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The first 24
While most heart attacks have the same underlying cause, the signs and symptoms can greatly vary from person to person. Consider what happened to Peter Blake of Brookfield.



One day last March, Blake returned from his daily six-mile walk feeling a little sick. "I was going to have dinner, but I wasnít really hungry. That shouldíve been the tip-off to me that something was wrong," he says. "I felt like I had a bad case of heartburn, so I went to lie down. That didnít help, and when I stood up, I felt light-headed and faint."

Blake, who is in his mid-60s, went into another room and sat down, waiting for the discomfort to pass. "After about three hours, it was getting progressively worse," he says, noting there is a history of heart and vascular disease in his family. "My father and brother both suffered from it, so I began to worry this could be a heart attack. I remembered hearing you should take an aspirin, so I did that. Then I told myself it might be a good idea to unlock the front door, in case someone had to come in."

Finally, Blake called 911. "It wasnít an easy decision for me. I kept denying it was my heart," he says.

But it was a heart attack. Brookfield paramedics rushed Blake to the Heart Hospital in Wauwatosa, where physicians discovered a blocked artery leading to his heart and inserted a stent ó a tiny mesh tube used to force the artery to open, allowing blood to flow.

What happened to Blake is not uncommon, says Dr. Javed Tunio, co-chair of cardiovascular services and director of cardiac imaging for Wheaton Franciscan Health Care. "We see it all the time. People feel like they have heartburn or gas and they wait, thinking it will go away, or they donít want to bother their family by telling them about it. That is a mistake."

While some heart attacks are sudden and intense, most start slowly with mild pain or discomfort and get worse over time. "If the blood supply to the heart is cut off for more than a few minutes, heart muscle cells suffer permanent injury. Those muscle cells are never replaced," Tunio says.

Tunio stresses that many heart attacks do involve discomfort in the center of the chest that feels like pressure, squeezing, fullness or pain. "People describe it as severe, as if an elephant was sitting on their chest," he says. "It can be accompanied by shortness of breath, sweating, nausea or light-headedness."

Sally Andersen of Waukesha had a visit from that elephant on May 19, when she experienced the second heart attack of her life. "I had taken my husband to his cardiologist earlier that day. I started to have pains across my back and underarms, followed by very bad pain in my chest. I told my husband I thought I was having a heart attack and so we immediately drove to Waukesha Memorial Hospital," she says.

Fortunately, 82-year-old Andersen recognized right away that she was having a heart attack and reacted quickly. "It was the same feeling I had 16 years ago. I knew I had to get to the hospital right away," she says.

Although Andersen had some of the classic symptoms of a heart attack, many women do not. "Older women in particular may feel very weak, fatigued and nauseous. There can be discomfort in other areas of the upper body, such as the jaw, neck or stomach," says Dr. Imad Katib, interventional cardiologist with ProHealth Care. "Diabetics may also have these unusual symptoms. That is why some patients may not think to mention it.

"People should be aware if these symptoms donít ease up after 10 to 15 minutes, they should talk to someone about it. Call for help. We see people who have waited for two or three days sometimes and they may have severe heart muscle damage by that time," Katib says. "We have a saying that Ďtime is muscle.í The sooner you can get to the hospital, the better our chance of saving heart muscle."

Blake also warns itís better to err on the side of caution. "If you think youíre having a problem, you might end up with no problem, but itís better to call for help. Donít be tempted to brush off the symptoms."

It's a sign

Heart attack symptoms differ widely. One person may have minor pain while another has excruciating pain. The National Institutes of Health describes these warning signs for men and women:

Chest discomfort or pain that feels like pressure, fullness or squeezing in the center of the chest

Upper body pain in shoulders, arms, back, neck, teeth or jaw

Stomach pain that feels like heartburn

Shortness of breath

Anxiety or a feeling of panic

Light-headedness or dizziness

Sweating and cold, clammy skin

Nausea and vomiting

Women may have all, none or a few of the above typical symptoms, according to the NIH. Women are more likely than men to also have heart attack symptoms without chest pain.