Every Second Counts

Dr. Yasin Jamali Danesh MD, Assistant Professor of Emergency Medicine and Specialist Emergency Medicine Specialist at Iranian Hospital Dubai raises awareness on what to do in the event of a heart attack

Different things can cause chest pain or discomfort, many of which are not serious. Having chest pain does not necessarily mean you are having a heart attack. But because chest pain can be a sign of a heart attack, it is important to seek help and get treatment as quickly as possible.

When to seek help

If you have chest pain that is new, severe, prolonged, or worrisome, call for an ambulance immediately (in the UAE, call Dubai Corporation for Ambulance Services ‘DCAS’ 998). The Emergency Medical Services (EMS) personnel in the UAE community are well prepared to dispatch rapidly and will take you to the nearest hospital. If it turns out that you are having a heart attack, every minute is important, and the faster you get to a hospital, the sooner you can receive treatment.

Do not drive yourself to the hospital and do not ask someone else to drive you. Calling for an ambulance is safer than driving for two reasons:

Chest pain causes

Chest pain generally originates from one of the organs in the chest (heart, lung, or esophagus) or from the components of the chest wall (skin, muscle, or bone). Occasionally, organs near the chest, such as the gall bladder or stomach, can cause chest pain. Pain in the chest may also be the result of ‘referred pain’ from the neck or shoulder joint.

Depending upon the cause, chest pain can have varying qualities (sharp, dull, or burning pressure, tightness or squeezing) and can be located in one or several areas (middle of the chest, upper or left chest, back, arms, jaw, neck, or the entire chest area). Pain may worsen with activity and improve with rest, and there may be other symptoms (sweating, nausea, rapid heart rate and/or shortness of breath).

Angina — Heart-related chest pain

All organs and tissues in the body require oxygen and nutrients, which is carried in the blood. The heart pumps oxygen and nutrient-rich blood through a huge network of arteries throughout the body, which includes vessels that supply blood to the heart muscle. These vessels, called coronary arteries, lie on the surface of the heart and branch into smaller vessels located within the muscle .

Angina is the term for chest pain caused by ischemia. Angina is particularly common during physical activity, when the heart rate and pressure are increased due to the heart's demand for more oxygen. Angina develops if the demand for oxygen exceeds the amount of oxygen delivered to the heart muscle by the coronary arteries.

Heart attack — A heart attack, or myocardial infarction (MI), occurs when the surface covering of a fatty plaque ruptures in heart vessels . A blood clot (also called a thrombus) can form on the plaque, which can partially or completely block the artery. This blockage slows or blocks blood flow to the area of heart muscle fed by that artery. If this continues for more than 15 minutes, the muscle can become damaged or ‘infarcted’ (which means that the tissue in that area dies). A person having a heart attack may feel chest discomfort that is similar to an episode of angina, but more prolonged and intense.

Symptoms of a heart attack — Most people think that a heart attack is sudden, intense, and dramatic, but this is not always true. Many heart attacks start slowly as mild pain or discomfort, which builds in intensity with time. It is common for a person with a heart attack to have other symptoms, such as discomfort in one or both arms, back, neck, jaw, or stomach, shortness of breath, breaking out in a cold sweat, nausea, or light-headedness. However, some heart attacks occur without these symptoms.

The best advice for anyone with chest pain is to seek help immediately. Every minute that passes between the start of the attack and getting treatment means increased loss of heart muscle.

In emergency department, the healthcare provider will ask you about your pain, whether it feels like tightness, pressure, discomfort, or sharp pain, how severe it is and whether certain activities make it better or worse, where the pain is located, and whether it radiates to other areas, such as your neck, throat, jaw, or arms. They will also ask about any other symptoms you have. There are also several different tests that are used to determine the cause of chest pain including :

Electrocardiogram — An electrocardiogram (ECG) depicts the progress of the electrical wave through various parts of the heart muscle. In people with ischemic chest pain, there are often changes in the ECG. A normal ECG means that a heart attack is less likely, but it does not rule out angina or a heart attack.

Blood tests — Blood tests, including tests to measure troponin, creatine kinase (CK), or CK-MB, can be used to measure certain enzymes normally found in the heart muscle. During a heart attack, these enzymes leak out of the heart into the blood. Tests of cardiac enzymes are usually repeated over the course of several hours. And if the result are positive or contradictory, the patient should be visited by cardiologist in ER or in outpatient clinic for further diagnostic tests and management such as Exercise Stress Test , Cardiac echocardiogram and coronary artery catheterization ( coronary angiogram ) .

One final advice, your healthcare provider is the best source of information for questions and concerns related to your medical problem.