Heart Attack Chest Pain Location

Overview

According to the World Health Organization, cardiovascular diseases (CVD) are the leading cause of death in the world. About 18 million people die from CVD all over the world, and two-thirds of these diseases occur due to heart attacks and strokes, with one-third of deaths occurring in people younger than 70 years of age.

About heart attack

Myocardial infarction, commonly known as a heart attack, occurs when part of the heart can not receive enough oxygen either due to hypoxemia, spasm or blockage of arteries and results in death or necrosis of the heart muscles.¹

It is a medical emergency, and you should immediately seek medical attention if you experience any symptoms related to a heart attack.

Like every organ, the heart needs an uninterrupted supply of oxygenated blood to function correctly. Coronary arteries arising from the ascending aorta carry the oxygenated blood to the heart. 

Any disruption in the blood supply increases the stress on the heart, and lack of oxygen to the myocardial cells can result in the death of these cells and lead to ischaemia and, ultimately, infarction. 

A person then experiences different signs and symptoms of the heart attack, such as moderate to severe chest pain (angina), sweating and shortness of breath.

Pathophysiology of Heart Attack

Coronary artery disease is most commonly caused by the buildup of atherosclerotic plaques. The fat and cholesterol deposits along the walls of the vessels and form fatty streaks.

Inflammation plays an essential role in the pathogenesis of atherosclerosis. Endothelial cell dysfunction results in the accumulation of cholesterol (LDL) and macrophages in the intima (innermost layer of a blood vessel) and forms foam cells. 

These foam cells accumulate and release cytokines and growth factors, resulting in smooth muscle migration and further buildup of cholesterol and macrophages. Thus the atherosclerotic plaque grows in size and narrows the arteries.²

In some cases, the blood supply can also be reduced by the spasm of the coronary arteries.

Common causes

Coronary artery disease (CAD), also known as ischaemic heart disease (IHD), is the most common cause of heart attack in the UK and worldwide. 

Over time, fatty streaks form along the walls of coronary arteries. Certain risk factors can result in the formation of atherosclerotic plaque, which breaks and forms blood clots which can occlude the arteries and decrease the blood supply. 

These risk factors are classified into modifiable and non-modifiable.³

Non-Modifiable Risk Factors.

These risk factors can not be altered by altering your lifestyle habits and are thus named non-modifiable. 

• Age
• Gender
• Family History

Modifiable Risk Factors.

A sedentary lifestyle and unhealthy eating habits can raise the risk of cardiovascular diseases. No exercise, low physical activity, eating fast food rich in cholesterol, and taking high-sugar carbonated drinks can cause some conditions that can increase the risk of a heart attack. 

Making specific lifestyle changes can dramatically reduce the risk of plaque formation and coronary artery disease. Therefore, these risk factors are termed modifiable risk factors. 

Common examples are:

• Dyslipidemia ( high cholesterol levels)
• Hypertension ( high blood pressure)
• Diabetes Mellitus
• Smoking
• Hypoxia

Symptoms

Plaques are formed gradually over the years. However, a person never experiences a heart attack until there is complete occlusion of one or more branches of the coronary arteries. Some people experience stable angina when there is more than 70% occlusion or unstable angina if there is ischaemia.

Some of the common symptoms of heart attack are:⁴

• Chest pain that doesn't go away on rest
• Chest pain radiating towards the lower jaw, neck, arms ( left arm commonly) and back
• Sweating
• Shortness of breath
• Cold, clammy extremities
• Feeling faint
• A sense of impending doom can also be experienced by some people 
• Atypical symptoms such as abdominal pain and nausea also occur in diabetics and women

These symptoms may not be present in a heart attack, and it's important to remember that everyone reacts to pain differently. As diabetes can damage nerves and alter how you perceive pain, this is a common occurrence in the elderly or those with the disease.

Diagnosis

The initial and most crucial step in diagnosing a heart attack in an emergency is recording the heart's electrical activity via a 12-lead ECG machine.

Ischaemia or infarction can disrupt the electrical activity of the heart. It is noted in the ECG that heart attack can be diagnosed immediately. Patients can then be referred for PCI or thrombolysis.

However, in some cases, ECG changes are insignificant, and other necessary investigations will be needed. These include:

• Serial ECGs to note the changes in the heart's electrical activity
• A detailed history of signs and symptoms and identifying cardiovascular disease risk factors
• Blood tests, such as the levels of Trop I. Trop I is a cardiac enzyme. Death of myocardial cells releases this enzyme in the blood, and its levels rise gradually. They can be detected after four hours of the onset of symptoms
• Echocardiograms can also be helpful in some cases as it uses ultrasound to see the image of the heart
• Cardiac catheterization. This technique passes a flexible tube through peripheral arteries to inject the dye
• Coronary angiogram uses an x-ray to detect the dye injected via cardiac catheterization to see the blockage of the arteries

When to seek medical attention

A heart attack is a medical emergency and requires acute management. Failing to do so will result in fatal complications and, eventually, the death of a person. 

If you experience any of the symptoms mentioned above and have the risk factors, you must seek medical attention.

Heart attack and chest pain

Remember that not all chest pains are heart attacks. It can also be musculoskeletal, due to trauma to the chest wall, or caused by some underlying pulmonary disease. Hence, it is essential to understand if your chest pain is a heart attack.

How to know if your chest pain is a heart attack? 

Not only a heart attack but several other conditions can result in chest pain. Following are some indicators that your chest pain could be the result of a heart attack:

• A feeling of pressure, fullness, or squeezing in the middle of the chest
• Spreading ache or chest discomfort to the arms, neck, jaw, or back
• Having chest pain that is accompanied by nausea, shortness of breath, or sweating
• Chest pain that lasts longer and doesn't go away on resting
• Fatigue, weakness, lightheadedness, dizziness, fainting, or an irregular heartbeat are additional signs of a heart attack

If the chest pain is related to cough then pulmonary disease is suspected and if it is related to eating then gallstones can be suspected. Similarly, pain on empty stomach can be a result of acid reflux.⁵  

Panic attack also presents in the simialr manner and ECG or the history of stress can be helpful in ruling out the heart attack in such cases. The patient will have a normal ECG. 

Heart attack chest pain location

Cardiac pain most commonly occurs in the centre of the chest or toward the left side. You feel like someone is squeezing or crushing your chest or heart. The pain, however, may also radiate towards the jaw, neck, left arm, or both shoulders.

Is heart attack pain in one spot?

Typical heart attack pain occurs in the chest. However, it can radiate to different parts of the body:

• The cardiac chest pain radiates towards:Neck
• Lower jaw
• Both shoulders 
• Both arms but commonly towards the left arm.
• Back

How to manage chest pain from heart attack?

Call 999 or your local emergency medical services immediately if you think you or someone else may be having a heart attack. Do not let uncertainty prevent you from seeking assistance. 

The patient should take a seat, relax, and maintain composure. At the same time, they wait for emergency medical assistance. 

Taking nitroglycerin or aspirin if available or prescribed by your doctor can reduce the damage to the heart. These are vasodilators and blood thinner, respectively and can improve the blood supply.⁶

Tips to recover from heart attack chest pain

• If you experience chest pain or other signs of a heart attack, seek emergency medical help immediately
• Consider making the lifestyle changes your doctor advises, such as giving up smoking and eating a balanced diet, in addition to the prescriptions you are given
• As advised by your doctor, exercise regular physical activity to enhance cardiovascular health and lower your risk of developing another heart attack
• Reduce emotional stress by using stress-reduction techniques like yoga, meditation, or deep breathing exercises
• Keep your cholesterol and blood sugar levels in check
• Follow your doctor's advice regarding medication and dietary changes, like quitting smoking and adopting a healthy lifestyle7
• As advised by your doctor, get regular exercise to increase your cardiovascular fitness and lower your risk of heart attacks in the future

Summary

A heart attack is a medical emergency and has fatal complications. It is crucial to understand the signs and symptoms of a heart attack.

This will help you to seek medical care immediately if you experience typical chest pain or have any risk factors.