Heart attack

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Acute MI	Anterior heart arteries	Heart, front view	Heart, section through the middle
Heart attack symptoms	Posterior heart arteries	Post myocardial infarction ECG wave tracings	Progressive build-up of plaque in coronary artery

Myocardial infarction; MI; Acute MI

Chest pain behind the sternum (breastbone) is a major symptom of heart attack, but in many cases the pain may be subtle or even completely absent (called a "silent heart attack"), especially in the elderly and those with diabetes. Often, the pain radiates from your chest to your arms or shoulder; neck, teeth, or jaw; abdomen or back. Sometimes, the pain is only felt in one these other locations.

The pain typically lasts longer than 20 minutes and is not fully relieved by rest or nitroglycerine, both of which can relieve pain from angina.

The pain can be intense and severe or quite subtle and confusing. It can feel like:

• Squeezing or heavy pressure
• A tight band on the chest
• "An elephant sitting on [your] chest"
• Bad indigestion

Other symptoms you may have either alone or along with chest pain include:

• Shortness of breath
• Cough
• Lightheadedness - dizziness
• Fainting
• Nausea or vomiting
• Sweating , which may be profuse
• Feeling of "impending doom"
• Anxiety

During a physical examination, the doctor will usually note a rapid pulse. Blood pressure may be normal, high, or low. While listening to the chest with a stethoscope, the doctor may hear crackles in the lungs, a heart murmur, or other abnormal sounds.

The following tests may reveal a heart attack and the extent of heart damage:

• Electrocardiogram (ECG) -- single or repeated over several hours
• Echocardiography
• Coronary angiography
• Nuclear ventriculography

The following tests may show the by-products of heart damage and factors indicating you have a high risk for heart attack:

• Troponin I and troponin T (proteins involved in muscle contraction)
• CPK and CPK-MB
• Serum myoglobin

Review Date: 11/14/2005
Reviewed By: Steven Kang, MD, Division of Cardiac Pacing and Electrophysiology, Cardiovascular Consultants Medical Group, Oakland, CA. Review provided by VeriMed Healthcare Network.