È indigestione o un attacco di cuore?

What are the signs of a heart attack?

A attacco di cuore occurs when one of the arteries to the heart gets completely blocked. This means the part of the heart supplied by that artery is starved of oxygen-rich blood, and the muscle is at risk of dying without medical help. The sooner the treatment, the more muscle you can save.

‘The most common sign of a heart attack is a severe, constricting, heavy pain in the chest,’ says consultant cardiologist Dr Andrew Archbold from BMI L'Ospedale Indipendente di Londra. ‘It’s usually a diffuse pain starting in the centre or left of the chest, often radiating out into one or sometimes both arms, or into the jaw.’

However, Dr Archbold says it’s not a pain that you could point at with one finger and say ‘it hurts here’ like you could with a pulled muscle. Nor does it usually appear on its own – people having a heart attack often feel sick (and might even vomit), feel sweaty, clammy or breathless. Some say they also experienced a feeling of dread or doom.

Because the pain experienced during a heart attack cannot be specifically located, and can often be mild, it can be confused with other sorts of chest pain such as indigestion or angina.

Angina is an early warning sign that your arteries are narrowing. Its primary symptom is chest pain so the first time you experience it, you may think you’re having a heart attack.

‘Angina starts on exertion, but fades quickly with rest,’ says Dr Archbold. If your symptoms started when you were sitting still, don’t reduce when you rest or (if you’ve already been diagnosed) don’t stop after you’ve used your normal angina treatment, call an ambulance.

Indigestion also has very similar symptoms to a heart attack and may be the cause of your chest pain, particularly if you’ve had a very large or spicy meal in the hour before symptoms start. ‘Even doctors can’t always tell the difference without doing an EEG or a blood test, but it’s better to be safe than sorry,’ says Dr Archbold.

No – and this is when things get complicated. ‘About 10% of people get an atypical presentation where they feel chest pain but it’s not bad enough to immediately seek help,’ says consultant interventional cardiologist Dr Kamal Chitkara of BMI The Park Hospital in Nottingham. ‘This is particularly common in people with diabete where the nerves can sometimes alter sensation so pain isn’t felt as acutely.’

Those who have had slowly progressing malattie cardiache also don’t always get a severe pain. Dr Archbold says, ‘If you’ve had a progressive narrowing of the arteries, your body will actually create new channels, called collaterals, through which blood flows. During a heart attack – when that narrowed artery finally blocks – the collaterals still work, reducing your symptoms such as chest pain.’

Women, particularly pre-menopausal women, also don’t necessarily present with heart attacks in that ‘chest clutching’ way you see in movies. In fact, a study published in the journal Circulation found only 30% of women had traditional chest pain symptoms, and in many cases it was more of an ache than a pain.

Instead, they had symptoms such as shortness of breath, weakness, nausea, stomach upset or back pain, which is extremely hard to diagnose as a heart attack. Extreme fatigue in the month before the attack was found to be the most common symptom – if you suddenly find you can’t do normal tasks, like make a bed without needing a rest, see a doctor urgently.

Always call 999 if you’re worried – the main reason people die from a heart attack is not seeking help soon enough. ‘If you suspect you’re having a heart attack, and can safely take aspirin, chew and swallow one tablet (ideally 300mg) as that can start to thin the blood. Then lie down with your head propped up and wait for help to arrive,’ says Dr Chitkara.

Don’t go hunting for any aspirin if you don’t have some nearby; the exertion of climbing stairs to the bathroom cabinet could put extra strain on your heart. Stay calm and remember that help is on its way.

Once they receive professional medical care, most people who have a heart attack make a full recovery. Within a few months you should be back on your feet and back to normal life.