Epidemiology and prevention of venous thromboembolism

Warning Signs Of A Heart Attack

A heart attack can occur with or without chest pain. You may experience pain in other spots, like the shoulder, and symptoms, including sweating and fatigue, among others.

Did you know that you can have a heart attack without feeling any chest pain? Heart failure and heart disease don't show the same signs for everyone, especially women.

The heart is a muscle that contracts to pump blood throughout the body. A heart attack (often called a myocardial infarction) occurs when the heart muscle doesn't get enough blood. Blood carries oxygen and nutrients to the heart muscle. When there isn't enough blood flowing to your heart muscle, the affected part can get damaged or die. This is dangerous and sometimes deadly.

Heart attacks happen suddenly, but they normally result from long-standing heart disease. Typically, a waxy plaque builds up on the walls inside your blood vessels that feed the heart muscle. Sometimes a chunk of the plaque, called a blood clot, breaks off and prevents blood from passing through the vessel to your heart muscle, resulting in a heart attack.

Less commonly, something like stress, physical exertion, or cold weather causes the blood vessels to contract or spasm, which decreases the amount of blood that can get to your heart muscle.

There are many risk factors that contribute to having a heart attack, including:

A heart attack is a medical emergency. It's really important to listen to what your body is telling you if you think you might be having one. It's better to seek emergency medical treatment and be wrong than to not get help when you're having a heart attack.

Most people with heart attacks experience some sort of chest pain or discomfort. But it's important to understand that chest pains don't occur in every heart attack.

Chest pain is a common sign of a heart attack. People have described this sensation as feeling like an elephant is standing on their chest.

Some people don't describe chest pain as pain at all. Instead, they may say they felt chest tightness or squeezing. Sometimes this discomfort can seem bad for a few minutes and then go away. Sometimes the discomfort comes back hours or even a day later. These could all be signs your heart muscle isn't getting enough oxygen.

If you experience chest pains or tightness, you or someone around you should call 911 immediately.

Pain and tightness can also radiate in other areas of the body. Most people associate a heart attack with pain working its way down the left arm. That can happen, but pain can also appear in other locations, including:

According to the American Heart Association, women tend to report heart attacks that cause pain, specifically in the lower abdomen and lower portion of the chest.

The pain may not be concentrated in the chest at all. It could feel like pressure in the chest and pain in other parts of the body. Upper back pain is another symptom women more commonly cite than men.

Sweating more than usual — especially if you aren't exercising or being active — could be an early warning sign of heart problems. Pumping blood through clogged arteries takes more effort from your heart, so your body sweats more to try to keep your body temperature down during the extra exertion. If you experience cold sweats or clammy skin, then you should consult your doctor.

Night sweats are also a common symptom for women experiencing heart trouble. Women may mistake this symptom for an effect of menopause. However, if you wake up and your sheets are soaked or you cannot sleep due to your sweating, this could be a sign of a heart attack, especially in women.

Fatigue can be a less commonly recognized heart attack sign in women. According to the American Heart Association, some women may even think their heart attack symptoms are flu-like symptoms.

A heart attack can cause exhaustion due to the extra stress on your heart to try to pump while an area of blood flow is blocked. If you often feel tired or exhausted for no reason, it could be a sign that something is wrong.

Fatigue and shortness of breath are more common in women than men and may begin months before a heart attack. That's why it's important to see a doctor as early as possible when you experience early signs of fatigue.

Your breathing and your heart pumping blood effectively are very closely related. Your heart pumps blood so it can circulate to your tissues as well as get oxygen from your lungs. If your heart can't pump blood well (as is the case with a heart attack), you can feel short of breath.

Shortness of breath can sometimes be an accompanying symptom to unusual fatigue in women. For example, some women report they would get unusually short of breath and tired for the activity they were performing. Going to the mailbox could leave them exhausted and unable to catch their breath. This can be a common sign of heart attack in women.

Lightheadedness and dizziness can occur with a heart attack and are often symptoms women describe. Some women report they feel like they might pass out if they try to stand up or overexert themselves. This sensation is certainly not a normal feeling and shouldn't be ignored if you experience it.

Heart palpitations can range from feeling like your heart is skipping a beat to having changes in heart rhythm that can feel like your heart is pounding or throbbing. Your heart and body rely on a consistent, steady beat to best move blood throughout your body. If the beat gets out of rhythm, this could be a sign you're having a heart attack.

Heart palpitations due to heart attack can create a sense of unease or anxiety, especially in women. Some people may describe heart palpitations as a sensation their heart is pounding in their neck, not just their chest.

Changes in your heart's rhythm shouldn't be ignored, because once the heart is consistently out of rhythm, it requires medical intervention to get back into rhythm. If your palpitations are accompanied by dizziness, chest pressure, chest pain, or fainting, they could be confirmation that a heart attack is occurring.

Often people begin experiencing mild indigestion and other gastrointestinal problems before a heart attack. Because heart attacks usually occur in older people who typically have more indigestion problems, these symptoms can get dismissed as heartburn or another food-related complication.

If you normally have an iron stomach, indigestion or heartburn could be a signal that something else is going on.

If you think you are having a heart attack, you or someone nearby should call emergency services immediately. It's unsafe to drive yourself to the hospital during a heart attack, so call an ambulance. While you may feel awake and alert enough to drive, the chest pain could get so severe that you may have trouble breathing or difficulty thinking clearly.

After you call emergency services

When you call emergency services, the dispatcher may ask you about the medicines you take and your allergies. If you don't currently take a blood thinner and you aren't allergic to aspirin, the dispatcher may advise you to chew an aspirin while you're waiting on medical attention. If you have nitroglycerin tablets, you may also wish to use these as directed by your doctor to reduce chest pain.

If you have a list of medications you currently take or any information about your medical history, you may wish to take this information with you. It can speed your medical care.

At the hospital

When you arrive at the hospital, you can expect the emergency medical personnel to take an electrocardiogram (EKG). This is a pain-free way to measure your heart's electrical activity.

If you're having a heart attack, an EKG is performed to look for unusual electrical patterns in your heart. The EKG can help your doctor determine if the heart muscle is damaged and what part of your heart was damaged. A doctor will also likely order a blood draw. If you're having a heart attack, your body usually releases certain proteins and enzymes as a result of the stress to your heart.

If you're having a heart attack, your doctor will discuss treatment options with you. Your risk of severe heart damage is lowered if you start treatment within several hours of developing symptoms.

What are the signs of heart failure in your feet?

Swelling, called edema, can occur in your feet if you have heart failure.

What are the 4 signs your heart is quietly failing?

The 4 most common early symptoms of heart failure are:

fatigue

reduced stamina (can't do as much)

orthopnea (shortness of breath when lying flat)

coughing

edema or ankle swelling

See your doctor immediately if you have these symptoms.

What happens to your feet before a heart attack?

There are no symptoms in your feet specifically that indicate a heart attack is likely.

There are symptoms you may experience in your feet that may indicate reduced blood flow and may mean you have peripheral vascular disease or cardiovascular disease and need to see your doctor or healthcare professional. These symptoms include:

swelling in your feet, ankles, or both

foot sores that are slow to heal

toenails that grow slower than usual

one foot is colder than the other

weak pulse in one foot or both

What signs do you get a month before a heart attack?

Symptoms of a heart attack that you may have a month or more before are called angina or prodromal symptoms, and they may include:

chest pain

tiredness

sleepiness

anxiety

arm weakness

arm pain

According to the Centers for Disease Control and Prevention, an estimated 200,000 deaths from heart disease and stroke are preventable. Even if you have risk factors for heart disease or have already had a heart attack, there are things you can do to reduce your risk of having a heart attack in the future.

People who have already had a heart attack should make sure to take all medications prescribed to them by their doctor. If your doctor placed cardiac stents to keep your heart vessels open or you had to have bypass surgery for your heart, taking the medications your doctor prescribed to you is vital to preventing a future heart attack.

Sometimes, if you require surgery for another condition, your doctor may recommend stopping some medications you take for your heart. An example might be an antiplatelet (anticlot) medication like clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta). Always check with the doctor you see for your heart before you stop taking any of your medications. It's unsafe to abruptly stop many medications, and stopping abruptly could increase your risk of heart attack.

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Blood Clots Are Common And Can Be Deadly, But Many Americans Don't Know Enough About The Risks

Temple Health is on a mission to raise awareness about one of the least-known and most under-diagnosed serious medical conditions – a potentially deadly one that can be prevented, if caught early.

Blood clots, which often form to control bleeding in injured blood vessels, sometimes occur in deep veins, usually in the lower leg, thigh or pelvis and occasionally in the arm. When this happens it's called deep vein thrombosis, or DVT. Sometimes a part of the clots or multiple sections break off and travel through the bloodstream to the lungs, causing a blockage called a pulmonary embolism (PE) – which can be fatal. Together, these conditions are known as Venous thromboembolism, or VTE.

MORE: Young adults are aging faster, and that may help explain their rising cancer risk

As many as 900,000 Americans suffer from blood clots and pulmonary embolisms each year, with up to 100,000 dying, according to estimates from the U.S. Centers for Disease Control and Prevention. Every six minutes, one American dies of a blood clot, which can result from inactivity, such as sitting during long-distance plane trips or lying in bed during an illness or post-surgery. Blood clots also occur spontaneously.

Though blood clots are the leading cause of preventable deaths in U.S. Hospitals and pulmonary embolism is the third most frequent cause of cardiovascular-related disease among Americans, many people do not understand these conditions. Also, Black Americans have a 30-60% higher occurrence of blood clots than white Americans, and, as with many other health disparities, researchers don't yet know why.

That is why Dr. Parth Rali, associate professor of thoracic medicine and surgery at Temple's Lewis Katz School of Medicine, and Temple Health have endorsed the Blood Clot Prevention and Treatment Act, a bill U.S. Rep. Lisa Blunt Rochester (D-Delaware) introduced last month in honor of her late husband, who died at 52 from a pulmonary embolism. The legislation is designed to raise national awareness about DVT/PE, and create more action and advocacy for its prevention. 

"It's about primary prevention and also secondary prevention," Rali said.

Once someone has had a blood clot, they are at a higher risk for developing another one, Rali said. A person who has had a spontaneous blood clot with "no other risk factors involved" has a 30% chance of developing another clot over the next 10 years, according to the National Blood Clot Alliance.

Other risk factors for developing blood clots include pregnancy, cancer, hospitalizations, obesity and older age. But blood clots can occur without any known risk factors.

"It's a disease that can affect any race, any gender, any ethnicity," Rali said.

Catching and diagnosing blood clots early is one of the most effective methods of preventing pulmonary embolisms.

The CDC's estimate of 900,000 people who suffer from VTE each year is "just the tip of the iceberg" because current electronic medical record symptoms do "not have bandwidth to capture all the adverse outcomes and track (all) the data regarding blood clots," Rali said. "If you don't know how to capture the magnitude of this problem, you can't come up with an intervention."

Another complicating factor with blood clots is that people who have them – and some may not know it – are seeing all different kinds of clinicians. A pregnant woman with a blood clot, for instance, will most likely see her obstetrician/gynecologist. Because different physicians "may not have expertise in managing a blood clot," the disease often "becomes deadly or gets underreported, under-studied, under-treated, under-optimized in routine medical care," Rali said.

To solve that problem, Temple Health has trained clinicians and health care workers across the health system to recognize signs of a blood clot. Anytime someone comes into the hospital with a blood clot, or whenever someone already in the hospital shows signs of a blood clot, a specialized response team immediately activates, Rali said.

"It's a life-changing event, once you have a blood clot," Rali said. "Your life changes forever. You're always in a constant fear of getting a second blood clot or blood-clot-related side effects."

Rochester's bill calls for a three-pronged approach:

• Increase public awareness of blood clot signs and symptoms and educate health care providers and hospitals on the signs, symptoms and treatments of blood clots by requiring the CDC to conduct a nationwide public awareness campaign.

• Establish an advisory committee to provide advice, information and recommendations to the Secretary of the Department of Health and Human Services regarding programs, policies and research to promote the diagnosis, treatment and prevention of blood clots and pulmonary embolisms.

• Improve our understanding of who and how many Americans are impacted by blood clots by requiring the CDC to conduct a study on new ways of detecting and monitoring blood clots at the national level.

Symptoms of deep vein thrombosis and pulmonary embolism

According to the Mayo Clinic deep vein thrombosis can cause these symptoms:

• Leg swelling• Leg pain, cramping or soreness that often starts in the calf• Change in skin color on the leg — such as red or purple, depending on the color of one's skin• A feeling of warmth on the affected leg

Deep vein thrombosis can occur without noticeable symptoms.

The warning signs and symptoms of a pulmonary embolism include:

• Sudden shortness of breath• Chest pain or discomfort that worsens when taking a deep breath or when coughing• Feeling lightheaded or dizzy• Fainting• Rapid pulse• Rapid breathing• Coughing up blood

Signs Of Postpartum Depression

Postpartum depression is a severe, long-lasting feeling of depression you may have after giving birth. Most people will have strong emotions after having a child, like feeling anxious, afraid, or guilty and could experience crying episodes and fatigue or restlessness; these early emotions may start during pregnancy (peripartum depression) and last from 2 to 3 weeks after giving birth. In about 1 of 7 people who have a newborn baby,  postpartum depression will occur.

Some early symptoms may include:

Anxiety

Feeling sad or overwhelmed

Having mood swings or irritability

Having trouble with focus, sleep, or appetite

Crying

While these symptoms can be common in new parents, If you have some of the early warning signs of postpartum depression, talk to your doctor or counselor right away. The earlier you seek treatment, the sooner you can start to feel like yourself again.

Your strong emotions after childbirth don't get better. It's common to have a dip in mood during your baby's first 2 weeks. After that, you should feel better. But if you're still sad or even hopeless weeks later and the feelings are growing stronger, that's more than the early emotions that are more common after childbirth.

Sadness or guilt take over your thoughts. Some parents may feel upset every so often. But if you have frequent crying spells, or you often feel unhappy about being a parent, or you're often "down on yourself" as a parent, these may be among the first signs of postpartum depression.

You lose interest and motivation to do things you enjoy. If you notice a change in your interest in doing certain activities you used to do before you were pregnant and had your baby, you may be experiencing postpartum depression. Talk to your doctor about changes in your mood and habits.

You have trouble making decisions or focusing. Maybe you're too tired to think straight. Maybe you just don't care. If you can't decide whether or not to get out of bed, take a shower, change your baby's diaper, or take them for a walk, these may be early signs of postpartum depression.

You worry you won't be a good parent. Being worried about parenting is common among parents whose babies are sick or premature or were born with special needs. But if this is not your situation, then having constant doubts about yourself as a parent could mean something else.

Your sleep patterns or eating habits have changed. It's natural for the way you sleep and eat to change when you become a new parent. But if you can't even rest when your child is napping, or you're sleeping all the time, that's likely something other than a new sleep pattern.

You lose motivation, energy, and interest in your baby. If you notice a change in how active you're able to be or if you have a decrease in interest in your baby or feel like you don't want your baby, talk to your doctor as soon as possible. This is another symptom of postpartum depression.

You think about harming yourself or your baby. Thoughts of suicide, or hurting yourself or your baby, are advanced signs of postpartum depression and even postpartum psychosis, a rare and serious mental illness that happens with postpartum depression. If you're having any kind of suicidal thoughts, you're in crisis and need to call your doctor or the Suicide & Crisis Lifeline at 988 immediately to get help.

Although there's no official test for diagnosing postpartum depression, you will have a doctor's visit about 2-3 weeks after having your baby and they will do a depression screening. This will include questions about your emotions and the well-being of you and your baby.

Some warning signs you may have postpartum depression include:

Your depression becomes stronger over time. 

Your strong emotions last for more than 2 weeks.

You have trouble taking care of your baby.

It's difficult to handle normal daily tasks.

You have thoughts about hurting yourself or your baby.

If you think you may have postpartum depression, talk to your doctor as soon as possible. The treatment options vary and depend on how severe your case is. They can include:

Antidepressants

Anti-anxiety medication

Support group

Behavioral or talk therapy

Your doctor may also be able to refer you to someone who specializes in mental health. Or you can seek resources from organizations in your area like the National Alliance of Mental Illness or Postpartum Support International. If you have thoughts of hurting yourself or are in emotional distress, the 988 Suicide & Crisis Lifeline can help.  

Postpartum depression is a range of strong, long-lasting emotions you may feel when you have a baby. If you experience certain emotional changes, like crying spells, mood swings, or sadness, talk to your doctor as soon as possible. While these symptoms can be common and mild for some new parents, they can also be early signs of postpartum depression if they last longer than 2 weeks, grow stronger, change your ability to take care of your child or daily activities, or involve thinking of hurting yourself of your baby.

What are the red flags for postpartum depression? Some signs you may have postpartum depression is if you aren't able to do daily tasks or take care of your baby due to strong feelings or emotions during your pregnancy or after childbirth. These signs can include crying spells, not wanting to be around your family and friends, loss of energy or the ability to focus, anxiety, and thoughts of harming yourself or your baby. If you have any of these symptoms, it's best to tell your doctor as soon as possible. While some early symptoms can subside for some new parents, they could also be early signs of postpartum depression.

What are the red flags for postpartum psychosis? Postpartum psychosis is an extreme form of postpartum depression that requires immediate care. Some of the symptoms include hallucinating, feeling paranoid or ashamed, or becoming very active. With this condition, there's an increase in the risk of hurting yourself or your baby, which is why emergency treatment is needed. Treatment may involve medication, treatment, and therapy.

What is the most reliable predictor of postpartum depression? 

There are many risk factors for postpartum depression, including:

If you or a family member have had depression before

Trouble in your relationship or marriage

Little to no social support

Having mixed feelings about your pregnancy

Having a difficult pregnancy (for example having health conditions or delivering early)

Having a baby with certain health conditions

Being a single parent or having your child at a younger age (under 20 years old)

Being a parent of multiples (twins, triplets, etc.)

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