Each year *1.1 million Americans experience a heart attack: *460,000 of them are fatal. Of those who die, almost half do so suddenly, before they can get to a hospital. Although a heart attack is a frightening event, if you learn the signs of a heart attack and what steps to take, you can save a life - perhaps even your own.


WHO IS AT RISK

Many people think that heart attacks are a "man's problem," yet heart disease is actually the number one killer of both men and women in the United States. In men, the risk for heart attack increases significantly after the age of 45. In women, heart attacks are more likely to occur in the years after menopause (usually after the age of 50) However, younger men and women can also have heart attacks. Besides age, factors that increase the risk for heart attack are:

• A previous heart attack or procedure to open up the
  coronary arteries
• Family history of early heart disease:
  • Father or brother diagnosed before age 55
  • Mother or sister diagnosed before age 65
• Diabetes mellitus
• High blood cholesterol
• High blood pressure
• Cigarette smoking
• Overweight
• Physical inactivity

If you have one or more of these factors, see your health care provider to find out how to reduce your risk of having a heart attack.

*From the Department of Emergency Medicine, Virginia Commonwealth University's Medical College of Virginia, Richmond (J.P.O.) and the National Heart Attack Alert Program, National Heart, Lung, and Blood Institute. National Institutes of Health, Bethesda, MD (M.M.H.) Correspondence to Dr Joseph Ornato, Dept. of Emergency Medicine, Virginia Commonwealth University's Medical College of Virginia, Richmond, VA.


LEARN THE SIGNS

Many people think that a heart attack is sudden and intense, like the "Hollywood" heart attack depicted in the movies, where a person clutches his or her chest and falls over. The truth is that many heart attacks start as a mild discomfort in the center of the chest. Someone who feels such a warning may not be sure what is wrong. The discomfort (and other symptoms) may even come and go. Even people who have had a heart attack may not recognize the signs, because the next one can have entirely different symptoms. The warning signs of a heart attack are shown below. Learn them, but also remember: even if you're not sure it's a heart attack, you should still check it out promptly.

Heart Attack Warning Signs

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing or fullness.
• Discomfort in other areas of the upper body. Symptoms can include discomfort in one or both arms or in the back, neck, jaw, or stomach.
• Shortness of breath. This symptom often accompanies chest discomfort. However, it can also occur before the chest discomfort.
• Other signs may include breaking out in a cold sweat, nausea, or light-headedness. Some patients report a sense of impending doom.

PLAN AHEAD

Make a plan now for what you would do if a heart attack should happen. It will save you time and could help save a life. To plan ahead:

• Learn the heart attack warning signs listed in this article.
• Talk to your doctor about your heart attack risk and what you can do to reduce it. Ask specifically about aspirin and the use of nitroglycerin.
• Talk with your doctor, family members, friends, and coworkers about the heart attack warning signs and the importance of acting fast. Discuss the benefits of calling 9-1-1 instead of going to the hospital by car. Knowing what to do if a heart attack occurs could save your life or theirs.

For more information on lowering your risk of heart disease, check out the following National Heart, Lung and Blood Institute websites:

http://www.nhlbi.nih.gov/health/public/heart/index.htm: a directory of heart disease prevention and treatment information for patients and the public.

http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm: a patient brochure, "High Blood Cholesterol - What You Need To Know"

http://hin.nhlbi.nih.gov/atpiii/calculator.asp: a 10-year heart attack risk calculator

http://www.nhlbi.nih.gov/chd/index.htm: a "Live Healthier, Live Longer" website for patients and the public.