How long do warning signs of a heart attack show before the actual attack?

If a person has a heart attack that kills them pretty much instantly, what warning signs are there to look for and how far in advance to the actual attack would they show up?  I have a friend that recently passed away of a heart attack and I don't think he knew what was coming.  He just had been compaining recently of back pain and the day he passed he thought he slept on his arm wrong and said he felt funny but couldn't put his finger on it except to say that his back hurt a lot (he had been complaining about his back for about a month  and had been to the doctor a few times and they gave him pain meds) .  If he had taken his blood pressure 30-60 minutes before demise would it be high or low or something?  Would there be anything else that could have been a warning?

[Rosemary349]

Hi, I'm sorry to hear about your friend.  Your question is one i've been asking.  I don't think there has been any research into prodromal symptoms before a heart attack and that is because for a long time doctors saw a heart attack as the outcome of having furred up arteries......so people thought that you would get warnings, either high blood pressure, high cholesterol, shortness of breath on exercising, etc.....and of course these are warnings for people that their arteries might be getting blocked....

but, i think it's 85% of heart attacks occurs without warning....or at least the warnings people have traditionally looked for.

My guess is your friend's back pain was a warning, but because it wasn't classic chest pain the docto's didn't get suspicious.

The same happened with my dad back in september.  He was fit and healthy, he would have passed an exercise test.....but he had indigestion for two days and died on the third.  The indigestion was felt in the stomach and not in the chest, so he didn't think it was serious.

I've been thinking a lot about this.  I'm curious as to whether this could be researched, for example by interviewing survivors of 'first heart attacks' where there were no traditional heart disease symptoms beforehand.

Fatigue will be one of the clues, but that's a difficult one because people can be fatigued for many reasons....

I wish i had the answers, maybe one day they will be discovered.  Hopefully sooner rather than later.

I'm really sorry about your friend.

[ed34]

The biggest cause of death in the UK is from heart disease causing heart attacks. A heart attack doesn't have to have prior symptoms at all, in fact quite a number of cases show they had no previous discomfort at all. The problem is, you can have a blockage in a coronary artery that restricts blood flow by 70% and notice nothing wrong. Some people may get angina. Blood pressure is not a way to really detect heart attack, this is done with an ecg and other tests such as a troponin blood test.

[RadioAstronomyObserver]

I picked up on the "Feeling Funny" statement.  I'm not sure if I should describe it in an open forum since there are a lot of people who come here and pick up on bits of information and instantly panic because they have something that resembles the situation.  Either way and without describing the feeling, there was a specific feeling that if I feel it again I'd know enough to get to the hospital quick.  I felt this at 8-ish pm and by 9-ish I was in bed and fell asleep, at 10 or 11 I was on my way to the hospital having a very good idea what the problem was.  The "feeling" may be Me specific(?),  Mom had something similar to what Terileefun described; a pain in the sholder, she had dad rub it most of the night but as it wasn't getting better they went to the hospital just to have it checked out as if it were just a tight muscle.  Looking at it that way, I guess everybody is different.

[Rosemary349]

the other problem as i understand it is that you can have a very small blockage of about 20% and it ruptures and causes a clot.  This then blocks up an artery and causes a heart attack.....there'd be no classic symptoms leading up to this event, because the blockage wouldn't have been felt (and most of us have those sized blockages already).

Original poster, this is what causes all the uncertainty.  It's not easy to predict.  I think a lot of it has to be intuition.  I knew my dad was exhausted and worn out for the last two years.....but i didn't listen to my worries because people tell me i'm over anxioius (i am, i'm also often right i hate to say).  I notice in the week leading up to his death he was relatively normal.....but there were some odd things.  I came into the house and he had the heater on....and it was early autumn and he never needed heat.  He didn't feel the cold.  He looked worn out and vulnerable to me.  Then there were two days of indigestion (that was not felt in the chest).  That was a warning but it was not recognised.  I'd say any indigestion that doesn't go away within an hour or so, cannot be linked to something you ate, should be checked out.  

it also appears from what you and other posters have said, pains in the arms or the back.

It's clear that people shouldn't just wait for classic symptoms as many people don't get these.

[kenkeith]

The warning signs of having a heart attack may depend on the underlying cause, and we all agree the result is damaged heart cells.

One could have an ischemic (lack of oxygenated blood) heart attack that occurs slowly over a period of time. Often it is what is referred to as a silent heart attack as the individual is not experiencing any symptoms, or there could be symptoms over a period of time that include chest pain, shortness of breath, fatigue, etc.  That happened in my situation, the cells were eventually stunned from lack of oxygen and damaged heart cells did not contract sufficiently (hypokinesis) to pump blood into circulation and blood backed up into the lungs causing congested heart failure.

A heart attack can be sudden from a clot blocking blood flow or it can be due to electrophysiological abnormalities causing an irregular, fast heart rate resulting in cardiac arrest, coma and death. One may experience heart palpitations, and/or a sharp chest pain.

[Southern_woman]

Hi, I can tell you some of my feelings were not pain but a tight kind of feeling in my chest
like a burning and it can afect your arm,s ,neck,,so any kind os discompfort needs to be
checked out,  last time  the only thing was my blood pressure was to the ceiling
would not even take on my BP machine,so call911  let them decide, it,s way safer.

[ed34]

just shows how much it differs with people. During my heart attack my blood pressure was fine, my ecg looked fine, my troponin level was high. However, the key thing is that eating was causing my heart attacks, not anything else. By the time I got to hospital, the pains had gone.

[kenkeith]

The question relates to an acute heart attack, and would indicate necrosis (death) of heart cells (myocardio infarction).  There is no information that lists a **gastric disorder as a symptom.

On another post you included diarrhea with digestive disorder.  If you where suffering from diarrhea and an MI , you would probably be out of breath running to the bathroom as the prevailing symptom.  It is highly probable you where not having a heart attack(s).  

The symptoms of heart disorder include certain types of pain, shortness of breath, fatigue, palpitations (awareness of slow, fast, or irregular heartbeats), light-headedness, fainting, and swelling in the legs, ankles, and feet. However, these symptoms do not necessarily indicate a heart disorder. **For example, chest pain may be due to a respiratory or digestive disorder rather than to a heart disorder.  I wasn't aware chest pains can be caused by a digestive disorder!  I'll pass it along for your information.

Also, there are multiple conditions that can cause elevation of troponin besides myocardial ischemia like sepsis, renal failure, decompensated heart failure, pulmonary embolism, coronary vasospasm, prolonged hypotension and tachycardias associated with hypotension to mention few

[skydnsr]

Some people even have a heart attack, get over it, and never know that they had it.  Maybe they find out about it later on, when they have tests run for something else, and the damage is evident on an ekg.  

Sometimes someone will even have a heart attack (or a stroke), live over it, survive for a long time without knowing that they had it, and then when they finally die of whatever, the heart attack or stroke is discovered on autopsy.  

So no, not only do many heart attacks not give you any advance warning -- at least not any kind of warning that you recognize for what it is -- some heart attacks aren't even diagnosed until after death.

So that leads to the question, how many people have had heart attacks or strokes, and it is never known about -- ever -- because the individual recovered without treatment, they never had any tests that would have revealed the damage, and they did not have an autopsy after death?

I read the results of a study back in the 1990's in which the investigators did a series of autopsies to check a random sample of deceased people for strokes, and it was an amazing number of undiagnosed strokes that they found.  I want to say, it was something like 10% of the population that had had strokes that were not previously known about.  I'm sorry  I can't cite the study anymore, and don't quote me on the exact percentage.  I just remember being totally amazed that it could be that large a percentage of the population that had had strokes without knowing about it.  It is a testament to the body and the mind's ability to adapt to anything.

Jim Harbaugh, who was a very tough football player when he was at U.Mich and in the NFL, talked in an interview one time about his grandfather's having  gone through a heart attack without knowing about it until much later.  His grandfather felt kind of bad for a while but got over it.  He finally went to a doctor much later, for something else, and the doctor gave him an ekg.  When the doctor saw the evidence of the scar tissue on the ekg and asked the old man about his past heart attack, Jim Harbaugh's grandfather was like, what heart attack?

[kenkeith]

I distinquished between ischemia and an acute heart attack.  We know about silent heart attacks, I experienced same, and that condition usually brings on heart failure over a period of time.  The appropriate blood supply is inadequate due to occluded coronary vessels and heart cells are damaged causing hypokineses (impairment of wall movement). The impairment reduces the heart's left ventricle's ability to pump enough blood to meet the system's demand.  

Heart failure is an ejection fraction of less 30%, and my source indicates there are about 26% of the heart disorder population that are in heart failure mode and don't know they have a heart condtion...some individual's system compensate very well.

An acute myocardio infarction is almost always the result of a clot, arrhythmia (very fast and irregular heartbeats), heart muscle constriction from drugs, rupture, etc.

TIA's are small strokes of the brain and are not uncommon within the CAD population resulting in an impairment of memory and cogniitive functioning.  Occasionally, I watch the Health channel on TV when there are autopsies, and it it is not unusual to see clots and some bleeding within the brain that goes unnoticed with the individual.

Vascular dementia (VaD) is impairment of memory and cognitive functioning that is caused by cerebrovascular disease. VaD is widely accepted as the second most common cause of cognitive impairment; Alzheimer's disease (AD) is the first. Despite the high prevalence of VaD, the chemical and biologic mechanisms are poorly understood and no specific pathologic criteria for diagnosis exist

[BrokenPen]

Heart attacks can be silent. Many healthy people had “silent” myocardial infarction and were lucky enough to continue their life without being affected severely. This is particularly common in diabetic patients.

Blood pressure is not at all related with heart attack, unless the damage is severe enough to cause cardiac failure and a severe drop in blood pressure. Otherwise, there might be a rise in blood pressure caused by the pain of heart attack, but most patient’s BP will be unaffected.

The fastest method of diagnosis is the ECG. The most accurate one is the Troponin. This is a protein complex that is found only in cardiac and skeletal muscles. There are structural differences between the one found in cardiac muscles which is called Troponin T and I, and that of the skeletal muscles, making it a sensitive and specific marker.

Heart attack is capricious and can manifest in many illogical forms. I’ve known many people who presented with typical symptoms of peptic ulcer disease (nausea, vomiting, gastric upset, heartburn). They were only diagnosed by doing routine ECG. I have known a friend who had a severe left groin pain. For three days he didn’t stop suffering despite the analgesia. The first routine ECG showed no abnormality. Docs expected celiac diseases, then appendicitis after expecting situs inversus, then renal colic. On the third day, a professor suggested to repeat the ECG. It showed severe ischemia, and the cardiac markers were all raised.

What I mean is that any symptom can be that of a heart attack. It would very hard to investigate every minor symptom. The absence of risk factors should provide a sense of safety.

[ed34]

Are there any theories that you know of why discomforts from an organ can radiate into so many parts of the body and throw Doctors off track? My troponin was high and I was on the floor with the typical centre of the chest pains but there seems to be many deviances from this, and not quite what you would expect. I still find it shocking that some people can experience a heart attack and not feel a thing.

[BrokenPen]

This is called referred pain. Many theories were built in order to explain the exact mechanism of the referred pain; most of them agree that the cause originates from spinal cord segments. The pain which originates from any visceral organ like heart or gall bladder is transmitted through the afferent nerves to their specific spinal cord segment. This same segment innervates a specific somatic portion (chest and left arm in case of the heart, right shoulder in case of the gall bladder.) Thus, instead of feeling the pain at its original place, it would be felt at those different places. It is somehow like the phone lines when you compose a number and intercept a conversation.

Of course, all humans do not share the same anatomy. There are many variations in the body, and some individuals have different nerve divisions that make the visceral pain felt in rather strange parts.

That’s what I think. If anyone has a better explanation, I will be thankful to read a different comment.  

[ed34]

Thank you for the explanation, it does make perfect sense. I used to wonder if it was to do with the area of the heart which had the insufficient blood supply but I've proved that wrong in myself. As my circumflex was cleared, symptoms stayed the same. When my LAD was opened  my symptoms have remained the same. I know I'm speaking of angina now, not heart attack, but it's really the same thing but milder (hope you agree).
The only remaining blockages I have are in RCA, which must be the cause of the angina. Typical how its the last one but all cardiologists seem to put all the blame on the left side of the heart just because it does most of the work.

[skydnsr]

On looking back at my answer, I think I missed the main point, which is that your friend died.  I do want to express my condolences.  But in response to your question about warnings, he may not have had any warning.  If he did not have any warning that he understood as being heart-related, then he did not have any warning of what was about to happen.  I'm sorry.

[BrokenPen]

Just one question, did you repeat the angiography after your last stent? I agree with you that your pain might originate because of your obstructed RCA. Saying that the pain arises from the left part of the heart because it “it does most of the work” doesn’t seem convincing to me. Many people had implanted many stents and left some branches obstructed and never complained of any pain.

If there’s no stenosis in any other part, I don’t think you should worry about the pain. Keep your blood pressure, blood sugar and cholesterol under control. Daily walking could improve your symptoms by the slow development of collateral vessels to overcome the obstructed or stenosed parts.

Is your pain continuous or intermittent? Are there factors aggravating your pain like exercise or heavy meals or exposure to cold? What do you do to relieve your pain? For how long does it last? Again, I agree with you that anginal pain has most of the characteristics of myocardial infarction, but it is important to know whether you are having stable or unstable angina.

[Rosemary349]

I didn't know that daily walking could lead to development of collateralls.  Interesting.

Responding to explanations for the varied discomfort people can feel....i was told that the phrenic nerve was likely responsible for my dad's stomach discomfort and lack of appetite and indigestion....this nerve is linked to the heart and the stomach so the signals can be confusing and is the reason a lot of people mistake a heart problem for indigestion.....but he definitely didn't have chest pain in the two days leading up to the heart attack (but he did have it in the last few minutes)

[lovinglife92033]

I've been having a lot of fatigue for two years, and it's getting worse.  This year I've been having heart attack symptoms. I never get the reflux in the stomach until a couple days ago.. These last few months I've been having sharp pains, and now the pains are every day on and off.  I smoke, but not much.  I have cut down to one cigarette or two a day because after smoking I am nauseated sometimes or my muscles are weak for about thirty min.  I am 43, and consider myself in good shape.  I started exercising and I am short on breath, fatigue and weakness all the time, all day long.  I am a bit depressed, but have reason to.. Dizziness, muscle in my neck is hurting more this week.. The pain in my chest is very painful and moves from the left to the mid section. Once in a great while, not often I felt a little tension in the right side.  The only thing is, I have no medical.  So, I am on my own with this.  I don't want to die, but I never get the acid reflux.  Until yest. and today a few times.. I believe I will have a heart attack at home and die because I can't afford the E.R... I don't want to go in their now even with the symptoms I have because it's embarassing if it's nothing and the expense... I can't afford..Ever...  I'm afraid I'm going to die, and I have kids and I'm all they have.  I don't know what to do. Maybe I'm wrong... But even now, I have pain and sometimes the bottom of my throat... Last week what scared me is I woke up holding my chest.  I was in so much pain... I was half asleep and when the pain finally went away I went to sleep...  IDK..What to do...

[livy7117]

I'm a 13 yr old girl and for three days have been experiencing heart attack symptoms such as: sharp pain in my chest  that comes and goes, sharp pains in both arms that come and go, sharp pains in the back, neck, a nd occasionally jaw. i have been feeling fatigued although i haven't done anything strenuous. I am very scared and if anybody has any advice please tell me! (heart attacks dont run in the family)

[erijon]

You are not having a heart attack, at your age it is almost an impossibility. You are far too young to have developed blockages as these are not a real risk until after age 40. Also, your doctor would have found any other form of heart disease when they saw you.

You can relax, I'm sure you're fine. Just let your Mother know if you don't feel right, but I am pretty sure you're getting worked up over nothing heart related.