Is It a Heart Attack or a Stroke? Know the Signs, Save a Life

By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.

Your arm, neck, and jaw ache. A coworker had some similar symptoms before his heart attack, but you hesitate because you did a lot of extra weekend chores. Thinking you’re just sore and out of shape, you pop some ibuprofen and settle down for some evening television.

All afternoon, you’ve had a bad case of the dropsies and trouble focusing your eyes. You vaguely remember reading that those could be signs of a stroke, but you decide to take a nap and see if you wake up feeling better.

So, were these folks correct in their actions?

Heeding the Signs Saves Lives

As these examples demonstrate, knowing the signs of a heart attack or stroke isn’t always as clear cut as you would hope. Making the call for an ambulance is automatic when someone collapses in front of you. But when symptoms are more subtle, people tend to second-guess themselves—worrying more about what sort of commotion it might cause than about their long-term health.

I tell anyone who’s faced this decision that it’s always better to be safe than sorry. See a doctor and get a trained opinion. As I’ll discuss in this article, heart attacks and strokes are not events you should gamble on – losing could literally cost you your life.

What Is a Heart Attack?

A heart attack (or myocardial infarction, its clinical name) occurs when one of the arteries leading to the heart becomes blocked, and blood can’t flow through it. Without oxygen and nutrients from fresh blood, the part of the heart that’s been cut off becomes distressed and dies.

The blockages that lead to heart attacks are caused by blood clots. Occasionally the clots travel to the heart from other areas of the body, such as the legs or lungs, but usually they’re the result of long-term atherosclerosis (hardening of the arteries) and a sudden plaque rupture.

Clots form when the plaque in a narrow, hardened artery wall is put under too much stress and breaks apart. The body perceives this as an injury, and sends macrophage cells and proteins to repair it. However, the presence of these extra cells makes the already narrow passageway even more crowded—causing the platelets and fibrin in the blood to begin sticking together, forming a clot.

Highway construction is a good analogy for this. If you’re driving on a four-lane interstate where three lanes are closed, it puts a lot of stress on the lane that’s still open. If that lane suddenly develops a pothole, the road crew needed to fix it will cause traffic to stop altogether.

The longer the heart tissue goes without oxygen, the more of it dies. This “scarred area” disrupts the electrical signals that previously traveled through it, and reduces the heart’s pumping ability.

Signs You May Be Having a Heart Attack

The most important thing to know about the signs of a heart attack is that they can be dramatically different in women than in men. Men tend to be more prone to the chest-clutching “Hollywood heart attack” seen in movies and television. Signs of a heart attack in women (and heart disease in general) often are more subtle.

Signs of a Heart Attack in Men:

  • Chest pain
  • Pain in the neck, arm, or jaw
  • Rapid or irregular pulse
  • Shortness of breath
  • Anxiety / sense of doom
  • Nausea/vomiting
  • Light-headedness / dizziness
  • Fatigue / weakness
  • Sweating
  • Feeling of having to burp

Signs of a Heart Attack in Women:

  • Discomfort, pressure, or pain in the chest and/or back
  • Tingling or pain in the jaw, elbow, or arm
  • Shortness of breath and/or lightheadedness with exertion
  • Sudden, profound fatigue
  • Tightness in the throat
  • Dizziness and/or vertigo
  • Indigestion (women often feel that if they could “just burp,” they would feel better)
  • Nausea and/or vomiting
  • Disproportionate sweating with activity

Heart Disease In Women

What Is a Stroke?

Strokes may be confused with heart attacks because the underlying causes and symptoms are similar, and because the most common type of stroke—the ischemic stroke—also occurs when an artery becomes blocked. The key difference between a stroke and a heart attack is that strokes affect the brain, not the heart.

In fact, the National Stroke Association calls stroke a “brain attack.”

Of all cardiovascular events, I fear strokes the most, for this very reason. Whereas heart attacks may limit your vitality, their effects can be managed with the right medications and lifestyle changes. Strokes, on the other hand, can cause devastating disability—robbing people of their ability to walk, talk, and perform other basic life skills.

Two Kinds of Strokes

There are two kinds: ischemic strokes and hemorrhagic strokes.

  • Ischemic strokes, as I mentioned, are the most common (about 87 percent) and are caused by the same chain of events that cause heart attacks. However, instead of losing partial function of the heart, a stroke causes damage to the brain. This is why many people who suffer strokes need extensive therapy to relearn speech and motor skills, or suffer problems with cognition and memory.
  • Hemorrhagic strokes make up only 13 percent of strokes, but they are the most deadly, accounting for roughly 40 percent of all stroke-related deaths. A hemorrhagic stroke occurs when an artery or blood vessel in the brain bursts, and bleeds freely into the surrounding tissue. The bleeding causes swelling and pressure, which damage and destroy nearby brain cells.

There is also a third event that deserves mention here—the transient ischemic attack, or TIA. If you have a TIA, you will experience symptoms similar to those of an ischemic stroke, but those symptoms will resolve on their own after a few hours or even minutes. Though it’s tempting to ignore these episodes, denial can have serious consequences. TIAs are like tremors before an earthquake; if you’re experiencing them, you are significantly more likely to have a full-blown stroke.

Ministrokes (TIAs) Are Often Warnings that “Real” Strokes Are About to Happen

Signs You May Be Having a Stroke

As with heart attacks, the signs of a stroke can be different in women than they are in men.

Signs of a Stroke in Men

  • Weakness in either an arm or leg, or in both limbs on the same side of the body
  • Sudden headache
  • Difficulty speaking, slurred speech
  • Leg instability, or a gait stagger
  • Stumbling, difficulty walking or picking up objects, or other problems with balance or coordination
  • Weakness in the facial muscles, including a one-sided facial droop
  • Double vision or loss of vision on the same side for both eyes
  • Dizziness, vertigo
  • Change in consciousness

Signs of a Stroke in Women

Look for the same symptoms as in men, plus:

  • Facial pain or one-sided limb pain
  • Palpitations
  • Nonspecific neurological symptoms such as hiccups, nausea, and generalized weakness

If you think someone may be having a stroke, give them this quick test. It’s easy to remember because the instructions follow the first four letters of the word “stroke”:

  • S: Ask the person to SMILE. If one side of their mouth droops, that can signal a stroke.
  • T: Ask the person to TALK and speak a simple sentence coherently.
  • R: Ask the person to RAISE both arms.
  • O: Ask the person to stick OUT their tongue, which should be straight.

If the person has trouble with any of these tasks, call 911 immediately.

Remember, Immediate Action Gets the Best Results

If you think someone may be having a heart attack or stroke—or that you may be having one yourself—get to a hospital as quickly as possible. Don’t worry that you may be overreacting or misinterpreting your symptoms. It’s far better to live with a little embarrassment than to always wish you’d have made a different choice.


© Stephen Sinatra, MD. All rights reserved.

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