Heart Attack and Stroke Symptoms

Dr. Mike
3 days ago
6 min read

Updated: 3 days ago

Summary

In 2023:
- 1 in 3 people died from cardiovascular disease, including heart attack and stroke.
- While 3 people have a heart attack every 2 minutes in the U.S., 1 in 5 people who had a heart attack may not know.
Heart Attack Symptoms may include chest pain/pressure, shortness of breath, and/or jaw/neck pain, though there are other important symptoms provided below.
Stroke Symptoms may include facial drooping, arm weakness, and difficulty with speech, though there are other important symptoms provided below.

This document is provided for educational and informational purposes only and is not intended as, nor should it be construed as, medical advice. The information contained herein is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your physician or other qualified healthcare provider before starting, stopping, or changing any medication, supplement, or treatment plan.

Why Care about Heart Attack and Stroke?

According to the Centers for Disease Control, one person dies every 34 seconds from cardiovascular disease, which includes heart attack and stroke. In 2023, approximately 1 in 3 people died from cardiovascular disease, with 1 in 6 of those deaths being in people younger than 65 years old. Every two minutes, three people have a heart attack. Importantly, roughly 1 in 5 heart attacks are silent. So, unfortunately, heart attacks are all too common and many won't even know they had one? It is essential for you to learn heart attack and stroke symptoms for you and those around you.

Stylized graphic of hand over heart suggestine Levine's sign, which is associated with heart-related pain.

Heart Attack Symptoms

There are some symptoms which are common with heart attacks, such as a chest pain or discomfort. However, many people can have heart attacks without chest pain. They may have other symptoms such as jaw, neck, or back pain. Some may also have an arm or shoulder pain. Some, such as diabetics, may only have shortness of breath and may not have pain, though others may get the shortness of breath with their chest pain. However, when listing these symptoms, it is very important to know that everyone is different and there is NO PERFECT ANSWER to what symptoms a person experiences with a heart attack. I have practiced long enough that I have seen a surprising constellation of symptoms ultimately related to a heart attack. The short answer is to always call 911 if you are scared and think you may be having a heart attack.

Heart Attack Symptoms

Chest pain/discomfort

Shortness of breath

Jaw, neck, or back pain

Other Symptoms

Anxiety

Nausea/vomiting

Lightheadedness

Table 1. Heart Attack Symptoms

For some, anxiety, nausea, vomiting, and lightheadedness are prominent symptoms of the heart attack, which may be seen more often in women. Importantly, the most common symptom for a heart attack in women is the same as men, which is chest pain. Unfortunately, these symptoms are seen in many other scenarios, so they can be very confusing for patients and physicians alike. It is always best to be cautious and let your physician know of changes in your health and promptly seek medical attention if your symptoms have changed.

Heart Attack Signs

When a physician is evaluating a patient who may be having a heart attack, they may see very concerning signs such as a cold sweat, rapid or irregular heartbeat, markedly abnormal breathing, pale appearance, or even loss of consciousness.

Details Matter

When your physician is working with you to review your symptoms, they will want to know details you may not realize are important. These include:

What were you doing when the symptoms started?
How long have they lasted?
What symptoms were together, at the same time? For example, chest pain may be felt with shortness of breath.
What made the symptoms better?

Some people get symptoms that gradually worsen and slowly build over days or weeks. You may get a brief chest twinge when doing hard work, but days or weeks later you develop longer lasting, more painful chest pains with lighter activity, possibly with worsening shortness of breath. This scenario is very important to convey to your doctor, as it may indicate a concerning situation in your heart. Some may not see the change in severity as readily, as they may decrease or stop doing activities which create the symptoms. For instance, they may have been able to push mow the entire lawn without stopping, but now have to take 2 or 3 breaks because otherwise they get chest pain while mowing. Again, let your doctor know if this sounds similar to what you are experiencing.

Heart Attack Prevention

A variety of factors can aid in potentially preventing heart attacks:

Aggressive blood pressure control (<130/80 mmHg)
Risk Assessment – Tools such as AHA PREVENT to risk stratify
Risk-based cholesterol treatment
Regular exercise of either
- >150 minutes/week of moderate-intensity (brisk walk @ 3.5 mph or bicycling 10 mph)
- >75 minutes/week of vigorous-intensity (jogging, running, swimming laps)
Weight management
- Diabetes prevention
- Obstructive sleep apnea prevention
Optimize diabetes management, ensuring metformin is first-line and consider newer agents
Smoking cessation

Heart Attack Prevention in Women

In addition to the above items of prevention, women need to be aware they have a number of unique factors which can increase their cardiovascular risk and, if enough factors are present, are as important as knowing you have an abnormal coronary calcium score over 100. Risk is also increased with systemic inflammation, autoimmune disorders, and breast cancer. Of note, the inclusion of menopausal hormone therapy in Table 3 is nuanced and warrants its own blog post discussion. Briefly, greatest risk is attributed to oral formulation, administration more than 10 years after menopause, and when patient age is over 60 years old. Lastly, "risk" is important to understand, as there can be "absolute risk" and "relative risk", so this will need to be another blog post, otherwise this long post would become unbearable.

Age at menarche (early is <12 yo and late is >16 yo)	Infertility (>12 mos without success)	Premature menopause (<40 yo)
Exogenous hormones (e.g., oral contraceptives & menopausal hormone therapy)	Miscarriages	Premature ovarian insufficiency (<40 yo)
Gestational diabetes	Polycystic ovarian syndrome	Preterm delivery (<37 weeks)
Gestational hypertension (≥140/90 mmHg after 20 weeks without proteinuria)	Preeclampsia (≥140/90 mmHg after 20 weeks with proteinuria)/eclampsia	Small for gestational age at birth (<10^th percentile)

Table 2. Risk Enhancers of CV Risk in Women. Three or more conveys similar risk to CAC ≥100.

Download the official Evexeya Health form used to assess these cardiovascular disease risk factors in women. Even if you don't have an Evexeya Health physician, you can fill out this form and take it to your own physician to ensure they have the information.

Stroke

While cardiologists such as myself don’t take care of a person actively having a stroke, as that patient is typically cared for by a neurologist, cardiologists are involved in disease prevention that can influence stroke prevention and cardiologists are often involved in caring for patients if they are found to have had a heart problem that caused the stroke.

Stroke Symptoms

Essential warning signs of stroke (FAST):

F – Face Drooping – Is one side of the face drooping? Ask the patient to smile and look for asymmetry.

A – Arm Weakness – Is one arm weak? Are they able to hold their arms up in front of them?

S – Speech Difficulty – Is speech slurred?

T – Time to call 911 – Do not wait! Every minute counts.

Other symptoms include numbness, especially on one side of the body, confusion, difficulty with vision, walking, balance, or coordination, or a severe headache. Women may be more likely than men to manifest stroke as general weakness, disorientation, memory problems, fatigue, or nausea/vomiting.