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Physician Referral Online
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Awareness of symptoms and warning signs critical

Television and movies have us believing that heart attack symptoms always involve dramatic chest clutching and reports of feeling like an elephant's sitting on your chest. While many people do have these symptoms, a large percentage of heart attack patients report other less "classic" symptoms like shortness of breath, weakness, dizziness and indigestion as this new study reports.

We have known for a long time that up to 50 percent of women may experience atypical symptoms with a heart attack. This is one of the first studies reporting that almost equal numbers of men may also present with atypical symptoms.

Heart attack symptoms
In the Emergency Department (ED) at Yale-New Haven Hospital (YNHH), we often have patients who present with symptoms other than chest pain—profound weakness, dizziness, indigestion or shortness of breath—that prompt the physician or nurse to obtain an immediate EKG and look for evidence of heart disease.

Diagnosis is tricky
Many of the tools we have such as initial blood tests and EKGs are not sufficient to tell us for sure if the patient's symptoms are related to heart disease. That's the primary reason we opened our Chest Pain Center, a four-bed unit that adjoins the ED. Usually in less than 12 hours we can perform a series of tests, including repeated blood work, EKGs and exercise tolerance tests to identify those patients with heart disease.

Only a small percentage of the patients in the center actually turn out to have heart problems, and they can be identified and treated quickly. The majority of our patients go home without a diagnosis of heart disease. However they often have risk factors for heart disease such as smoking, high blood pressure, diabetes and high cholesterol levels. These patients are referred back to their primary care physicians to continue treatment and counseling for risk factor modification.

Delay can be deadly
Awareness of heart attack symptoms is important because delay in treatment can cause sudden death or more severe heart damage. Here at YNHH we implemented the Women's Heart Advantage program to promote awareness, particularly among women who often delay treatment. This comprehensive campaign educates women, physicians and the general public about the symptoms of heart disease, actions to take when experiencing these symptoms and the importance of risk factor identification.

Everyone needs to be aware of subtle changes in their health that may signal an impending heart attack. When our cardiac clinical nurse specialist, Janet Parkosewich, talks to patients about their heart attack experience, the majority report feeling a new sensation, different than usual, a few weeks or days before their heart attack. These feelings led to more intense and continuous heart attack symptoms.

Because these early symptoms are subtle and fleeting, they are often attributed to stress, being out of shape or indigestion. You may dismiss them as unimportant and not call your health care provider to have them checked out. But if you have any recurring symptoms such as dizziness or shortness of breath, you need to go to your doctor. He or she may send you for emergency treatment or they may order diagnostic tests to assess your health.

If you feel something is definitely wrong with you, you need to call 9-1-1 and get to the ED as soon as possible.

Know your risk factors
Symptom awareness is important, but heart disease isn't sudden. It's a process that develops over many years. That's why identifying your risk factors is critically important.

If you smoke, are overweight or have high blood pressure, high cholesterol, diabetes or a family history of heart disease, you need to see a physician. Your doctor can help you lower your risk of developing heart disease by prescribing medications and offering information or referral for lifestyle changes regarding diet, exercise or smoking cessation.

Seeking help for any subtle changes in your health can be the key to keeping you away from the emergency department, but don't procrastinate. Be assertive, know your risk factors for heart disease, visit your doctor for help in managing your health, pay attention to your body, know the symptoms of a heart attack and seek emergency help quickly if you need it.

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Dr. D'Onofrio is an emergency physician at Yale-New Haven Hospital and an associate professor in the section of emergency medicine at the Yale School of Medicine.