Can Heart Attack Symptoms Last For Months?

What is a heart attack?

Heart attack, otherwise known as myocardial infarction, is one of the most common causes of death worldwide. About 3 million people each year have a major cardiac event called a STEMI/ complete blockage of arteries, or acute ST- elevation Myocardial infarction. Furthermore, around 4 million patients have a NSTEMI/ partial blockage, or non-ST- elevation, according to the British Heart foundation. 

It is now increasingly seen in undeveloped countries. There is a lot of research being done with regards to the diagnosis, management, treatment and recovery from an acute cardiac event. This has resulted in earlier detection and better therapies. Research suggests that many factors are responsible for an emerging epidemic of coronary heart disease such as obesity, diabetes, certain lifestyle modifiable factors such as smoking, dyslipidemia, hypertension, abdominal obesity, and diabetes in men (94% in women). Typically partial or complete coronary artery blockages due to plaques that are capable of rupture account for 70% of fatal cardiac happenings. This process reduces circulation of blood in the heart by reducing coronary artery flow through epicardial narrowing of passages, as well as by a process called embolization by thrombus. A surgery is usually the mode of treatment for stenoses and other cardiac issues are treated with thrombotic and antithrombotic medications. Coronary spasm, emboli, or dissection of the coronary artery are primary causes of infarction in the absence of occlusive atherosclerosis, and are seen in 5–10% of patients with STEMI and in 10–15% of patients with NSTEMI. Imaging techniques such as MRI and CT scan help with risk assessment, along with genetic history of the patients can help with preventing disease. A heart attack is a major event that causes a lot of scarring and damage to the heart. It is important to err on the side of caution and be aware of symptoms and red flags. ¹

Causes and risk factors

There are many causes and risk factors for myocardial infarction with identifiable and modifiable risk factors, such as: 

• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Obesity
• A physically inactive lifestyle

There are many acute and chronic factors that may lead to a heart attack, some of which are irreversible. The irreversible and chronic factors associated with myocardial infarction include:

• Age
• Gender
• Genetics  

Other factors include hyperlipidemia, smoking, diabetes mellitus, hypertension, obesity, and lack of exercise. These factors are modifiable and if they are alleviated, it can help reduce the risk and reverse the progression of cardiac diseases. They can also prevent future cardiac events and cardiac failure.

There are also acute factors like morning hours and external triggers. It is said that internal trigger mechanisms (which can be biochemical, vasoconstrictive and prothrombotic) can create prothrombosis, and other coronary syndromes like heart attack, stroke and cardiac failure. Prevention of these triggers includes regular exercise, lifestyle modifications like eating heart healthy foods, and in some cases, medications. Reducing blood flow and vulnerability to plaques can be dealt with antiplatelet, antithrombotic, and antiarrhythmic agents. 

Atherosclerosis proceeds through a formation of fatty streak and a formation of a non vulnerable plaque to a vulnerable plaque that can cause a heart attack. Regular monitoring of symptoms and a pretty straightforward approach to risk factors like regular exercise, smoking cessation, statins for cholesterol, gemfibrozil and ace inhibitors as pharmacologic agents, dietary modifications, antioxidants and thiazolidinediones for obesity will make sure that risk factors are taken care of.

Overall, a heart-healthy diet, being Active and cardiac rehabilitation programs are the ABCs of heart health. ^2,3

Symptoms of a heart attack

Symptoms of a heart attack can include:

• Chest pain or discomfort
• Arm pain
• Sweating, including cold sweats
• Shortness of breath
• Nausea
• Vomiting
• Heart palpitations
• Weakness 

Chest pain may radiate from the left arm up to the neck.

Accurately estimating a heart attack is important to improve mortality, morbidity, complications of AMI and decreasing size of infraction in terms of patient management, disease recovery and healthcare costs. Accurate diagnosis is necessary, especially as some patients may develop different heart attack symptoms.

Typical symptoms

Typical symptoms include chest pain, chest discomfort, and heaviness/pressure. Women present typical symptoms but this does not increase with age like men. Typically 85% of heart patients report chest pain (radiating or in a place), changes in breathing or other respiratory signs (in 35% of patients), and diaphoresis (in 18.3% of patients). 

Atypical symptoms

These heart attack symptoms have been noticed in elderly patients with acute myocardial infarction. These include dyspnea, syncope with exertion, palpitations with effort, abdominal complaints, Chronic fatigue, unexpected behaviour and no prominent chest pain. There is also less pain in the left arm, right arm and neck. There might also be sudden shortness of breath. There can also be pain due to indigestion, epigastric or abdominal pain, back or jaw tightness of pain, nausea, vomiting and a general feeling of unwellness.⁴

Can heart attack symptoms last for months?

Women experience heart attack symptoms that are vague and not typical. This delays their health care seeking and puts them at risk for mortality and morbidity. It is said that heart attack symptoms present themselves months ahead of time. Some of these red flags include and can be described by the acronym CURBS which stands for Chest sensation or pain,  unusual fatigue, radiating pain to back jaw or arm, breathing difficulties and sweating. Some symptoms that can manifest 1 year ahead would be FACTSS: Fatigue,anxiety, Chest discomfort, tummy indigestion, shortness of breath, and sleeping difficulties. 

Diagnosis

A heart attack can be diagnosed by various heart attack symptoms. Irregular heartbeat called arrhythmias, plaques and other heart problems can be detected with the following tests: 

Electrocardiogram (ECG or EKG)

This records the electrical activity with electrodes attached to the skin.

Cardiac enzymes test

A lab blood test to detect if there is a leakage of key enzymes that detects if there is a disease associated with it. 

X-ray

Chest X-ray for the heart, blood vessels and presence of fluid in the lungs ²

Echocardiogram

This identifies the area of the heart where the dysfunction lies. It is an extremely reliable method to detect myocardial infarction associated with heart abnormalities. This is a non-invasive procedure and is able to detect even minor cardiac anomalies like regional cardiac dilation which is responsible for an increase in mortality.

CT scan

This technique produces a high-definition picture of the heart and blocked blood vessels/ coronary arteries. There are two types of CT scan: coronary CT angiogram and coronary artery calcium scan. ³

Magnetic Resonance Imaging

This shows a clear image of the heart, including the artery lumen and artery wall. MRI can measure plaque burden and constituents.

Treatment

Treatments for heart attacks include: drugs like aspirin,beta-blockers, thrombolytic therapy, anti-arrhythmic drugs, calcium channel blockers,statins and ACE inhibitors. Angioplasty and coronary bypass grafts are surgical procedures for the treatment of heart attacks.

Recovery

Recovery takes days, weeks and several months after a heart attack. It depends on several factors like diet, and lifestyle. A cardiac rehabilitation program is a must. It is important to follow medication. It is important to keep fit and eat a healthy diet, strict adherence to cardiac medications, and follow-up appointments with physicians and cardiologists. It is required to be physically active, and increase knowledge about cardiovascular health. Changing lifestyle habits by quitting smoking, avoiding fast and fried foods, eating heart-healthy foods and reducing sugary drinks is also helpful. ⁵

Prevention

Prevention is better than cure. Heart disease has lots of risk factors like smoking, drinking alcohol, high levels of stress, and poor nutrition combined with eating fatty food. Obesity, diabetes, hypertension, eating uncooked food, and high cholesterol are also linked to cardiovascular disease risk. A person is also at a higher risk if he has an immediate family member with heart disease. Identifying these risk factors and being proactive is the first step in achieving success and mastery over heart disease. Physical activity, eating healthy and nutritious food, taking care of weight gain, and regular health checkups can help prevent heart disease. ⁶

When to see a doctor

It is key to understand the difference and it is thought that if the symptoms go away it is probably unimportant. Shortness of breath and excessive sweating are signs that the problem is heart related. For more information please visit the British Heart Foundation for additional resources.

Summary

It is difficult to live a quality life with risk factors of CVD and AMI. It is advisable to monitor symptoms ahead of time, be proactive about risk factors, better manage cardiac rehabilitation programs, and be more aware of cardiac disease in general. Heart attacks are much like a silent scream from the heart and are not a minor crisis. This increase in knowledge and awareness is the first step for change. You have two choices. Prevention and cure. Prevention is always the better choice.