If you think either you or someone near you is having either a heart attack or stroke, you should call 911 immediately, even if you are not sure.

What is a heart attack?

Heart attack occurs when sudden damage and/or death occurs to a portion of the heart muscle. The damage to the heart muscle usually is caused by a blocked coronary artery, which then prevents oxygen from getting to the muscle tissue of the heart. Heart attack is the most common cause of death in the US

Arrhythmias (an abnormal heart beat) also can cause a heart attack. Examples of life-threatening arrhythmias include ventricular fibrillation and sudden cardiac arrest, in which the person will die within a few minutes.

Heart attacks can result in permanent heart muscle damage. If the extent of the heart muscle damage is large, the person may die. 

What is a stroke?

A stroke occurs when brain tissue becomes deprived of oxygen, leading to damage or death of the brain tissue in the region affected by the stroke. The most frequent cause of a stroke is clot that blocks a blood vessel in the brain (ischemic stroke).

Hemorrhagic stroke (leakage or rupture of a blood vessel within the brain) is a less common cause of stroke.

Strokes can result in permanent brain tissue damage and/or death. If the extent of brain tissue damage is large, the person may die. It is the fifth most common cause of death in the US.

Heart attack and stroke are medical emergencies.

What is a mini-stroke (TIA)?

A transient ischemic attack (TIA, mini-stroke) occurs when there is a temporary blockage of a blood vessel in the brain, producing symptoms similar to a stroke. However, during a transient ischemic attack, the stroke symptoms resolve completely within a short period of time after the clot blocking the vessel breaks apart, and thus does not produce any permanent damage or lasting effects. Transient ischemic attacks often are a warning sign of an imminent full-blown stroke, and thus require immediate medical treatment.

You do not want to have a heart attack or stroke because both can lead to disability or death. In terms of mortality statistics, heart attacks are more common since they are the leading cause of death in the US, while strokes are the fifth leading cause of death.

However, individuals may have more difficulty afterwards if they survive a stroke than if they survive a heart attack, though this will depend on how much brain tissue is damaged after the stroke. For example, a stroke can cause profound life-altering disabilities, such as losing the ability to communicate verbally or to use certain parts of your body (for example, your right arm and right leg). If you fear permanent disability worse than death, you may think that a stroke is worse than a heart attack.

The warning signs of heart attack and stroke are not the same.

Heart attack symptoms and signs

The classic warning symptoms and signs of a heart attack in men and women may include:

• Chest pain or chest discomfort (pressure, squeezing, fullness) that may come and go
• Pain or discomfort that may radiate to the shoulders, arms, back, abdomen, jaw, or teeth
• Shortness of breath
• Sweating
• Lightheadedness or fainting
• Nausea and vomiting

Stroke symptoms and signs

Recognition of stroke symptoms is vital for emergency treatment.

The acronym “FAST” stands for recognition of:

• Facial drooping
• Arm weakness
• Speech difficulty
• Time for action

If you or someone you are with experiences the symptoms (FAST) call contact 911 immediately.

Other classic warning symptoms and/or signs of a stroke may include:

• Numbness or weakness of the face, arm, or leg, usually affecting only one side of the body
• Difficulty speaking or understanding speech
• Confusion or loss of consciousness
• Difficulty seeing out of one or both eyes
• Sudden severe headache

Heart attacks and strokes are similar in that they both:

• Usually have a sudden onset
• Are caused by disruptions in the flow of oxygen-rich blood
• Produce signs and symptoms suddenly
• Can cause debilitating symptoms and health problems that may or may not improve over time
• Can be disabling
• Should be treated immediately in an emergency department
• Can cause death if enough of the person's brain or heart tissue is damaged

Neurologists that treat people who have had a stroke consider a stroke just as important as a heart attack because of the similarities between these two life-threatening conditions. Many neurologists refer to a stroke as a "brain attack."

Symptoms and signs of heart attack in women

In addition to the classic symptoms of heart attack symptoms, women may have somewhat different signs and symptoms that may include:

• Abdominal pain (discomfort or pain feels like heartburn or indigestion)
• Dizziness
• Moderate to severe fatigue
• Clammy skin

Symptoms and signs of stroke in women

In addition to the classic signs and symptoms of a stroke, women may also experience other symptoms such as:

• Shortness of breath
• Disorientation
• General weakness
• Agitation
• Nausea/vomiting
• Behavioral changes and/or hallucinations
• Seizures
• Hiccups

Some women may have a mixture of the classic and less common signs and symptoms of stroke or heart attack.

Heart attacks and strokes (ischemic strokes) are caused by blood clots (thrombosis). These two conditions share essentially the same risk factors, which include:

• Family history
• Smoking
• High cholesterol levels
• Hypertension (high blood pressure)
• Obesity
• Diabetes
• Stress
• Physical inactivity

Heart attack treatment

Cardiopulmonary resuscitation (CPR) is the initial emergency treatment for heart attacks if the patient person has no pulse and/or if an available defibrillator is ineffective in restoring a pulse. Clot busting medications that can help open blocked arteries or angioplasty and stent placement to open a blocked artery are potential initial treatments available for a heart attack.

If a person with heart attack symptoms is able to swallow, many doctors will recommend initial treatment of four chewable 81 mg “baby aspirin” (do not use aspirin that are coated or labeled as extended release). Some patients may require emergency coronary artery bypass grafting (surgery that removes segments of blocked heart arteries and replaces them with open vessels taken from other areas of the body).

Stroke treatment

There are two major types of stroke, with the majority due to a blocked artery in the neck or brain. About 15% of strokes are due to either leakage or rupture of a brain aneurysm, which leads to bleeding in the brain (hemorrhagic stroke). Unfortunately, both types of stroke can have the same initial symptoms. Emergency medical treatment depends on which type of stroke you or another person is having.

Time to diagnose the type of stroke is critical to treatment since each type of stroke requires different treatment and is time-dependent. It is critical for 911 personnel and the emergency department medical personnel to know the time that the symptoms of stroke first developed or were noticed, as this can determine the treatment options. In contrast to heart attacks, do not give aspirin to a person having a stroke, as aspirin could make the stroke worse if it is hemorrhagic.

Upon arrival to the hospital, a CT scan of the head will be immediately ordered to image the brain and determine the cause of the stroke symptoms. If the CT scan indicates an ischemic stroke, and if the patient’s stroke symptoms started within 4.5 hours of when they are evaluated, then the treatment can be similar to that of heart attacks (a clot dissolving medication may be administered) if there are no contraindications.

In certain cases, individuals with certain types of ischemic strokes may be candidates for procedures to open up the blocked artery, even if they are outside this time-window. Ultimately, the treatment decisions generally are made with the input from various specialists (neurologist, emergency physician, interventional radiologist) and the treatment options may vary depending on many different factors.

Hemorrhagic strokes can be difficult to treat. Medical treatment includes tightly controlling blood pressure, stopping medications that may increase the bleeding, and monitoring/controlling the pressure inside the brain with surgical placement of a drain to remove blood. A decompressive craniotomy (opening up the skull to relieve the pressure and/or remove blood from around the brain) is an emergency surgery procedure that also may be considered by a neurosurgeon. Other surgical procedures may be undertaken to clamp or seal up a ruptured/leaking aneurysm or damaged vessel.

Patients with severe heart attacks or severe strokes may require assisted ventilation (life-support).

If you survive the initial event, the prognosis for heart attacks and strokes is highly variable. Some individuals may recover fully and lead normal lives, whereas other individuals may suffer severe permanent disability and require lifelong care. The prognosis depends on the severity of the person’s initial stroke or heart attack, whether they are able to seek medical treatment in a timely manner, their underlying health and medical problems, and the effectiveness of the treatment options available to the them when they are evaluated. The elderly individuals with chronic medical illnesses (such as COPD, diabetes or cancer, for example) often have worse outcomes.

The prognosis for heart attacks is somewhat worse than strokes, as heart attacks are the leading cause of death in the US.

Because heart attacks and strokes have many of the same risk factors, the measures to reduce the risk of these two diseases are the same.

Various lifestyle modifications can decrease the risk of developing a heart attack or stroke. No matter what your age, you can reduce the risk of heart attack and stroke by engaging in a regular exercise program and by eating a well-balanced healthy diet. A low-fat diet with plenty of vegetables and fruit, in addition to moderate exercise several days a week is recommended.

Other things you can do to prevent a heart attack or stroke include:

• Stop smoking
• Limit your alcohol intake
• Reduce stress

For certain individuals, taking the above measures can also help decrease their risk of developing high blood pressure, diabetes and high cholesterol, which are all risk factors for having a heart attack or stroke. However, if you are diagnosed with high blood pressure, diabetes, or high cholesterol, and you are prescribed medications to help manage these conditions, it is very important to take these medications as instructed to better control these chronic illnesses. Regular check-ups with your doctor or other healthcare professional also are important to monitor and manage these conditions.