Here’s what Hollywood gets wrong about heart attacks
Like anyone who’s seen the ’70s sitcom “Sanford and Son,” cardiologist John C. Hostetter, MD, FACC remembers when Fred G. Sanford (played by comedian Redd Foxx) would dramatically fake having a heart attack in response to some bit of dismaying news from his son. He’d clutch his chest, describe intense pain and exclaim, “It’s the big one.”
Unlike some other viewers, Dr. Hostetter knows that’s actually a misrepresentation of what many heart attack victims experience.
“A good part of the population pictures that, but the classic presentation is vague pressure, tightness or heaviness that is in the center of the chest,” he said. “Sometimes people will describe it as a band-like sensation around their chest. They just don’t feel quite right. The location isn’t that important, but it’s sort of central and usually not described as severe pain.”
“It’s uncomfortable, but if you can put your finger and say, it hurts me right here, it’s probably not your heart.”
People often expect that they’ll feel pain from a heart attack on the left side of their chest, but that’s not necessarily the case, he said. “A coronary event often creates central pressure, heaviness or tightness, and it’s typically exertional. If you can bring this discomfort on by exerting yourself, whether it’s walking or climbing stairs or doing yard work, if it starts with exercise and resolves with rest, that’s pretty concerning.”
The symptoms can radiate from the chest, Dr. Hostetter continued.
“If you’ve got a tightness, pressure or heaviness in the center of your chest and it goes to your jaw and both arms, that’s concerning for a coronary presentation.
“Less typical symptoms can be shortness of breath when doing activities that were not challenging a few weeks before or a sudden increase in fatigue or decrease in exercise intolerance.”
Usually Not Sharp Pain
Usually, heart issues do not cause sharp pain, he said.
“Typically, if pain is related to breathing, it’s not your heart. If you take a deep breath and it hurts you, that’s usually not coronary disease; it’s a respiratory thing. And if it’s related to meals, if it happens after eating or when you're lying down in the easy chair after eating your evening meal, that’s more likely to be a gastrointestinal problem.”
If pain gets worse with arm movements or feels better when you lie down or sit up, that’s more likely to be a pulled muscle.
“If it’s musculoskeletal, pain would be sharp and localized and would be worse with certain movements and positions,” he said. “That’s a rib pain or a muscular injury. Sometimes people tell me that for the last five years they feel pain if they lie in certain positions or take deep breaths, and those things are typically more musculoskeletal. Sometimes discs in the neck and back can cause some numbness, tingling or vague discomfort in the arms and the chest that people can confuse for the heart.”
Some Truth in Film Depictions
But the Hollywood heart attack isn’t a total myth, he said.
“Certainly, acute heart attacks can present with that crushing elephant on the chest, like Fred Sanford,” he said. “If it’s new or escalating in frequency and keeping you from doing something, you need to seek attention. If you’re having ongoing symptoms that aren’t going away, you should call 911. If something happens in terms of an electrical event or an arrhythmia, you don’t want to be in your own car. You want an EMS there who can respond quickly.”
Dr. Hostetter said that typically what precedes an acute cardiac event is a plaque limiting the blood supply to the heart.
“If your heart’s not getting enough blood, that leads to injury. What we consider a heart attack is when the main arteries suddenly rupture and become unstable. It goes from being a mild or moderate non-obstructive plaque to suddenly severe.
“That’s why people can walk two miles one day and then three days later have a heart attack, because there was plaque in there but it wasn’t obstructing. There was a change in the nature of the plaque. If we can ever figure out which plaques are vulnerable, someone will win the Nobel Prize for that because a lot of people are fairly full of atherosclerosis in multiple areas, but you don’t know which plaque is going to become unstable.”
That’s why stenting is helpful for a certain group of people who are having active symptoms, Dr. Hostetter explained. But it is not helpful to just put stents in plaque in an artery that hasn’t ruptured yet, he said.
“Typically, we treat stable coronary disease with medicines for cholesterol, as opposed to stents.”
