Understanding High Mortality in Heart Attacks: Signs, Gender Differences, and Prevention

A heart attack, also known as a myocardial infarction, is a life-threatening medical emergency that occurs when the blood flow to the heart muscle is blocked, causing damage or death of the heart cells. Heart attacks are one of the leading causes of death worldwide, and they can strike anyone, regardless of age, gender, or lifestyle. However, many people are unaware of the warning signs of a heart attack, or they may ignore or dismiss them as something less serious. This can delay the diagnosis and treatment of the condition, and increase the risk of complications and death.

In this article, you will learn about:

  • The High Risk of Death from Heart Attacks
  • How to Recognize the Signs of a Heart Attack
  • Silent Heart Attacks: When There is No Chest Pain
  • How Men and Women Experience Heart Attack Symptoms Differently
  • What to Do If You Suspect a Heart Attack
  • How to Prevent Heart Attacks in Your Daily Life
  • Frequently Asked Questions
    • Can stress cause a heart attack?
    • Can you have a heart attack while sleeping?

Table of Contents

The High Risk of Death from Heart Attacks

Heart attacks are one of the leading causes of death worldwide, claiming millions of lives every year. A heart attack occurs when the blood supply to a part of the heart muscle is blocked, usually by a blood clot. This can damage or destroy the heart tissue, impairing the heart’s function and potentially causing fatal complications. The sooner a heart attack is diagnosed and treated, the better the chances of survival and recovery. However, many people fail to recognize the signs of a heart attack and delay seeking medical attention, putting their lives at risk.

The reason lies in the fact that, apart from chest pain, there are many other warning signs of a heart attack. However, the general public is often unaware of these symptoms, mistaking them for other conditions, leading to delayed medical intervention. Dr. Evangelos Giannitsis, a physician at Heidelberg University Hospital in Germany, emphasizes that for every 30-minute delay in seeking treatment from the onset of symptoms, there is a 7.5% increase in the one-year mortality risk, underscoring the critical importance of timely medical care.

How to Recognize the Signs of a Heart Attack

The most common symptom of a heart attack is chest pain or discomfort, which may feel like pressure, squeezing, tightness, or heaviness. The pain may last for more than a few minutes, or come and go intermittently. However, chest pain is not always present or severe, and some people may experience no chest pain at all. Therefore, it is important to be aware of other possible signs of a heart attack, which may vary depending on the individual, the location and extent of the blockage, and the duration of the attack.

In addition to pain in the chest, discomfort may be felt in other areas such as the jaw, neck, arms, stomach, or back. Symptoms may also include weakness, shortness of breath, dizziness, sweating, and vomiting. It’s challenging because a considerable proportion of heart attacks have no clear warning signs. According to a 2011 multinational study, one-third of women and about one-fourth of men experience a heart attack without any symptoms, remaining unaware of their condition. These are called silent heart attacks, and they can be just as dangerous as those with obvious symptoms.

Silent Heart Attacks: When There is No Chest Pain

One of the most common misconceptions about heart attacks is that they always cause severe chest pain. However, some people may experience mild or no chest pain at all, especially women, older adults, and people with diabetes. These are called silent heart attacks, and they can be just as dangerous as the ones with obvious symptoms.

A silent heart attack occurs when the blood flow to the heart muscle is reduced or blocked, but the person does not feel any pain or discomfort in the chest. Instead, they may have other symptoms, such as:

  • Discomfort in the jaw, neck, arms, stomach, or back
  • Shortness of breath
  • Weakness
  • Dizziness
  • Sweating
  • Nausea
  • Vomiting

Some people may not have any symptoms at all, or they may mistake them for indigestion, acid reflux, or a minor illness. A 2016 study published in the journal Circulation found that up to 45% of heart attacks are silent, meaning that the person is unaware of having a heart attack. Silent heart attacks are more common in men than in women, and they are more likely to occur at night or during sleep.

Silent heart attacks can have serious consequences, such as heart failure, arrhythmias, or sudden cardiac death. They can also increase the risk of having another, more severe heart attack in the future. Therefore, it is important to recognize the signs of a silent heart attack and seek medical attention as soon as possible.

How Men and Women Experience Heart Attack Symptoms Differently

Heart attacks are not only a leading cause of death for both men and women, but they also affect them differently. Research has shown that there are gender differences in the symptoms, causes, and outcomes of heart attacks. Understanding these differences can help improve the prevention, diagnosis, and treatment of heart disease in both sexes.

One of the most notable differences is the prevalence and type of chest pain during a heart attack. Chest pain is the most common symptom of a heart attack, but it is not always present or severe. A 2011 study published in the Journal of the American Medical Association found that women are more likely than men to have heart attacks without chest pain, especially younger women. The study also found that women have a higher proportion of other symptoms, such as fatigue, nausea, dizziness, fainting, neck pain, jaw pain, and arm pain. These symptoms may be mistaken for other conditions, such as anxiety, stress, or menopause, leading to delayed medical care and worse outcomes.

Men, on the other hand, are more likely to have chest pain as the main symptom of a heart attack, but they may also have no symptoms at all. About one-third to one-fourth of men may have silent heart attacks, which are often detected later by an electrocardiogram (ECG) or blood test. The absence of symptoms may prevent men from seeking medical attention, resulting in more damage to the heart muscle and a higher risk of complications. The average delay between the onset of symptoms and the arrival at the hospital is 2 to 5 hours for both men and women, but it can be longer for those with atypical or no symptoms.

Another difference between men and women is the underlying cause of heart attacks. The most common cause of heart attacks is coronary artery disease (CAD), which is the narrowing or blockage of the arteries that supply blood to the heart. CAD is more prevalent and develops earlier in men than in women, partly due to hormonal and genetic factors. However, women are more likely to have other causes of heart attacks, such as coronary microvascular disease (CMD), which is the dysfunction or spasm of the small blood vessels in the heart. CMD is often overlooked or misdiagnosed, as it may not show up on standard tests, such as angiography or stress tests.

Finally, there are differences in the outcomes and survival rates of heart attacks between men and women. Women tend to have worse outcomes and lower survival rates than men, especially younger women. A 2019 study published in the European Heart Journal found that women are less likely than men to receive guideline-recommended treatments, such as aspirin, beta-blockers, statins, or revascularization, after a heart attack. Women are also more likely to experience complications, such as bleeding, heart failure, or stroke, after a heart attack. The study suggested that these disparities may be due to the under-recognition, under-diagnosis, and under-treatment of heart disease in women, as well as the lack of gender-specific research and guidelines.

What to Do If You Suspect a Heart Attack

Heart attacks are medical emergencies that require immediate attention and treatment. However, many people do not seek medical help when they experience the symptoms of a heart attack, either because they are unaware of them, they do not think they are serious, or they do not want to bother others. A recent qualitative study published in the Journal of Cardiovascular Nursing4 interviewed 30 women who had survived a heart attack and found that only half of them sought medical attention when they felt unwell. The other half either ignored, denied, or rationalized their symptoms, or they waited for them to go away. Some of the reasons they gave for not seeking help were:

  • They did not know the symptoms of a heart attack or did not think they applied to them.
  • They attributed their symptoms to other causes, such as stress, anxiety, indigestion, or infection.
  • They did not want to alarm their family or friends, or they did not have anyone to ask for help.
  • They did not want to go to the hospital or call 911, or they did not have access to transportation or insurance.
  • They hoped their symptoms would resolve on their own, or they tried to treat them with home remedies.

The study highlighted the need for more education and awareness about the symptoms and risks of heart attacks, especially among women and other groups that may have atypical or silent symptoms. It also emphasized the importance of seeking medical help as soon as possible, as every minute counts when it comes to saving the heart muscle and preventing complications. Here are some steps to take if you suspect a heart attack:

  1. Call 911 or your local emergency number. Do not drive yourself or have someone else drive you, unless there is no other option. An ambulance can provide faster and safer transportation, as well as life-saving treatment on the way to the hospital.
  2. Take aspirin, if advised by the emergency operator or a health care provider. Aspirin can help prevent blood clots and reduce the damage to the heart muscle. However, do not take aspirin if you are allergic to it, or if you have a bleeding disorder or a stomach ulcer.
  3. Take nitroglycerin, if prescribed by your doctor. Nitroglycerin can help widen the blood vessels and improve blood flow to the heart. However, do not take nitroglycerin if you are taking medications for erectile dysfunction, such as sildenafil (Viagra) or tadalafil (Cialis), as this can cause a dangerous drop in blood pressure.
  4. Stay calm and rest. Try to relax and breathe slowly and deeply. Sit or lie down in a comfortable position. Do not exert yourself or do any physical activity that may worsen your symptoms or strain your heart.
  5. Inform someone nearby. If you are alone, try to contact a family member, a friend, or a neighbor, and let them know your situation and location. They may be able to assist you or call for help if you lose consciousness.

Remember, the sooner you get treatment for a heart attack, the better your chances of survival and recovery. Do not ignore, delay, or downplay your symptoms. Trust your instincts and get help right away.

How to Prevent Heart Attacks in Your Daily Life

Heart attacks can be prevented by adopting a healthy lifestyle that includes regular exercise, a balanced diet, and stress management. Some of the specific recommendations are:

Exercise: Physical activity helps to improve blood circulation, lower blood pressure, and strengthen the heart muscle. It also reduces the risk of obesity, diabetes, and high cholesterol, which are all risk factors for heart attacks. According to the American Heart Association, adults should aim for at least 150 minutes of moderate-intensity aerobic exercise or 75 minutes of vigorous-intensity aerobic exercise per week, or a combination of both. Some examples of aerobic exercises are walking, jogging, swimming, and cycling. However, people with existing heart conditions should consult their doctor before starting an exercise program and avoid activities that involve sudden or extreme exertion, such as push-ups, sit-ups, and weightlifting, as these can increase the strain on the heart and trigger a heart attack.

Diet: A heart-healthy diet consists of eating more fruits, vegetables, whole grains, nuts, seeds, and lean proteins, and limiting the intake of saturated fats, trans fats, sodium, added sugars, and alcohol. These foods provide essential nutrients, antioxidants, and fiber that can lower inflammation, cholesterol, and blood pressure, and prevent plaque buildup in the arteries. Some of the foods that are particularly beneficial for preventing heart attacks are:

Food group Examples Benefits
Vegetables Rapeseed, onions, bell peppers, basil, perilla, scallions, ginger, garlic, carrots, mustard greens, and broccoli Contain phytochemicals, such as flavonoids, carotenoids, and glucosinolates, that have anti-inflammatory, anti-oxidant, and anti-cancer properties
Fruits Pineapple, purple grapes, pomegranate, dates, papaya, apples, citrus fruits, and berries Rich in vitamin C, potassium, and polyphenols, such as resveratrol, quercetin, and anthocyanins, that can modulate blood pressure, platelet aggregation, and endothelial function
Nuts Walnuts and almonds High in unsaturated fats, fiber, protein, magnesium, and vitamin E, that can lower LDL cholesterol, improve insulin sensitivity, and reduce oxidative stress
Alpha-linolenic acid (ALA) Flaxseed oil, sage seed oil, perilla oil, mustard seed oil, and walnuts A type of omega-3 fatty acid that can inhibit inflammation, thrombosis, and arrhythmia, and protect the heart from ischemic injury

Stress: Stress can have a negative impact on the heart by increasing the levels of cortisol and adrenaline, which can raise blood pressure, heart rate, and blood sugar, and cause blood vessels to constrict. Chronic stress can also lead to unhealthy coping behaviors, such as smoking, drinking, overeating, and physical inactivity, which can further increase the risk of heart attacks. Therefore, it is important to manage stress by practicing relaxation techniques, such as deep breathing, meditation, yoga, and tai chi, or engaging in hobbies, such as reading, listening to music, gardening, or playing games. Seeking professional help, such as counseling or therapy, may also be helpful for some people who experience severe or persistent stress.

Frequently Asked Questions

Can stress cause a heart attack?

Stress is a well-known risk factor for heart attacks. When a person is under stress, the body releases hormones, such as cortisol and adrenaline, that prepare the body for a fight-or-flight response. These hormones can increase the heart rate, blood pressure, and blood sugar levels, and cause the blood vessels to narrow. These changes can impair the blood flow to the heart and damage the heart muscle. Moreover, chronic stress can lead to unhealthy habits, such as smoking, drinking, overeating, and sedentary lifestyle, that can worsen the cardiovascular health. Therefore, it is essential to manage stress by finding healthy ways to cope, such as relaxation, exercise, social support, and professional help.

Can you have a heart attack while sleeping?

Yes, it is possible to have a heart attack while sleeping. Although the body’s metabolism and blood pressure are lower during sleep, the underlying causes of heart attacks, such as plaque buildup, blood clots, or spasms in the coronary arteries, can still occur at any time. In fact, some studies have found that the risk of heart attacks is higher in the early morning hours, between 6 a.m. and noon, due to the changes in the circadian rhythm, hormonal levels, and blood viscosity. However, the symptoms of a heart attack during sleep may be less obvious or more easily ignored, such as chest discomfort, shortness of breath, sweating, or nausea. Therefore, it is important to seek immediate medical attention if one suspects a heart attack, even during sleep, as delaying treatment can result in more damage to the heart or death.

Reference

  • American Heart Association. (2020). American Heart Association Recommendations for Physical Activity in Adults and Kids. 
  • Mayo Clinic. (2019). Heart attack prevention: Should I avoid secondhand smoke? 
  • Liu, R. H. (2013). Health-promoting components of fruits and vegetables in the diet. Advances in nutrition, 4(3), 384S-392S.
  • Chong, M. F. F., Macdonald, R., & Lovegrove, J. A. (2010). Fruit polyphenols and CVD risk: a review of human intervention studies. British Journal of Nutrition, 104(S3), S28-S39.
  • Ros, E., & Hu, F. B. (2013). Consumption of plant seeds and cardiovascular health: epidemiological and clinical trial evidence. Circulation, 128(5), 553-565.
  • de Lorgeril, M., & Salen, P. (2004). Alpha-linolenic acid and coronary heart disease. Nutrition, metabolism and cardiovascular diseases, 14(3), 162-169.

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