Is it a stroke or a heart attack? How to tell
It is important to understand the signs and symptoms of each to ensure immediate treatment.
What is a heart attack?
Chest pain is a common sign of a heart attack, but not all heart attacks involve chest pain.
A heart attack — or myocardial infarction (MI) — happens when a problem somewhere in the body reduces or blocks blood flow to a coronary artery.
This can stop the flow of blood to the heart.
Coronary arteries supply the heart muscle with blood flow. They can become narrow if substances such as fat and cholesterol build up. The name of these substances is plaque.
Plaque usually builds up over several years. If pieces of plaque break off in a heart artery, a blood clot can form around it. This can stop the normal blood flow from reaching the heart muscle.
If this happens, part of the heart muscle does not get enough oxygen. This part begins to die if the blockage does not receive treatment quickly.
Scar tissue begins to replace healthy heart tissue. When there is damage or death to the heart muscle due to a lack of oxygen and nutrients, a heart attack can result.
According to the American Heart Association (AHA), someone in the United States has a heart attack every 40 seconds.
What is a stroke?
A stroke occurs when low blood supply to the brain stops the brain tissue from receiving oxygen and other essential nutrients.
It can happen when a blood vessel that carries oxygen and nutrients to the brain:
- bursts or
- is blocked by a clot
Any brain cells that do not receive oxygen begin to die. This can happen within minutes.
Sometimes a person will have a temporary clot. This can lead to an ischemic attack (TIA), or "mini-stroke."
A brain aneurysm is a bulge in an artery that can burst. It can lead to a stroke. The symptoms of a stroke and an aneurysm can be similar, but they may require different treatment.
A heart attack and a stroke can have similar symptoms, but there are also some important differences. In both cases, urgent medical treatment is necessary.
Heart attack symptoms
The most common symptoms of a heart attack include:
- chest pain or discomfort
- upper body discomfort
- pain that radiates down the left arm
- shortness of breath
- a cold sweat
- light-headedness or dizziness
Symptoms can vary between individuals. Some people have no symptoms or very mild symptoms and experience a "silent heart attack."
Not all heart attacks involve chest pain, even if discomfort is present. There may be a feeling of pressure on the chest.
Symptoms in women
The most common symptoms in women can be different from those in men.
Women may be more likely to experience:
- sudden weakness
- shortness of breath
- body aches
- sleep problems
- overall feeling of being unwell
- nausea, vomiting, and indigestion
- jaw pain
If a person has these symptoms, they need immediate medical attention.
Call 911 and ask for emergency help.
A severe headache can be a sign of a stroke.
Stroke symptoms depend on the part of the brain where damage occurs. The damage can affect a number of functions, including memory, speech, and muscle control.
Common symptoms include:
- sudden numbness or weakness in the face, arm, or leg, usually on one side of the body
- confusion or difficulty speaking or understanding speech
- sudden difficulty walking, dizziness, or loss of balance or coordination
- trouble seeing in one or both eyes
- sudden severe headache, which may also include vomiting, dizziness, or altered consciousness
What is F.A.S.T.?
The American Stroke Association urge people to remember the acronym FAST to recognize the signs of a stroke.
FACE DROOPING: Is one side of the face is drooping?
ARM WEAKNESS: Is one arm is weak or numb?
SPEECH DIFFICULT: Can the person repeat the sentence "the sky is blue" without slurring?
TIME TO CALL 911: The person needs immediate medical help.
Timely treatment can save a life or reduce the risk of complications after a stroke.
Some factors can increase the risk of heart attack or stroke, and people cannot change them.
- a family history of stroke or heart attack
- race or ethnicity
- conditions that make the blood "sticky," such as sickle cell anemia
People who have already had one stroke, mini-stroke, or heart attack have a higher risk of having another one.
Factors that people may be able to control include:
An unhealthful diet is a risk factor for both heart disease and a stroke.
- high blood pressure
- high levels of cholesterol and triglycerides
- overweight and obesity
- a poor diet
- a lack of physical activity
- drinking too much alcohol
Risk factors for a heart attack
People have a higher risk of a heart attack if they:
- are male
- have already had a heart attack
- have a diagnosis of heart disease, such as a congenital heart defect
Risk factors for stroke
People with a higher risk of a stroke include those who:
- have had a previous stroke, including a TIA or mini-stroke
- have used or are using drugs such as cocaine, ecstasy, amphetamines, or heroin
- have used birth control pills
- have sleep apnea
- have artery problems that may affect the brain, such as carotid artery disease
Conditions with similar symptoms
It is important to diagnose a heart attack or stroke correctly.
Conditions with similar symptoms to a heart attack
Other medical conditions can have similar symptoms and can affect the heart.
These conditions include:
Angina: A symptom of coronary artery disease that causes chest pain or discomfort due to the heart muscle not getting enough blood. Angina may feel like pressure or a squeezing pain in the chest area.
Aortic aneurysm and dissection: An enlargement that can burst or tear in the aorta, the main artery in the body. This is a life-threatening emergency.
Arrhythmias: Irregular or unusually fast or slow heartbeats. These can develop into more serious medical conditions such as atrial fibrillation, which can cause a stroke.
A blood clot in the lung: This can result from deep vein thrombosis, when a clot forms, often in the lower leg, and a part of it breaks off and travels to the lung. This needs emergency medical treatment.
Heartburn, acid reflux, or gastroesophageal reflux (GERD): This can also feel like a heart attack by causing severe chest pain.
Musculoskeletal pain: Sometimes damage to a muscle in the chest, neck, or arm can lead to pain that may resemble that which occurs with a heart attack.
It is important to seek emergency medical treatment for chest pain to be sure it is not a heart attack or another serious medical condition.
Conditions with similar symptoms to a stroke
The FAST acronym sums up some typical signs of a stroke, but other conditions can have similar symptoms. These include migraines, headaches, and seizures.
Other conditions that may have similar symptoms include:
Brain tumors: A mass develops on the brain tissue. People can experience headaches, weakness, loss of feeling in the arms or legs, problems walking, and changes in vision and speech.
Bell's palsy: A condition that happens because of damage to a nerve outside the brain. This can lead to paralysis or weakening of muscles on one side of the face and facial drooping.
Multiple sclerosis: A disease caused by inflammatory injury to the brain. Muscle weakness is a symptom.
If a person has stroke-like symptoms, it is important to call for help immediately. The sooner treatment can begin, the lower the risk of possible brain damage.
If a heart attack or stroke is possible, health professionals will start medical treatment right away, often before confirming the diagnosis.
In the past, doctors have often given aspirin to people who have had a stroke or heart attack. This is an anti-clotting agent, which means it thins the blood. It can help prevent further blood clotting.
If the problem is due to internal bleeding, however, as with some kinds of stroke, blood thinners will not be suitable as they can lead to more severe bleeding.
For this reason, it is important for a doctor to make a correct diagnosis.
People with a high risk of a heart attack or stroke may already take aspirin on a daily basis, but current guidelines only recommend this if a person has a low risk of bleeding.
Treatment for a heart attack
Immediate treatment may include cardiopulmonary resuscitation (CPR). This is appropriate if a person stops breathing and their heart stops. In some cases, it can help restore blood flow to the heart.
When emergency help arrives or when a person reaches the hospital, a doctor will provide other treatments.
Immediate interventions may include:
- clot-busting medication, known as thrombolytics
- nitroglycerin to improve blood flow
- oxygen therapy
- treatment for chest pain
Surgery and other medical procedures include:
- a bypass operation, to bypass the blocked blood vessel
- percutaneous coronary intervention, to widen the narrow blood vessels
In the longer term, the doctor will advise about:
- heart-healthy lifestyle changes such as diet or exercise
- cardiac rehabilitation
- ongoing medication to manage the condition
Treatment for a stroke
The type of treatment for a stroke depends on the type of stroke.
Common treatments include:
- clot-busting drugs and other medicines
- tissue plasminogen activator (TPA), which can be effective if a person receives it within around 3 to 4.5 hours of having a stoke
- mechanical clot removal, or thrombectomy, within up to 24 hours of symptoms appearing, based on brain imaging
Long-term treatment aims to:
- reduce the risk of another stroke
- address any functionality they have lost, for example, speech difficulties
The overall impact and treatment for the stroke will depend on the area of the brain involved and the amount of tissue damage. A doctor will decide if this is necessary and if any additional treatment is needed.
It is not possible to control all the factors that lead to a heart attack or stroke, but managing the preventable ones can reduce a person's risk.
Quitting smoking can reduce the risk of a stroke, a heart attack, and many other serious conditions.
- not smoking
- avoiding alcohol or drinking in moderation
- managing blood sugar levels
- keeping stress levels low
- managing blood pressure and cholesterol
- avoiding recreational drug use
Leading a healthful lifestyle with a balanced diet and exercise is another vital part of reducing the risk.
People who have had previous heart or stroke problems may also want to ask their doctor about including a dose of aspirin in their daily regimen.
Heart disease includes stroke and heart attacks.
According to the Centers for Disease Control (CDC), heart disease is the number one cause of death in the U.S. for both men and women.
About 735,000 Americans have a heart attack every year. In 210,000 of cases, these affect someone who has already had one heart attack before.
CDC figures also show that around 795,000 people have a stroke in the U.S. every year. Around 610,000 of these are new strokes, and the rest — nearly 25 percent — affect people who have already had one stroke.
People who experience a heart attack or stroke need rapid treatment to prevent further damage and complications.
If someone experiences any symptoms of a heart attack or stroke, someone should call the emergency medical services immediately. Quick action could save a life.