Some heart attacks appear suddenly. More often, heart attacks start with mild pain or discomfort. Look for these signs:

• Chest discomfort (can feel like uncomfortable pressure, squeezing and pain in the center of the chest). Usually lasts longer than a few minutes, or goes away and comes back.
• Discomfort or pain in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath
• Cold sweat, dizziness, feeling light-headed.
• Nausea or vomiting.

If you, or someone you’re with experiences one or more of these symptoms for longer than a few minutes, call 9-1-1 right away. Too often, those having a heart attack think symptoms will subside. Don’t wait to find out.

Comes on immediately without warning. Signs include:

• Person loses consciousness and does not respond to shaking.
• No normal breathing.
• No signs of circulation, movement or coughing.

If this occurs, call 9-1-1 and start cardiopulmonary resuscitation immediately. If an automated external defibrillator is available and someone trained to use it nearby, ask for help.

Chest pain or discomfort due to coronary heart disease. The heart muscle is not getting as much blood (and oxygen) as it needs. This usually occurs when one or more of the heart’s arteries is narrowed or blocked. Angina is usually recognized by uncomfortable pressure, squeezing or pain in the center of the chest, neck, jaw, shoulder, back or arm. If an individual has never experienced these symptoms, call 9-1-1 and have your symptoms checked.

Those with chronic stable angina feel chest discomfort upon exertion, or when under physical or emotional stress. Normally, the discomfort is resolved with rest, nitroglycerin, or both.

Abnormal heart rhythms affect the electrical system of the heart muscle, causing it to pump inefficiently. A person’s normal heartbeat is 60-80 times per minute at rest.

Heart rates of less than 60 beats per minute. Physically active individuals can have a resting heart rate of less than 60 beats per minute. If symptoms like fatigue, dizziness, lightheadedness or fainting spells occur repeatedly, 9-1-1 should be called. Particularly in the elderly or inactive individuals, this can signal insufficient blood flow to the brain.

The heart muscle becomes inflamed and doesn’t pump as it should. Congestive cardiomyopathy means the heart is enlarged and stretched. This is associated with Congestive Heart Failure. Blood clots stick to the heart’s inner lining and may break off. If this occurs in the right ventricle, a pulmonary clot can form. In the left ventricle, blood clots that break off may be carried to the brain, the kidneys or peripheral arteries.

Hypertrophic cardiomyopathy is an enlargement of the left ventricle. Blood flow is usually blocked, and the heart’s mitral valve may leak. This is usually a hereditary condition. Treatments: Beta-blockers, antiarrhythmic drugs.

Restrictive cardiomyopathy: Heart muscle of the ventricles becomes very rigid. The ventricles do not easily fill with blood between heartbeats. The individual is usually tired, have difficulty breaking on exertion, and may have swollen extremities. This type of cardiomyopathy is usually due to another disease.

Combination of rescue breathing and chest compressions. CPR should only be performed if the person is not breathing or blood is not circulating. Look for breathing, shake the person’s shoulders, and ask if they are all right. If someone is with you, have them call 9-1-1, while you start rescue breathing and chest compressions.

A – Make sure the person’s airway is open and clear.

B – You cover the person’s mouth and breath oxygen into their lungs.

C – Chest compressions help circulate blood to organs.

It is wise for everyone to take a CPR course from your local hospital, the American Red Cross, or the American Heart Association. Effective CPR means learning how to administer rescue breathing and chest compressions correctly.

Soft, fat-like, waxy substance found in the bloodstream and throughout the body. Cholesterol is present in everyone, and produces cell membranes and some hormones. Too much cholesterol in the blood is a major risk for coronary artery disease and stroke. Hypercholesteremia is a condition where individuals have high levels of blood cholesterol. Foods from animal products and saturated fats cause the body to make more cholesterol – often more than the body can handle.

Cholesterol cannot dissolve in the blood. Cholesterol is transported to and from cells by lipoproteins. Low-Density Lipoprotein (LDL) is the bad form of cholesterol, which can clog arteries and increase risk for heart attack and stroke.

High-Density Lipoprotein (HDL) is the good cholesterol. This is the form of cholesterol the body makes. It carries cholesterol away from your arteries.

Desirable	Less than 200 mg/dL
Borderline high risk	200-239 mg/dL
High risk	240 mg/dL and above

Less than 100 mg/dL	Optimal
100-129 mg/dL	Near optimal
130-159 mg/dL	Borderline high
160-189 mg/dL	High
190 mg/dL	Very high

For men, ideal HDL cholesterol levels are 40-50 mg/dL. For women, ideal HDL cholesterol levels are 50-60 mg/dL. HDL cholesterol that’s lower than 40 mg/dL is too low, and puts a person at risk for heart disease. HDL cholesterol levels can be increased by smoking cessation, maintaining a healthy weight, and 30 minutes of aerobic exercise, 5-7 days per week.

The heart muscle has suffered sufficient damage that it cannot pump enough blood to the body’s organs. The heart is not able to work efficiently, and patients feel short of breath and tired upon even mild exertion. As blood flow out of the heart slows, blood returning to the heart through the veins backs up. Swelling develops, fluid can collect in the lungs, and the kidneys may be unable to efficiently remove sodium and water from the body, increasing the swelling, or edema.

• Coronary artery disease
• Past heart attack, with scar tissue that prevents normal activity of the heart muscle
• High blood pressure
• Heart valve disease (in some CHF patients)
• Primary disease of the heart muscle, preventing it from efficiently pumping blood to all parts of the body.
• Infection of the heart valves
• Congenital heart defects

Most individuals with mild-to-moderate CHF can be treated, and have good quality of life.

Warning signs for stroke noted by the American Stroke Association are:

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body.
• Sudden confusion, trouble speaking or understanding.
• Inability to smile.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, with dizziness, balance or coordination problems.
• Inability to respond to simple commands.
• Sudden, severe headache with no known cause.

If you notice the onset of these signs, or if someone is with you, have them call 9-1-1 immediately. Time is brain. Clot-busting drugs given within three hours of onset can reduce long-term impairments.

A rapid heartbeat that can be accompanied by palpitations, chest pain, dizziness, lightheadedness, or near fainting. The heart is beating too fast to circulate blood effectively. If rapid heartbeats start in the ventricles, the heart’s ability to pump enough blood to the brain and other organs can be compromised. This is the most serious heart rhythm disturbance and requires immediate medical attention. If tachycardia changes into ventricular fibrillation, the lower heart chambers are unable to pump any blood.

Ventricular tachycardia and fibrillation can be converted to normal heart rhythm with electrical shock. Once under control, this condition can be treated with medication or with an implantable cardioverter defibrillator.

During heart disturbances in the upper chambers, the atria quiver instead of beating rhythmically. Not all blood is pumped out of the upper chambers. Blood can pool and clot. If part of a blood clot in the atria leaves the heart, it can lodge in an artery leading to the brain. This can result in stroke.

A form of fat that comes from food and is made in your body. Individuals with high triglycerides often have high total cholesterol, high "bad" cholesterol, and low "good" cholesterol levels. Those with diabetes or who are overweight are more likely to have high triglycerides.

Triglyceride levels of less than 150 mg/dL is normal. Borderline levels are 159-199 mg/dL. High triglycerides are 200-499 mg/dL.

Those with high triglycerides are treated with cholesterol-lowering medications – and counsel to eat a low-fat diet, keep blood sugars under control, lose weight, and exercise.