We've all seen at least one classic heart attack scene in a movie or TV show. The victim suddenly grasps his chest, contorts his face in pain and collapses to the floor. Everyone standing around has no doubt about what is going on and emergency help is summoned immediately.

While the scene may make for good drama, Steven C. Watsky, MD, FACEP, says most heart attack symptoms are not that clear-cut. As Medical Director of the Emergency Department at Manatee Memorial Hospital, Dr. Watsky has seen too many cases in which heart attack victims weren't sure what was wrong and waited too long before getting help.

"They go into denial and think, ‘It's only heartburn; it will go away.' So by the time we see them, the die is often cast and serious damage has already occurred," he says.

‘Time is muscle'
"One of the things we often say in this business is: ‘Time is muscle.' The less time there is between the onset of a myocardial infarction [heart attack] and the time treatment is given, the less heart muscle is lost," says Dr. Watsky.

A heart attack happens when part of the heart muscle is damaged or dies because it stops getting oxygen from the arteries, usually because of a blockage in those arteries.

Dr. Watsky points out that most heart attacks start slowly, with mild pain or discomfort in the center of the chest.

"Whenever someone experiences up to five minutes of persistent chest pain it's a sign to call 911 immediately," says Dr. Watsky. "Sure, it could be due to gastric causes, but let us figure that out."

Dr. Watsky says Emergency Department staff would rather see a dozen false alarms than see a patient suffer serious heart damage -- or die -- because of delayed treatment.

Symptoms and risk factors
Here are some signs that indicate you should seek immediate emergency care:

• Chest pressure, squeezing, fullness or pain
• Radiating pain in one or both arms, or in the back, neck, jaw or stomach
• Shortness of breath
• Breaking out in a cold sweat
• Nausea
• Dizziness or lightheadedness

Keep in mind that women often have different symptoms during a heart attack. (See related article on here.)

If you experience any of these symptoms, call 911 instead of driving yourself or having someone drive you to the hospital. The emergency medical services (EMS) crew will begin treatment as soon as they arrive. They also are trained and have access to equipment to revive someone whose heart has stopped.

Steven C. Watsky, MD, FACEP Medical Director Emergency Department Manatee Memorial Hospital 206 2nd St. East Bradenton, FL 34208 941-745-7466

Dr. Watsky says the only way to know for sure whether you are having a heart attack is to be evaluated by a doctor. In the hospital, doctors will review your medical history and take an electrocardiogram (EKG). Sometimes a blood test will be taken to detect abnormal levels of certain enzymes. You also will be given a stress test to see how your heart responds to physical activity.

You are most at risk for a heart attack if you:

• Are age 35 or older
• Are overweight or obese
• Smoke
• Have diabetes
• Have hypertension (high blood pressure)
• Have a high cholesterol level
• Have a sedentary lifestyle
• Have a family history of heart problems

Dr. Watsky cautions that if you don't fall into one of the above high-risk categories, don't assume your symptoms are not serious. "The bottom line is when in doubt, check it out," he says.

Should You Stop Aspirin Therapy?
Coronary patients often are advised to discontinue blood-thinning aspirin therapy prior to undergoing surgery or dental work to avoid increased bleeding. That might not be a good idea. In a recent study, researchers from University Hospital Pasteur in Nice, France, reviewed records of 1,236 patients hospitalized for coronary symptoms. Of those, 51 patients who had been on aspirin therapy for at least three months had acute coronary events less than one week after aspirin withdrawal. Talk with your doctor about what's best for you.