How to... spot a heart attack

HOW TO - 28TH JUNE 2017

Dr Robert Smith, consultant cardiologist at Royal Brompton & Harefield Hospitals, on what to do if you suspect someone is having a heart attack, the differences in symptoms between men and women, and how to mitigate your own risk of an attack

Firstly, what is a heart attack?
It is a blockage of the coronary arteries, resulting in a lack of blood getting to the heart muscle. The normal mechanism by which a heart attack occurs is that coronary plaque within an artery ruptures, resulting in a clot.

How does this present?
The symptoms can vary quite significantly. People imagine that if there is no crushing chest pain or pressure like an elephant sitting on their chest, it can’t be a heart attack—but it can. Other symptoms may include a dull ache in the chest or pain in the arms, shoulders and jaw. It is important to state these do not have to be on the left side, as people might think.

Will there always be pain, though?
No, and this an important point. Some patients, particularly diabetics, may not feel any pain at all. They may, though, be suddenly hit by a profound sweating and nausea. They will also usually look extremely unwell. One of the things clinicians always ask is: “Do they look like they are having a heart attack?” Because they will look dreadful as well as feeling dreadful.

Can heart attacks present differently in women and men?
They can. We do often see differences in the way that men and woman describe heart attacks but this is not always the case and any symptom can be reported by either gender. We also see racial differences, which can often relate as much to language and culture than to clinical or physiological differences. We tend to find that the ‘crushing central chest pain’ classically used to refer to heart attack symptoms is most commonly seen in Caucasian men. Importantly, though, we try not to generalise and treat each patient as an individual rather than based on their sex or racial background. Generally, irrespective of the nature of pain that is being described, a patient having a heart attack will look unwell.

What should you do if you suspect someone is having a heart attack?
Obviously the first thing is to call the emergency services. Then sit them down so they are comfortable, and stay with them. we would normally advise that you do not give aspirin or over the counter drugs. If appropriate, the paramedics will give aspirin when they arrive, and you don’t want to complicate the issue with extra drugs. If the patient is feeling faint, encourage them to lie down to prevent them from falling and improve blood flow to the brain.

Is there any value in trying to take them to the hospital?
No, unless in exceptional circumstances, do not attempt to take them to hospital yourself. Call the emergency services and stay with them, taking note of any changes in condition that occur. That way, if the person has passed out by the time the ambulance arrives, you can offer a rundown of events. If you try to drive, you can get stuck in traffic, you can’t travel at the speed the ambulance can. Also, you will be highly stressed while attempting to drive at high speeds, increasing the chances of an accident. Most importantly, if the patient becomes unwell en route, you will not have resources or the expertise to treat or resuscitate them. The greatest chance of survival in this circumstance, if not in hospital, will be in the back of an ambulance with a qualified paramedic team. So, keep things simple and call 999.

What can you do to mitigate your risk of a heart attack?
Get a check-up with your doctor. Check your cholesterol, blood sugar and blood pressure. It is also very important to inform your GP if there is a history of heart disease in the family. If you are worried, go and talk to your GP about the appropriate tests and do a little investigation into your family background. Also, don’t worry if the results are not perfect. Often changes to your lifestyle, with or without medication, can lower the risk of heart disease substantially in the longer term.

For more information, visit RB&HH Specialist Care