Dr. Laura Mosher shares information about the signs and symptoms of a heart attack.
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Heart Attack Signs and Symptoms
Featured Speaker:
Laura Mosher, MD
Dr. Laura Mosher is board certified in interventional cardiology, nuclear cardiology, cardiovascular diseases and adult echocardiography. She has participated in numerous peer groups and written articles on cardiovascular disease. Dr. Mosher’s clinical interests include cardiovascular disease prevention, chronic angina and women’s cardiovascular health. She is a member of the American Heart Association and has served on its board of directors. Transcription:
Heart Attack Signs and Symptoms
Introduction: Here's another edition of the BayCare Health System podcast series, Bay Care Health Chat with Melanie Cole.
Melanie Cole: Welcome. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing heart attacks, signs and symptoms. Joining me is Dr. Laura Mosher. She's an Interventional Cardiologist at BayCare. Dr. Mosher, it's a pleasure to have you join us again today. Let's just start with who is at risk for heart disease and thereby a possible heart attack.
Dr. Mosher: Sure. That's a great question and thanks for having me back on, Melanie, it's great to be chatting with you again. So I think that's a good question as to who needs to be on the lookout for heart disease. And the simple answer is pretty much everyone, heart disease doesn't care your gender, doesn't care your age. We're seeing younger people with heart attacks and people who thought that they were pretty healthy and think, hey, this couldn't happen to me. We see it. And so everyone needs to be on the lookout to know that there is a potential risk. And especially if you have a family history of heart disease in your family, you are probably at a higher risk as well.
Host: When you talk about a family history because that is a cause for some confusion for people. Maybe they had a relative in their 30s that had a heart attack, but maybe it was different circumstances or medical advancements hadn't been made yet. What is family history technically?
Dr. Mosher: Sure. That's a good question. So I typically, when I interview folks in the office or in the hospital, I always ask about is there anyone in your immediate family who's had heart trouble when they were young, like forties, fifties those folks raise a red flag for me and we're talking about mom, dad, brothers, sisters.
Host: Okay, so good. I'm glad that you explained that for us because that's important. People don't know if someone's 85 and they have a heart event, is that still considered it? So other risk factors that people concern themselves with, Dr. Mosher, is stress and diet, things along those lines. Can stress really contribute to heart disease and a possible heart attack?
Dr. Mosher: It most definitely does. Stress is a big player and I think it's really important for women too because women tend to have a very strong mind body connection. And when there's emotional stress it can really play out with physical symptoms and signs. One of our diagnoses in the cardiology field is something called Takotsubo cardiomyopathy and that's looks like a heart attack when the patients come in. But what it is what we call broken heart syndrome. Now it's not a true heart attack per se. Now the way that stress can affect heart attacks is if it raises your blood pressure, it tends to give you an adrenaline surge. It can worsen diabetes control because you're under stress. It also can make people overeat so that they gain weight and that makes blood pressure and diabetes control worse. And occasionally cholesterol levels too. And usually when people are under stress, they're not sleeping well either. And that can affect your heart health as well. So yes, I would say that stress plays a big role in heart disease.
Host: Well that's certainly true for women. And as you mentioned symptoms, we worry about heart disease, we worry about peripheral vascular disease, we worry about having a heart attack, and especially for women. So many of the symptoms that we can discuss mimic other things. They mimic stress that's going on in our lives. They mimic panic attacks, they mimic gas pains. There's so many things people feel chest pains. Now I know women experience a heart attack different than men, and we've heard about the studies from years ago when I was in grad school, we studied t was mostly men, but now we're seeing more women coming up with these kinds of symptoms. Please tell us the symptoms and how in any way can we differentiate heart issues from normal chest pain or things or musculoskeletal. There's so many things that come into play here.
Dr. Mosher: Right, and this is not a simple topic either, is sometimes even physicians are confused and we don't know the answer right away based on a patient's symptoms, it can be very difficult to tease it out, but typically what I would say is that still the number one symptom of a heart attack is chest pain. Regardless of male or female, but you're right, women can have different kinds of symptoms. The things that really raise red flags for us in men and women is going to be chest pain, occasionally associated with shortness of breath or, difficulty exerting yourself, a sweating and some nausea, upper abdominal pain. Those symptoms in association with chest pain really sort of raise red flags for us. Now women don't have to have those symptoms. Sometimes it may feel more like a chest pressure. It can be sort of a dull ache. It could feel more like indigestion or heartburn that just won't go away. Occasionally radiating to the left shoulder or the left arm. Sometimes jaw or neck pain can be a presentation of a heart attack in women. So it can be very atypical symptoms. And I've even seen women come in where they just didn't feel like they could do their normal walking that they normally would do. They felt more fatigued or they felt like they were getting breathless. And that was a sign of coronary disease setting in that they needed to pay attention to.
Host: Well, then Dr. Mosher, is there any way to tell in advance? Are there any gold standard tests? We don't want to wait till we've had the heart attack or some of these symptoms that would signal an impending heart attack. Is there any way besides risk factors that you would test a woman that came in with these kinds of pains? Would you do a stress test? Would you do an echocardiogram? What would you do to see if she does have any of that?
Dr. Mosher: Right? Good question. So I think the important thing is to first go see your doctor. If you notice that something feels different, something doesn't feel right. It's sometimes like you indicated, it's very hard to tell is this just a gallbladder or reflux disease acting up or is this actually my heart? But the important thing is to pay attention to your body and go see your doctor and get it checked out. Now what the doctor will most likely do is an EKG. That's what the stickers on the chest. And we look at the heart electrical activity and we look at the pattern and that can give us a lot of helpful information and that's such a quick and simple test that can be done in pretty much any doctor's office. Other testing you mentioned an echocardiogram is an ultrasound of the heart that looks at the heart valves and the heart chamber sizes and function that can give us very good information about the function of your heart and your heart valves. Not a good test for diagnosing heart attack however. If we think that there's coronary disease, we think there's blockage in the heart arteries, we may do several different kinds of things. We could do a stress test, we could do a cardiac CT scan or we could do a cardiac catheterization, which is also called an angiogram.
Host: So aside from that, and if a woman or a man feels these symptoms, what then? Is this something that is emergent? You get chest pains all the time. And as you mentioned, reflux, that's a really common reason. What do you do? You said go see your doctor, but do you go to the emergency room right away if they're intense or if they last a long time? What are the parameters by which you would call 911 or go to the emergency room?
Dr. Mosher: Right, so I think if someone has a new onset of symptoms that they've never felt before, if it's intense, if it's not going away after a minute or two, I think that it's important to call 911 and go to the emergency room. If you think you're having a heart attack, take some aspirin and get a list of your medications if it's nearby, and then prepare for the ambulance to come and take you to the hospital. I would not drive yourself and I would not have a family member drive you either because if it is in fact a heart attack, the EMS personnel can initiate treatments and call ahead to the ER and let them know that you're coming. That's very important piece of it.
Host: It is and I'm so glad you mentioned that. It's a great point to use EMS because they do have that direct connection to the emergency room. And then what, how will you tell if somebody is actually having a heart attack and what would you like people to know about possibly preventing it?
Dr. Mosher: So when they get to the emergency room, the ER physicians will assess the patient very quickly, check the vital signs, do an EKG and determine if this looks like an emergency heart attack and the patient needs to go suddenly to the catheterization lab. Or is this something where we can do further workup, blood work, if the EKG looks okay, a blood work test called a troponin can be very helpful. If the troponin is elevated, this is an enzyme level that comes from heart muscle. If it's abnormal, then that would indicate that there's some heart damage being done. Now that being said, in an acute heart attack where it's something happening suddenly where the blood vessel shuts down instantaneously, that level is probably not elevated yet, but it should be reflected on the EKG. So all of those tests and the evaluation from an ER physician is very, very important in terms of preventing a heart attack.
I think the most important thing is to know what your risk is and how to control your risk factors. So the risks are diabetes, smoking, high cholesterol, family history, high blood pressure, stress levels and inactivity. Some of those things we can't do anything about. We can't do anything about our family history. It's too late for that for sure. But what we can do is improve our diabetes control, make sure our blood pressure's optimally controlled, make sure our cholesterol levels are optimally controlled, stay healthy, stay at a healthy weight and stay active and to stop smoking if you do smoke. Those are very important steps in terms of preventing, developing heart disease and God forbid a heart attack. And then routine visits with your doctor are very important too to make sure that you're on the right track and you have a healthy plan in place.
Host: Thank you so much, Dr. Mosher. You are a great guest as always in such important information for listeners to hear. It really is. And that concludes this episode of BayCare HealthChat. Please visit our website at baycareheart.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips such that you received on this podcast and updates on the latest medical advancements and breakthroughs. Please follow us on your social channels. I'm Melanie Cole.
Heart Attack Signs and Symptoms
Introduction: Here's another edition of the BayCare Health System podcast series, Bay Care Health Chat with Melanie Cole.
Melanie Cole: Welcome. This is BayCare HealthChat. I'm Melanie Cole and today we're discussing heart attacks, signs and symptoms. Joining me is Dr. Laura Mosher. She's an Interventional Cardiologist at BayCare. Dr. Mosher, it's a pleasure to have you join us again today. Let's just start with who is at risk for heart disease and thereby a possible heart attack.
Dr. Mosher: Sure. That's a great question and thanks for having me back on, Melanie, it's great to be chatting with you again. So I think that's a good question as to who needs to be on the lookout for heart disease. And the simple answer is pretty much everyone, heart disease doesn't care your gender, doesn't care your age. We're seeing younger people with heart attacks and people who thought that they were pretty healthy and think, hey, this couldn't happen to me. We see it. And so everyone needs to be on the lookout to know that there is a potential risk. And especially if you have a family history of heart disease in your family, you are probably at a higher risk as well.
Host: When you talk about a family history because that is a cause for some confusion for people. Maybe they had a relative in their 30s that had a heart attack, but maybe it was different circumstances or medical advancements hadn't been made yet. What is family history technically?
Dr. Mosher: Sure. That's a good question. So I typically, when I interview folks in the office or in the hospital, I always ask about is there anyone in your immediate family who's had heart trouble when they were young, like forties, fifties those folks raise a red flag for me and we're talking about mom, dad, brothers, sisters.
Host: Okay, so good. I'm glad that you explained that for us because that's important. People don't know if someone's 85 and they have a heart event, is that still considered it? So other risk factors that people concern themselves with, Dr. Mosher, is stress and diet, things along those lines. Can stress really contribute to heart disease and a possible heart attack?
Dr. Mosher: It most definitely does. Stress is a big player and I think it's really important for women too because women tend to have a very strong mind body connection. And when there's emotional stress it can really play out with physical symptoms and signs. One of our diagnoses in the cardiology field is something called Takotsubo cardiomyopathy and that's looks like a heart attack when the patients come in. But what it is what we call broken heart syndrome. Now it's not a true heart attack per se. Now the way that stress can affect heart attacks is if it raises your blood pressure, it tends to give you an adrenaline surge. It can worsen diabetes control because you're under stress. It also can make people overeat so that they gain weight and that makes blood pressure and diabetes control worse. And occasionally cholesterol levels too. And usually when people are under stress, they're not sleeping well either. And that can affect your heart health as well. So yes, I would say that stress plays a big role in heart disease.
Host: Well that's certainly true for women. And as you mentioned symptoms, we worry about heart disease, we worry about peripheral vascular disease, we worry about having a heart attack, and especially for women. So many of the symptoms that we can discuss mimic other things. They mimic stress that's going on in our lives. They mimic panic attacks, they mimic gas pains. There's so many things people feel chest pains. Now I know women experience a heart attack different than men, and we've heard about the studies from years ago when I was in grad school, we studied t was mostly men, but now we're seeing more women coming up with these kinds of symptoms. Please tell us the symptoms and how in any way can we differentiate heart issues from normal chest pain or things or musculoskeletal. There's so many things that come into play here.
Dr. Mosher: Right, and this is not a simple topic either, is sometimes even physicians are confused and we don't know the answer right away based on a patient's symptoms, it can be very difficult to tease it out, but typically what I would say is that still the number one symptom of a heart attack is chest pain. Regardless of male or female, but you're right, women can have different kinds of symptoms. The things that really raise red flags for us in men and women is going to be chest pain, occasionally associated with shortness of breath or, difficulty exerting yourself, a sweating and some nausea, upper abdominal pain. Those symptoms in association with chest pain really sort of raise red flags for us. Now women don't have to have those symptoms. Sometimes it may feel more like a chest pressure. It can be sort of a dull ache. It could feel more like indigestion or heartburn that just won't go away. Occasionally radiating to the left shoulder or the left arm. Sometimes jaw or neck pain can be a presentation of a heart attack in women. So it can be very atypical symptoms. And I've even seen women come in where they just didn't feel like they could do their normal walking that they normally would do. They felt more fatigued or they felt like they were getting breathless. And that was a sign of coronary disease setting in that they needed to pay attention to.
Host: Well, then Dr. Mosher, is there any way to tell in advance? Are there any gold standard tests? We don't want to wait till we've had the heart attack or some of these symptoms that would signal an impending heart attack. Is there any way besides risk factors that you would test a woman that came in with these kinds of pains? Would you do a stress test? Would you do an echocardiogram? What would you do to see if she does have any of that?
Dr. Mosher: Right? Good question. So I think the important thing is to first go see your doctor. If you notice that something feels different, something doesn't feel right. It's sometimes like you indicated, it's very hard to tell is this just a gallbladder or reflux disease acting up or is this actually my heart? But the important thing is to pay attention to your body and go see your doctor and get it checked out. Now what the doctor will most likely do is an EKG. That's what the stickers on the chest. And we look at the heart electrical activity and we look at the pattern and that can give us a lot of helpful information and that's such a quick and simple test that can be done in pretty much any doctor's office. Other testing you mentioned an echocardiogram is an ultrasound of the heart that looks at the heart valves and the heart chamber sizes and function that can give us very good information about the function of your heart and your heart valves. Not a good test for diagnosing heart attack however. If we think that there's coronary disease, we think there's blockage in the heart arteries, we may do several different kinds of things. We could do a stress test, we could do a cardiac CT scan or we could do a cardiac catheterization, which is also called an angiogram.
Host: So aside from that, and if a woman or a man feels these symptoms, what then? Is this something that is emergent? You get chest pains all the time. And as you mentioned, reflux, that's a really common reason. What do you do? You said go see your doctor, but do you go to the emergency room right away if they're intense or if they last a long time? What are the parameters by which you would call 911 or go to the emergency room?
Dr. Mosher: Right, so I think if someone has a new onset of symptoms that they've never felt before, if it's intense, if it's not going away after a minute or two, I think that it's important to call 911 and go to the emergency room. If you think you're having a heart attack, take some aspirin and get a list of your medications if it's nearby, and then prepare for the ambulance to come and take you to the hospital. I would not drive yourself and I would not have a family member drive you either because if it is in fact a heart attack, the EMS personnel can initiate treatments and call ahead to the ER and let them know that you're coming. That's very important piece of it.
Host: It is and I'm so glad you mentioned that. It's a great point to use EMS because they do have that direct connection to the emergency room. And then what, how will you tell if somebody is actually having a heart attack and what would you like people to know about possibly preventing it?
Dr. Mosher: So when they get to the emergency room, the ER physicians will assess the patient very quickly, check the vital signs, do an EKG and determine if this looks like an emergency heart attack and the patient needs to go suddenly to the catheterization lab. Or is this something where we can do further workup, blood work, if the EKG looks okay, a blood work test called a troponin can be very helpful. If the troponin is elevated, this is an enzyme level that comes from heart muscle. If it's abnormal, then that would indicate that there's some heart damage being done. Now that being said, in an acute heart attack where it's something happening suddenly where the blood vessel shuts down instantaneously, that level is probably not elevated yet, but it should be reflected on the EKG. So all of those tests and the evaluation from an ER physician is very, very important in terms of preventing a heart attack.
I think the most important thing is to know what your risk is and how to control your risk factors. So the risks are diabetes, smoking, high cholesterol, family history, high blood pressure, stress levels and inactivity. Some of those things we can't do anything about. We can't do anything about our family history. It's too late for that for sure. But what we can do is improve our diabetes control, make sure our blood pressure's optimally controlled, make sure our cholesterol levels are optimally controlled, stay healthy, stay at a healthy weight and stay active and to stop smoking if you do smoke. Those are very important steps in terms of preventing, developing heart disease and God forbid a heart attack. And then routine visits with your doctor are very important too to make sure that you're on the right track and you have a healthy plan in place.
Host: Thank you so much, Dr. Mosher. You are a great guest as always in such important information for listeners to hear. It really is. And that concludes this episode of BayCare HealthChat. Please visit our website at baycareheart.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all the other BayCare podcasts. For more health tips such that you received on this podcast and updates on the latest medical advancements and breakthroughs. Please follow us on your social channels. I'm Melanie Cole.