The Evolution of Heart Attack Detection

When most of us think of what a heart attack looks like, we imagine a person clutching their chest in pain. However, it doesn't always look that way, so it may be time to change the way we think about heart attack detection.

According to the American Heart Association, 790,000 people in the United States have a heart attack each year. Learning how to recognize the signs of a heart attack can help save lives and prevent major damage to one of the body's most important organs.

Detecting a Heart Attack

Amardeep Singh, M.D., an interventional cardiologist with Mercy Medical Group, a service of Dignity Health Medical Foundation, says there are three important keys to heart attack detection: the patient's symptoms, an electrocardiogram (EKG), and a blood test.

The first step is to recognize the symptoms of a heart attack. "There can be some atypical presentations of somebody having a heart attack," Dr. Singh said, "and that would include patients who have diabetes, patients who are older, and women." Diabetics, for instance, have a higher risk for a "silent heart attack" — instead of being accompanied by typical symptoms like chest pain or a cold sweat, it may present as shortness of breath or fatigue during a routine activity, such as mopping the floor. Women may not experience the chest or arm pain that men typically experience. Instead, they may have excessive fatigue with pain in their back, jaw, or neck.

The next step would be to get an evaluation. Depending on the severity of the symptoms, this means either calling 911 or going directly to an emergency room, where an EKG and blood test will often be conducted simultaneously. "An EKG tells us a lot about the patient's heart and its rhythm," Dr. Singh said. "It will also tell us if the patient is having what we call an ST elevation myocardial infarction or a massive heart attack."

During a blood test, cardiac biomarkers will be drawn. A biomarker is a measurable indicator of a biological condition or state. "These biomarkers raise pretty quickly once there's damage happening to the heart," Dr. Singh said. "They're basically contractile proteins in the heart muscle that are released when there is heart damage happening." One protein in general, troponin, is very accurate in detecting heart damage, she added.

How Heart Attack Detection Has Evolved

Dr. Singh said that, in the past, health care workers didn't quite recognize that patients can have atypical presentations, which impedes heart attack detection and delays treatment. "I think physicians now are aware of atypical presentations of heart attack, and I think we're doing a pretty good job in the community of letting people know what a heart attack can present like," she said. "Traditionally, it was thought that men have more heart attacks — older men — so there was actually a delay in treatment for women and patients with atypical symptoms."

Physicians are now better able to pinpoint which biomarkers are released most immediately and which ones are the best for heart attack detection. They're also more sensitive to patients who have certain risk factors such as diabetes, smoking, a family history, or high cholesterol.

Although it's not currently being used routinely in patient care, Dr. Singh said there's research being done to discover biomarkers that can predict plaque rupture, one of the causes of a heart attack. There are also smart apps that can monitor heart rate and detect variations. While the sensitivity and accuracy aren't quite there yet, there's still research being done. "But patient symptoms are going to be the top sign," Dr. Singh said.

Heart attack education and prevention starts in the primary care office, Dr. Singh points out, and it's important for patients to know their numbers, such as BMI, cholesterol, and blood pressure. By knowing your risk factors and being aware of the warning signs, you'll have a better chance of detecting a heart attack early and improving your survival.