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A heart attack results from a blockage in the coronary arteries that supply blood and oxygen to the heart muscle. These obstructions usually develop over a period of time as plaque and fatty deposits build up inside the walls of the arteries.

iStockphoto

QUESTION

A friend recently had a heart attack. His main symptoms were vomiting and sweating profusely. I thought a heart attack produced really severe chest pain. How are you supposed to know if you're having a heart attack?

ANSWER

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The most common sign of a heart attack is, indeed, chest pain. But not everyone feels the same thing. Like your friend, some people have other symptoms. And, unfortunately, they may not realize they are having a heart attack and so delay seeking potentially life-saving medical treatment.

The challenge of recognizing a real heart attack arises from the fact that the heart doesn't have the same level of pain sensors found in some other parts of the body, such as the surface of skin, says Dr. Harindra Wijeysundera, an interventional cardiologist at Sunnybrook Health Sciences Centre.

"A lot of patients think of pain as being sharp – a stabbing-like discomfort they get when they cut themselves," he explains.

Heart attack pain can be different. It may feel like a pressure or tightness and general discomfort. It's sometimes described as an "elephant standing on your chest." The discomfort can radiate up to the neck and jaw or down the left arm. These are the typical symptoms of a heart attack and they usually include shortness of breath.

Others may experience non-typical symptoms such as an upset stomach or a feeling resembling heartburn. They may actually vomit and be extremely sweaty even though they are not hot. They can also feel lightheaded.

And, in some cases, the person notices only one symptom, while others feel an array of them.

To further muddy the waters, the pain or discomfort may not seem extremely bad. Many people think a heart attack will produce "severe, overwhelming, stop-you-in-your-tracks chest pain," Wijeysundera says. That isn't always the case.

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Not so long ago, it was thought that women were less likely than men to experience the crushing chest pain associated with a heart attack.

"But, to be honest, I think there is so much individual variability that I am not sure the gender differences stand up," says Dr. Stephanie Poon, a staff cardiologist at Sunnybrook. "Women can certainly feel heart attacks the same way as men." It's just impossible to predict how any particular person is going to feel when a heart attack happens.

A heart attack results from a blockage in the coronary arteries that supply blood and oxygen to the heart muscle. These obstructions usually develop over a period of time as plaque and fatty deposits build up inside the walls of the arteries. If left unchecked, an artery may become completely blocked. In some cases, the plaque ruptures or tears, causing the formation of a clot that immediately stops or hinders blood flowing to a part of the heart, thereby damaging the vital organ.

"For a lot of people, it is very much a progression and there are a lot of warning signs before they actually have a heart attack," Poon says.

"As the blockages get bigger and bigger, the supply of blood and oxygen to the heart muscle is decreasing as well," she explains. That means the individual may no longer be able to do daily activities – such as walking up a flight of stairs – without feeling winded or having some chest tightness.

"If you feel you're slowing down because you're always out of breath or getting chest tightness, you should go see your family physician," Poon says. "Hopefully, the doctor can begin preventive measures that nip the problem in the bud."

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But sometimes people ignore the warning signs, or the preventive measures are not enough to stop the inevitable and a heart attack still happens.

"If you are feeling really unwell, having chest tightness, shortness of breath, feel sweaty or very nauseated and it goes on for 15 or 20 minutes, or gets worse, then you should call 911 for EMS [Emergency Medical Services] to take you to the hospital," Poon says.

Don't try to drive yourself. "You can pass out at the wheel and have an accident," she warns.

"I often tell my patients to seek medical attention even if they are unsure they are having a heart attack," Wijeysundera says. "It's better to err on the side of caution because a heart attack is such a serious condition and unfortunately our warning symptoms are not always that great."

Paul Taylor is a patient navigation advisor at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook's Your Health Matters.

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