Knowing Heart Attack Signs

N E W   Y O R K, Feb. 22, 2001 -- Every morning while you are still asleep, your body experiences an adrenaline rush that helps it get revved up for the day. Most of us slumber through, ignorant of the ongoing biochemistry, but for people with coronary artery disease that morning rush can produce the scariest wake-up call of their lives.

For Bob Utecht the call came in 1996, when his body awakened him at 4 a.m. with a pain he believed was indigestion. The discomfort persisted for a couple of hours, as his skin grew clammy and his wife got more worried. By 7 a.m., she insisted he go to the hospital.

Utecht, 62 at the time, thought she might be overreacting, but was willing to humor her. He soon discovered he owed her his life.

"I didn't think it was serious," says the now-retired Poughkeepsie, N.Y. resident. "Until the ER doctors told me I was in the middle of a heart attack." The adrenaline rush had raised his blood pressure, rupturing the vulnerable, cholesterol-filled plaques lining his coronary arteries and cutting off the oxygen supply to his heart muscle.

Not All Attacks Classic

According to Dr. Randolph Martin, professor of cardiology at Emory University in Atlanta, Ga., Utecht's experience with an early morning heart attack is quite common. While many heart attack victims experience classic symptoms — such as an intense, ballooning chest pain, which radiates up to the arms, neck and eventually even teeth — up to a third of attacks have atypical signs, or are "silent."

Martin explains that the signs of a heart attack can vary from person to person, with women and diabetics usually more likely to experience subtle symptoms that make it difficult to recognize an attack is taking place. Those symptoms include abdominal pain, dizziness, unexplained anxiety, weakness, fatigue, palpitations and cold sweating.

"Women often present with extreme shortness of breath," says Emory's Martin. Instead of the chest pains that men tend to feel, female heart attack victims often experience an onset of intense nausea and abdominal pains, sweating, breathlessness and even vomiting.

These symptoms start suddenly and build up into a crescendo in a matter of minutes. "It's not a gradual thing," says Martin.A heart attack occurs when the blood supply to part of the heart muscle, or myocardium, is severely reduced or stopped when one or more of the coronary arteries that supply blood to the heart muscle is blocked. The blockage is usually from the buildup of plaque, along the artery wall. The plaque then tears or ruptures, triggering a blood clot to form that blocks the artery and leads to an attack.

If the blood supply is cut off severely or for a long time, muscle cells suffer irreversible injury and die. The death of too much muscle can prove fatal to attack victims. Doctors still don't know why attacks manifest differently in women, but they do know the risk accelerates in females after menopause when their bodies stop producing estrogen, which has protective effects. In fact, heart attacks and strokes are the number one killer of American women, according to the American Heart Association.

In the case of diabetics, "silent" attacks usually occur because the diabetes affects victims' nerves, diminishing their ability to feel the symptoms. "Women, especially if they're diabetic, must be extra careful," warns Dr. David Myerson, national spokesman for the American Heart Association.

He urges anyone experiencing suspicious symptoms to head for an emergency room as early as possible.

Won't Be Laughed Out of ER

"If you get to an emergency room soon enough you can literally stop the attack," says Myerson. "I have never seen anyone at an emergency facility laugh at a person who came in because of chest pains that did not turn out to be an attack."

In other words, better safe than sorry.

"It's not uncommon to find people who don't know they had an attack," agrees Emory's Martin.

Another thing to pay attention to, he says, is the time you are experiencing symptoms. Because most heart attacks take place between 4 a.m. and 10 a.m. when blood pressure fluxes are most dramatic, it's especially important to respond immediately if you are awakened by inexplicable or unfamiliar pains.

Bob Utecht can attest to that. Until the fateful morning when he woke up in pain, he believed he was healthy. Five years and one bypass later — with his eating and exercise habits completely revised — he knows better.