Overview (Brief about heart attacks)
A heart attack usually occurs when the supply of blood flow is blocked by a blood clot to the heart. Without enough blood and oxygen, the heart can be seriously damaged.
This can cause chest pain and many other symptoms which can lead to a cardiac arrest. Please seek medical attention immediately from a healthcare provider or healthcare professional if this occurs to you or someone else. If the heart attack is not treated immediately, this can cause extensive heart damage.1
A common cause of heart attacks is due to coronary heart disease (CHD). CHD causes your coronary arteries to become narrowed due to a gradual build-up of cholesterol or plaques. When a plaque bursts, a blood clot forms around that area so it can repair the damage to the artery wall. This clot may either cause a partial or total blockage in the coronary artery. This causes the heart muscle to be starved of oxygen and blood, triggering a heart attack.2
Less common causes can include: spontaneous coronary artery dissection, drug misuse and hypoxia (sudden drop in oxygen levels).1
Heart attack symptoms
Can upper back pain be a warning of a heart attack?
Link between back pain and heart attack
Back pain is more likely to be experienced by women. Back pain occurs when the brain is confused about the origin of the pain. So, during a heart attack, oxygen supply to the heart will become limited causing it to be starved of oxygen. This will cause the nerves connecting the heart to the brain to merge with those connecting to the neck and head so the signals get misinterpreted.7
Are women more likely to feel upper back pain?
Women are more likely than men to feel back pain or upper back pain among the other common symptoms of a heart attack. Women do not always feel the classic chest pain when having a heart attack. Instead, they may get breathlessness, nausea, back pain, tightness or discomfort in the arms or a general feeling of being unwell. 42% of women in a large study of 1.1 million people who had heart attacks said they did not feel any chest pain, and those who have been diabetic for a long time may feel the pain differently.5,6
Other signs women shouldn’t ignore
Other common signs of a heart attack that occur in women that should not be ignored:
- Uncomfortable pressure or squeezing or pain in the centre of the chest which may last more than a few minutes or comes and goes
- Pain or discomfort in the one or both arms, neck, back, jaw or stomach
- Shortness of breath with or without chest discomfort
- Cold sweat
The most important test to get if you suspect that you are having a heart attack is an electrocardiogram (ECG). This should be done within the first 10 minutes of being admitted to hospital. An ECG machine records the electrical activity in your heart, as every time it beats it sends an electrical impulse which is recorded onto a paper so doctors and nurses can see your heart’s functionality. The test can take just over 5 minutes to do. They attach electrodes which are flat metal discs which are stuck to your arms, legs and chest.
An ECG is important because it can:
- Confirm the diagnosis of a heart attack
- Determine what type of heart attack type you have had which will crucial to determining the best and most effective treatment for you
Reliable tests or indicators of heart attacks include:
- Blood tests: a sample of your blood will be taken so it can be checked for heart proteins. Blood tests will be done over a few days, and this will allow the damage to your heart to be assessed
- Chest X-rays: these can be done to check for complications because of the heart attack or for other possible causes of your symptoms
- Echocardiogram: scans your heart and builds a picture to identify areas that have been damaged4
- Coronary angiography: it can help find blockages and narrowing in the coronary arteries which can help decide what treatment is best for you
After having tests to determine if you have had a heart attack, this will then be classed into what type of heart attack you have had. This will then determine the type of treatment you will need if you have had a ST segment elevation myocardial infarction (STEMI) or another type of heart attack.
Primary percutaneous coronary intervention (PCI)
A PCI is the term for an emergency treatment for a STEMI as it widens the coronary artery (coronary angioplasty). You may also be given a blood thinning medicine to prevent clots from happening again, such as low-dose aspirin.
Coronary angioplasty is a specialist treatment that can only be done in certain hospitals that have the facilities and specialist staff. You will be taken to a special Heart Attack Centre where this procedure will be done.
During this procedure, where you'll be put under anaesthesia, a tiny tube with a pencil-shaped balloon at the end (balloon catheter) is put into a large artery in your groin or arm. Guided by X-rays, the tube is then passed through the blood vessels and up to your heart. Once the small balloon has reached the narrow space in your coronary artery, it will be inflated to open up the space. Finally, a flexible metal mesh (stent) is inserted into the artery to keep it open.
Medicine to break down blood clots
Medicines such as thrombolytics or fibrinolytics are used to break down blood clots via injections. They destroy the substance called fibrin which is a tough protein that makes up the blood clots and it acts like a sort of fibre mesh that hardens around the blood.
Or, you may be given a glycoprotein llb/llla inhibitor if you have a high risk of experiencing another heart attack in the future. Although this medication prevents blood clots, it will not dissolve them if they form but is an effective way to prevent your symptoms from worsening.
Coronary artery bypass graft
An alternative to a coronary angioplasty is a coronary artery bypass graft. This is used when you have abnormal anatomy of your arteries. This is because there are too many narrow sections in your arteries or many branches coming from your arteries that are also blocked.
This procedure involves taking a blood vessel from another part of your body, usually your chest, leg or arm. It would be attached to your coronary artery above and below the narrowed area or blockage, creating what is called a graft. Grafts diverts blood around narrowed and clogged areas of your arteries to your heart.
Other treatments can include lowering your blood pressure and cholesterol, losing weight, reducing or not smoking, eating a healthy and balanced diet, and exercising.3
What to do if you have symptoms of heart attack?
If you or someone else is experiencing symptoms of a heart attack, please seek medical attention immediately as heart attacks are a serious medical emergency.
Do the following:
- Call 999 for an ambulance
- Sit down and stay calm or help the other person to sit down slowly
- Take an aspirin if you have one within reach
- Wait for the paramedics or ambulance to arrive, and do not attempt to drive yourself to the hospital1
Common heart attack symptoms include nausea, tightness or pain in your chest, cold sweats and pain in your jaw, neck or back. For women, this will be the same except women are more likely to experience back pain. Back pain occurs due to the nerves connecting the heart, brain, neck and head lacking in oxygen, so confusing the body on the source of pain. If you are suffering from a heart attack or its symptoms, please seek medical help and call 999. The quicker you get seen and treated, the less damage caused to your heart.
- Heart attack [Internet]. British Heart Foundation. 2022 [cited 14 July 2022]. Available from: https://www.bhf.org.uk/informationsupport/conditions/heart-attack
- Heart attack [Internet]. nhs.uk. 2022 [cited 14 July 2022]. Available from: https://www.nhs.uk/conditions/heart-attack/
- How do I check my pulse? [Internet]. nhs.uk. 2022 [cited 14 July 2022]. Available from: https://www.nhs.uk/common-health-questions/accidents-first-aid-and-treatments/how-do-i-check-my-pulse/
- diagnosing a heart attack [Internet]. nhs.uk. 2022 [cited 14 July 2022]. Available from: https://www.nhs.uk/conditions/heart-attack/diagnosis/
- Canto J, Rogers W, Goldberg R, Peterson E, Wenger N, Vaccarino V et al. Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality. JAMA. 2012;307(8).
- Heart Attack & Stroke Symptoms [Internet]. Jean Hailes. 2022 [cited 24 July 2022]. Available from: https://www.jeanhailes.org.au/health-a-z/cardiovascular-health/symptoms-of-heart-attack-stroke-in-women
- Why a woman having a heart attack may complain of back pain rather than chest pain [Internet]. Norton Healthcare. 2022 [cited 24 July 2022]. Available from: https://nortonhealthcare.com/news/back-pain-heart-attack/#:~:text=Upper%20back%20pain%20can%20be,heart%20attack%2C%20especially%20in%20women.
- How I learned heart attacks in women are different [Internet]. Norton Healthcare. 2022 [cited 24 July 2022]. Available from: https://nortonhealthcare.com/news/heart-attack-in-women/