independent predictors of longer delay were: contacted physician, lacked similarity between experienced and expected symptoms, did not use 911 (older adults), lived alone, and contacted physician (younger adults). Primary care providers need to be aware that elderly persons are more likely to have mild or ambiguous acute myocardial infarction symptoms and education is needed for elderly persons regarding not only acute myocardial infarction symptoms but also rapid, action-centered decisions to attribute symptoms to heart problems and initiate ambulance use." Treatment of noncardiac chest pain of psychological origin. (Curr Treat Options Gastroenterol. 2006) Warning Signs of a Heart Attack (Circulation. 2001) Women’s Early Warning Symptoms of Acute Myocardial Infarction (Circulation. 2003)