If you think someone is having a heart attack, call 911 and have the patient chew an adult aspirin (325 mg) or four baby aspirins. While the Food and Drug Administration does not recommend aspirin for primary prevention of a heart attack, the use of aspirin here is for treatment of a potential heart attack, not prevention.
Heart attack symptoms
The main symptom is chest pain, which most people don’t have trouble recognizing. However, there are a number of other, more subtle, symptoms such as discomfort or pain in the jaw, neck, back, arms and epigastric, or upper abdominal areas.
Others include nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). Less than one-third of people know these other major symptoms, yet some studies find that as much as 35 percent of patients do not present with chest pain as their primary complaint.
There has been a raging debate about whether men and women have different symptoms when it comes to heart attacks. Several studies speak to this topic.
Men vs. women
There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack. In a Swedish study of 54,000 heart attack patients, a significantly greater number of women died in hospital or near-term after having a heart attack when compared to men.
The women received reperfusion therapy, artery opening treatment that consisted of medications or invasive procedures, less often than the men.
One theory about why women are treated less aggressively when first presenting in the ER is that they have different and more subtle symptoms.
Women’s symptoms may include pain in the lower portion of the chest or upper portion of the abdomen and may have significantly less severe pain that could radiate or spread to the arms. But, is this true?
Not according to several studies.
In one observational study of approximately 2,500 patients, all of whom had chest pain, there were some subtle differences in pain, but it was of a similar nature.
There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain, and duration.
Of these, there was some small amount of divergence: The duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.
This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack.
In the GENESIS-PRAXY study of a younger population, with the median age of 49 for both men and women, results showed that chest pain remained the most prevalent presenting symptom for both.
However, of the patients who presented without distinct chest pain and with less specific EKG findings, more were women than men. If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific.
What have we learned? The simplest lessons are that most patients have chest pain, and that both men and women have similar types of chest pain. However, this is where the simplicity stops. The percentage of patients who present without chest pain varies significantly depending on the study.
Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women.
When it comes to heart attacks, suspicion should be based on the same symptoms for both sexes.