Would you recognise a heart attack in your client?

With vigorous physical activity being a trigger for cardiac arrest, it is critical that fitness professionals know how to recognise the symptoms of heart attack, writes Dr Tom Buckley.

Would you recognise symptoms of a heart attack in yourself or others while exercising? A recent Australian study of master age footballers suggests that half of us would not be confident to recognise a heart attack in ourselves, with even less expressing confidence in recognising one in others.1

What is even more concerning is that in this study one fifth of participants (21.6%) experienced at least one potential cardiac symptom during physical activity in the preceding 12 months, but only one quarter (24.2%) of them sought medical advice.

Reasons to recognise

So why should we pay particular attention to these findings? Well firstly, heart disease continues to be the leading cause of death in Australia today and the chances are that 2/3 of us will either develop heart disease in our lives or be directly affected by someone close to us suffering heart disease.2 

Secondly, Australian research has shown that exposure to heavy or vigorous physical exertion triggers heart attacks in 14% of heart attack patients, with the highest risk in sedentary individuals (77 times higher relative risk compared to when not exerting vigorously. This drops to a risk of 2.3 in those who exert at this level >4 times a week.3 Yes, even for regular exercisers, there is still an increased risk of heart attack while exercising vigorously. This is known as the exercise paradox, in that physical exertion is preventative of heart disease in the long run, but can potentially trigger a heart attack while exerting at high intensity.

As a fitness professional working with both experienced exercisers, and those completely new to exercise,  therefore, you have a higher likelihood of witnessing the symptoms of heart attack in a client or other member training in your facility.

The difficulty in spotting heart attack

Now it’s easy to think, “I can’t believe people would not recognise a heart attack in themselves or in others”. But when it comes to recognising symptoms, and acting on it, it gets complex.

The Heart Foundation states that the most common sign of a heart attack is chest discomfort or pain, which can spread to the arms, neck, jaw or back.4 But, unlike the way it’s usually represented on television and in movies, not everyone who is having a heart attack complains of chest pain. This is especially true in women, the elderly or those with a history of diabetes, for whom chest pain does not always feature as a key symptom. In fact, in some there may be no symptoms at all (known as a silent heart attack).

Symptoms to watch out for

Shifting the focus away from looking solely for chest pains, The Heart Foundation highlights some of the other symptoms that we should be alert to as potential indicators of heart attack.

It should be noted that it is possible to experience several of these symptoms or just one, that they usually last for at least 10 minutes, and may come on suddenly or get worse as time passes.

These symptoms include:

• Dizziness, lightheadedness or feeling faint – the room (or your outdoor environment) starts spinning, or your vision starts to fade
• Nausea, indigestion, or vomiting – these can be symptoms of many non-cardiac conditions, but it is important not to dismiss them
• Shortness of breath – while shortness of breath can be brought on by physical activity, extreme temperatures, or high altitudes, one should be vigilant when:
  • breathlessness is present when not exercising
  • increased rate of breathing is not the usual increase one normally experiences for a given level of exertion
  • breathlessness is accompanied by other potential symptoms such as chest tightness, dizziness, or any of the other symptoms listed here.
• Sweating or a cold sweat – with the latter also often referred to as a sudden chill in your body.

The next steps

While recognising the symptoms is the first step, doing something about it seems even more challenging.

In the Australian master’s football study, only one fifth of those who experienced symptoms on the football pitch actually went to their doctor to get checked out.

Additionally, in response to a hypothetical episode of chest pain while playing, less than half (46.6%) stated that they would leave the field immediately, preferring to stay on the field to see if the pain eased, with more competitive A grade players eight times more likely to continue playing until their performance became unsatisfactory or until the end of the game, often citing not wanting to let the team down as a potential reason.

There are three phases in relation to seeking help with heart attack symptoms:

1. Appraisal delay: the time the person takes to appraise the symptoms as a sign of illness;
2. Illness delay: the time taken from deciding one is ill until deciding to seek medical care; and 
3. Utilisation delay: the time from the decision to seek care and arrival at hospital. 

The greatest proportion of total prehospital delay is patient delay, that is, phases one and two, that may account for almost two thirds of the time from symptom onset to treatment. This is important, as early treatment has been repeatedly shown to result in better outcomes and quality of life after a heart attack.

So, what should you do if you suspect you, or one of your clients, are experiencing heart attack symptoms?

The Heart Foundation states: ‘If you’re experiencing the warning signs of a heart attack or are worried you or someone you know is having a heart attack – tell someone. If symptoms are severe, or getting worse, or last for more than 10 minutes, call Triple Zero (000) immediately.’

Telling someone you are not feeling okay is critically important, because should you lose consciousness, it may significantly delay, or prevent, help arriving. 

Interestingly, it has been shown that telling a stranger results in shorter delays to hospital, compared to telling a close family member, possibly because the stranger is likely to be more objective and call an ambulance quicker, rather than take responsibility in a scenario they may not be trained for.

Cardiologists frequently say ‘time is muscle’. If you, or someone you are with, experiences potential heart attack symptoms, don’t take the chance that they will go away of their own accord: tell someone, act quickly and seek medical advice. If symptoms are severe, getting worse, or last for more than 10 minutes, call Triple Zero (000) immediately.

REFERENCES

1. Francis, M., Buckley, T., Tofler, A.R. Tofler, G.H. (2022) Masters Age Football And Cardiovascular Risk  (MAFACARI) Internal Medicine Journal. doi:10.1111/imj.15660
2. Australian Institute of Heath and Welfare. Heart, stroke and vascular disease- Australia. (2021) https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/hsvd-facts/contents/about
3. Buckley, T., Soo Hoo, S. Y., Shaw, E. Hansen, P. Fethney, J., & Tofler, G. (2019) Triggering of Acute Coronary Occlusion by Episodes of Vigorous Physical Exertion. Heart, Lung and Circulation, 28, 1773–1779.
4. Heart Foundation. What is a heart attack.(2022) https://www.heartfoundation.org.au/conditions/heart-attack

Dr Thomas Buckley

Thomas is an Associate Professor at the University of Sydney in the Critical/ Acute Care teaching and research team as well as Research Education Academic Director (North Precinct and Sydney Nursing School).

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