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DISCUSSION – Despite of all advances in the management of cardiovascular diseases, yet discrimination between chest pain due to AMI and non- cardiac chest pain remains a dilemma. Unfortunately, not much literature is available about the characteristics of chest pain to differentiate these two conditions. Only three of the selected studies combined different signs and symptoms for the diagnosis of AMI.8 – 10 Age is an important determinant of AMI in patients having chest pain. Incidence of AMI increases with increasing age. In females age of presentation is even higher by 5-10 years.11 In our study, we found that majority of the patients were between the age of 41-70 years, while a study conducted by Malik et al, 85% of the patients were between 41-60 years of the age.2 Age of presentation was slightly higher in our population as compared to that which was noticed by British Heart Foundation i.e.30-69 years.12 In Belgium Bartholomeeussen et al 13 found that incidence of AMI is high at the ages between 45–75 years. Our results are in accordance with the study conducted by Bartholomeeussen et al.13 However the mean age for first MI among south Asian is lower compared to the individuals in other countries.14 At any given age, prevalence of coronary heart disease is greater in men than in women.15 Risk factors like hypertension and hyperlipidemia are more prominent for men than women in the late 40- to early 50-year range; then their prevalence is higher in women. Women have an extra protection during their early reproductive life due to the effect of sex hormones. In our study majority of the patients with AMI were male (79.8%). Studies conducted by Hafeez et al and Shabbir et al also showed male dominance.16, 17 Albarran et al 18 had also discovered that AMI is more common in males (68%) as compared to females (32%). Chirsten et al 19 found AMI prevalence was 62% in males. In a local study conducted by Mujtaba et al 20 at Karachi had also similar findings. Site of the chest pain gives important clue to the diagnosis of ACS/AMI. Pain which is located in the center of chest is more likely to be ischemic than a peripherally located chest pain. We found that precordial chest pain is the most common site for chest pain. There were 127(38.4%) patients with precordial chest pain in our setting. De Silva also noticed that precordial and retrosternal sites are most common sites for chest pain in CAD.21 Bosner et al 22 analysed 1212 patients (534 men and 678 women) for the aetiology of their chest pain; of those 180 patients (92 men and 88 women) were diagnosed as having CHD. Pain was present on the left side of chest in 56 (63.6%) females and in 63 (68.5%) males. Bosner et al 22 noticed that chest pain was localized on the right side of the chest in 34.1% patients. However, in our settings none of the patient presented with right sided chest pain. Most common site where AMI pain radiates is left shoulder and arm.23, 24 This is because of presence of heart on the left of chest, so pain radiates along left sided cervical nerve roots. In our study 55(16.6%) patients had pain radiation to left shoulder, left upper arm and ulnar side of left forearm. Solt et al 25 claimed a high prevalence of chest pain radiation to the jaw especially in females. However, we have noticed that only 4(1.2%) patients had pain radiation to the jaw alone but pain radiation to the jaw was present in combination with radiation to shoulder and neck in 22.7% patients. Duration of chest pain more than 20 minutes can be taken as cutoff for AMI. In our study, it was found that 90% of patients had chest pain persisting for >20 minutes. Similar results have been proven in multiple other international studies.26, 27 However those attacks of chest pain that are not very severe or prolonged, but distressing enough for patients to contact a general practitioner, present a more difficult problem in diagnosis and management.28 Although chest pain is the most important symptom of AMI but it may be invariably absent in some patients. In our setting 6.9% patients had symptoms other than chest pain (painless AMI). In a study conducted by Hafeez et al pain less MI was seen in 6 % of the patients.16 Abidov et al 29 also found that some patients may present with symptoms other than chest discomfort; such as “angina equivalent” symptoms include dyspnea (most common), nausea and vomiting, diaphoresis, and unexplained fatigue. Chest pain remains most important symptom of AMI but in few patients it may not be there. Further studies on large scale are required about the characteristics of chest pain favoring AMI.

How does a heart attack affect the left arm?

Symptoms can be different for men and women – Men and women experience heart attack symptoms in slightly different ways. The main difference is how pain radiates.

For men: Pain will spread to the left shoulder, down the left arm or up to the chin. For women: Pain can be much more subtle. It may travel to the left or right arm, up to the chin, shoulder blades and upper back — or to abdomen (as nausea and/or indigestion and anxiety). Women are also more likely to experience these accompanying symptoms: shortness of breath, nausea, vomiting and back or jaw pain.,

Some heart attacks are sudden and intense, but most start slowly with mild pain and discomfort. Surviving a heart attack depends upon how well you recognize and react to these symptoms. Remember that “time is muscle.” The sooner you receive medical care, the sooner heart muscle can be saved.

Why does chest pain radiate down the arm?

Angina is chest pain or discomfort that occurs if an area of your heart muscle does not get enough oxygen-rich blood. It is a common symptom of coronary heart disease, which limits or cuts off blood flow to the heart. There are several types of angina, and the symptoms depend on which type you have.

Angina chest pain, called an angina event, can happen when your heart is working hard. It can go away when you stop to rest again, or it can happen at rest. This pain can feel like pressure or squeezing in your chest. It also can spread to your shoulders, arms, neck, jaw, or back, just like a heart attack.

Angina pain can even feel like an upset stomach. Symptoms can be different for women and men. To diagnose angina, your doctor will ask you about your signs and symptoms and may run blood tests, take an X-ray, or order tests, such as an electrocardiogram (EKG), an exercise stress test, or cardiac catheterization, to determine how well your heart is working.

Can heart pain radiate to left arm?

3. Angina – Angina occurs when the heart is not getting enough oxygen. Angina can cause left arm pain that is often accompanied by shoulder, neck, back, or jaw discomfort along with a feeling of indigestion, Angina is often a symptom of coronary artery disease and should be taken seriously. Talk with your doctor about your left arm pain and other symptoms to get a proper diagnosis of angina.

What is radiating pain of myocardial infarction?

Mechanism – There are several proposed mechanisms for referred pain. Currently there is no definitive consensus regarding which is correct. The cardiac general visceral sensory pain fibers follow the sympathetics back to the spinal cord and have their cell bodies located in thoracic dorsal root ganglia 1-4(5).

As a general rule, in the thorax and abdomen, general visceral afferent (GVA) pain fibers follow sympathetic fibers back to the same spinal cord segments that gave rise to the preganglionic sympathetic fibers. The central nervous system (CNS) perceives pain from the heart as coming from the somatic portion of the body supplied by the thoracic spinal cord segments 1-4(5).

Classically the pain associated with a myocardial infarction is located in the mid or left side of the chest where the heart is actually located. The pain can radiate to the left side of the jaw and into the left arm. Myocardial infarction can rarely present as referred pain and this usually occurs in people with diabetes or older age.

• Also, the dermatomes of this region of the body wall and upper limb have their neuronal cell bodies in the same dorsal root ganglia (T1-5) and synapse in the same second order neurons in the spinal cord segments (T1-5) as the general visceral sensory fibers from the heart.
• The CNS does not clearly discern whether the pain is coming from the body wall or from the viscera, but it perceives the pain as coming from somewhere on the body wall, i.e.

substernal pain, left arm/hand pain, jaw pain.

Does heart attack pain in left arm come and go?

Carpal tunnel syndrome – Carpal tunnel syndrome (CTS) also occurs due to nerve compression, but only when it affects the median nerve, which runs from the forearm to the palm of the hand. CTS causes numbness that starts in the fingers and can radiate up the arm.

1. This condition can sometimes also cause pain and make it difficult to grip objects.
2. The symptoms may get worse with certain activities that require a person to bend their wrist, such as reading a book or driving.
3. If a person seeks emergency care for a possible heart attack, doctors will check their blood pressure and pulse first.

They may then use tests to check whether the person is having a heart attack. The AHA note that the tests may include:

electrocardiogram (EKG), which looks at the heart’s electrical signalsblood testsX-raysCT or MRI scans

If doctors determine that the person is not having a heart attack, they may look at the arm for signs of injury. X-rays, MRI scans, and ultrasound tests can allow them to look at the bones and tissues in the arm to check for physical injuries. To check for CTS, doctors will ask the person to perform specific movements to see whether these trigger symptoms.

1. They may use ultrasound to check for enlargement of the median nerve or electromyography (EMG) to measure electrical activity in the arm.
2. The treatment that someone needs for dull pain in the left arm depends on the cause.
3. If doctors determine that a person is having a heart attack, they will work quickly to restore the blood flow.

The approach that doctors use for a heart attack will depend on the severity of the attack and a person’s overall health. According to the AHA, heart attack treatment may include:

Medications: Some medicines can help dissolve blood clots and clear the blockage. Angioplasty: During this procedure, doctors insert a tube in the blocked artery and attempt to open it. In some cases, they may insert a stent, which is a mesh tube that helps prop the artery open. Heart valve surgery: A surgeon removes the damaged heart valve and replaces it with an artificial valve. Bypass surgery: A surgeon creates a new passage for blood to flow through to the heart, bypassing the blocked artery. In some cases, this surgery may be minimally invasive. Heart transplant: Severe cases may necessitate a heart transplant, which involves replacing a person’s heart with a heart from an organ donor.

For injuries, the AAOS recommend the RICE approach, which stands for rest, ice, compression, and elevation. A person can use the RICE approach by:

avoiding using the arm and resting it whenever possibleapplying an ice pack several times a day to relieve pain and swellingwrapping the area with a bandageelevating the arm higher than the heart to bring down swelling

The AAOS also recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, for short-term pain management, and physical therapy, Rotator cuff injuries that do not respond to these treatments may require corticosteroid injections or surgery. Treatments for CTS include :

wearing a splint to keep the wrist straightavoiding activities that cause symptomscorticosteroid injections to reduce inflammation yoga, which can improve pain and grip strengthsurgery to relieve pressure on the median nerve

Although dull left arm pain can be due to an injury or a pinched nerve, there is a chance that it is a sign of a heart attack. A person should go to the emergency room or dial 911 right away if this is a possibility. If the pain is mild or occurs after an injury, a person can call their doctor for advice on how to proceed.

Dull pain in the left arm that comes and goes is a potential warning sign of a heart attack. It is important that people seek emergency treatment if they have the symptoms of a heart attack. If the arm pain results from an injury or a pinched nerve in the spine or wrist, a person may find relief by resting the arm, applying ice, and taking over-the-counter pain medication.

Physical therapy and yoga may help reduce pain and improve strength in people with injuries or CTS. However, the root cause of the pain will determine the more effective treatment. A doctor can identify the cause of arm pain and recommend the best treatments.

What is referred pain in the left arm?

What is referred pain in the upper arm? – Referred pain is a term used to describe a sensation of pain that is felt in a location other than the site of an injury. Referred pain in the upper arm is when pain is felt in the upper arm but the cause of the pain is located elsewhere. Physiotherapy is an effective treatment for referred pain in the upper arm.

Why is heart pain felt in the arm?

Why Arm Pain? – The association between a heart attack and arm pain may appear to be strange since the arm has not been injured. The reason for the pain in the arm is that the nerves that carry signals from the heart to the brain and those that do the same thing for the arm both send their signals to the same brain cells.

Why does the left side of my chest and left arm hurt?

How to ease a panic attack – Panic disorder is a mental health problem that can be treated. Your doctor may recommend psychotherapy or cognitive behavioral therapy. If it’s an ongoing problem, there are some medications that might help. In order to ease a panic attack, you might find it helpful to:

practice stress management and relaxation techniquesjoin a support groupstay away from caffeine, tobacco, alcohol, and recreational drugsengage in regular physical activitymake sure you get a full night’s sleep every night

Heartburn is the chest pain and discomfort you get when digestive acid flows up into your esophagus (acid reflux or gastroesophageal reflux). You might also have :

a burning sensation in your upper abdomen and chestsour or metallic taste in your mouthstomach contents flowing up to the back of your throat

Heartburn generally happens fairly soon after you’ve eaten. It can also happen when you lie down within a few hours of eating. It can even wake you from a sound sleep. Acid reflux can sometimes progress to a more severe form called gastroesophageal reflux disease (GERD).

What is the pathophysiology of myocardial infarction?

Abstract – Myocardial infarction is defined as sudden ischemic death of myocardial tissue. In the clinical context, myocardial infarction is usually due to thrombotic occlusion of a coronary vessel caused by rupture of a vulnerable plaque. Ischemia induces profound metabolic and ionic perturbations in the affected myocardium and causes rapid depression of systolic function.

• Prolonged myocardial ischemia activates a “wavefront” of cardiomyocyte death that extends from the subendocardium to the subepicardium.
• Mitochondrial alterations are prominently involved in apoptosis and necrosis of cardiomyocytes in the infarcted heart.
• The adult mammalian heart has negligible regenerative capacity, thus the infarcted myocardium heals through formation of a scar.

Infarct healing is dependent on an inflammatory cascade, triggered by alarmins released by dying cells. Clearance of dead cells and matrix debris by infiltrating phagocytes activates anti-inflammatory pathways leading to suppression of cytokine and chemokine signaling.

1. Activation of the renin-angiotensin-aldosterone system and release of transforming growth factor-β induce conversion of fibroblasts into myofibroblasts, promoting deposition of extracellular matrix proteins.
2. Infarct healing is intertwined with geometric remodeling of the chamber, characterized by dilation, hypertrophy of viable segments, and progressive dysfunction.

This review manuscript describes the molecular signals and cellular effectors implicated in injury, repair, and remodeling of the infarcted heart, the mechanistic basis of the most common complications associated with myocardial infarction, and the pathophysiologic effects of established treatment strategies.

Where is left arm cardiac pain?

Left arm pain — and how the pain moves — can be one of the key differences between men’s and women’s heart attacks. In men, the left arm pain will move from the shoulder down the left arm or up to the chin. If the pain comes on suddenly and is unusually severe, or is accompanied by pressure or squeezing in the chest, seek emergency treatment immediately.

In women, the pain can be subtler, It can radiate to the right or left arm. It can involve the chin, shoulder blades and upper back. The pain can reach into the abdomen and feel like nausea, indigestion and anxiety. Women are more likely than men to experience shortness of breath, nausea, vomiting and back or jaw pain.

Like in men, chest pain or discomfort is a common heart attack symptom in women. The pressure or squeezing can last for more than a few minutes or be intermittent in women. Seek emergency medical treatment immediately if you have heart attack symptoms.

Does angina cause pain in left arm?

Central chest pain or discomfort in the chest that doesn’t go away – it may feel like pressure, tightness or squeezing. pain that radiates down the left arm, or both arms, or to the neck, jaw, back or stomach. unconsciousness.

What causes left arm pain and numbness?

9. Allergic reactions – A severe type of allergic reaction, known as anaphylaxis, can cause paresthesia — numbness or a burning feeling — in the left arm in some cases. A person who has left arm pain and numbness along with chest pains should call 911 immediately, as these may be symptoms of a heart attack.

For others, it is important to speak with a doctor if arm pain or numbness is not going away on its own, or if the person also has other symptoms. Left arm pain and numbness can be symptoms of many conditions, one of the most serious being heart attack. Other potential causes include an injury, a pinched nerve, peripheral neuropathy, or hemiplegic migraine.

Treatment for arm pain and numbness depends on the cause. For example, a person can generally treat a mild elbow injury with rest, ice, and pain medication. Other conditions require ongoing management to control the symptoms and prevent complications.

Why is pain related to myocardial ischemia?

The mechanisms of cardiac ischemic pain remain obscure. It is unknown whether ischemia causes cardiac pain by the release of chemical substances or by mechanical stretching. It is also unknown whether ischemia activates specific nociceptors and pain fibers or mechanoreceptors and chemoreceptors.

What is the cause of radiating pain?

Heart attack – Pain that travels to your left arm may, in some cases, be a symptom of a heart attack, Other signs include:

shortness of breath or trouble breathingchest pain or tightnessa cold sweatlightheadednessnauseapain in the upper body

A heart attack is a medical emergency. Call 911 immediately if you think you’re having a heart attack. Mild radiating pain can often resolve on its own. However, you should see a doctor if you experience:

severe or worsening painpain that lasts longer than a weekpain after an injury or accidentdifficulty controlling your bladder or bowels

Get immediate medical help if you suspect a:

heart attack peptic ulcergallbladder attack

If your pain isn’t caused by a serious medical condition, you may be able to find some relief at home. Try these self-care measures:

Stretching exercises. Stretching may help reduce nerve compression and muscle tension. For best results, stretch regularly and gently. Avoid prolonged sitting. If you work at a desk, try to take frequent breaks. You can also do exercises at your desk, Cold or hot packs. An ice pack or heating pad may help ease minor pain. Over-the-counter (OTC) pain relievers, If you have mild sciatica or muscle pain, nonsteroidal anti-inflammatory drugs (NSAIDs) may help ease inflammation and pain. Some of the most common NSAIDs include:

ibuprofen (Advil, Motrin)naproxen (Aleve)aspirin

Radiating pain refers to pain that travels from one part of your body to another. The reason that radiating pain happens is due to the fact that all your nerves are connected. So, an injury or issue in one area can travel along connected nerve pathways and be felt in another area.

Pain can radiate from your back, down your arm or leg, or to your chest or back. Pain can also radiate from an internal organ, like your gallbladder or pancreas, to your back or chest. If your pain is due to a minor condition, stretching and OTC pain relievers may help. If your pain gets worse, doesn’t go away, or is accompanied by unusual symptoms, visit a doctor.

They can diagnose the cause of your pain and work with you to put together a treatment plan.

What is the difference between the pain of angina and the pain of myocardial infarction?

Angina is the specific type of pain you experience when the heart is in trouble. Heart attacks, on the other hand, occur when the narrowing is severe or causes a blockage, leading to actual damage to the heart muscle. In other words, a heart attack is an actual medical condition and angina is a symptom.

Can you have a heart attack without pain in left arm?

They may think that they strained a muscle in their chest or their upper back. It also may not be discomfort in the chest, it may be in the jaw or the upper back or arms,’ she says.

Why does my left arm hurt but no heart attack?

Pain in the left arm without chest pain can result from various issues, including injuries and nerve damage. These issues may cause arm throbbing, swelling, or numbness alongside pain. Pinpointing the type of pain can help a doctor identify the cause. For example, it may be a dull ache or a sharper, stabbing pain. Share on Pinterest Some causes of left arm pain without chest pain require medical attention. The causes of left arm pain without chest pain can range from mild to severe. Anyone who suspects that they are having a stroke or heart attack should receive emergency care. According to the Centers for Disease Control and Prevention (CDC), symptoms of a stroke can include sudden:

numbness or weakness in the limbs or face, usually on one side of the bodydifficulty balancing or walkingdizziness and confusiondifficulty speakinga severe headache

Some common symptoms of a heart attack include left arm pain with chest tightness or pain. However, heart attacks can present in a range of ways, and females, for example, may experience different or additional symptoms, It is also important to receive urgent treatment for a bone fracture, which tends to follow trauma, which may involve a car accident or sports injury, for example.

What causes pain in left shoulder and arm?

Overuse or injury of nearby tendons, such as the bicep muscles of the arms. Nerve injury that leads to abnormal shoulder movement. Tears of the rotator cuff tendons. Poor shoulder posture and mechanics.

Which injury can cause pain that radiates to the left shoulder?

Spleen injury – An injured or ruptured spleen can result in referred pain in the left shoulder, which is pain that travels from its original location to another part of the body. Referred shoulder pain that relates to a spleen injury is known as Kehr’s sign. Abdominal tenderness is another common sign of a spleen injury. Other symptoms include lightheadedness, blurred vision, and fainting.

How do you know if left arm pain is a heart attack?

Call for medical help right away or go to the emergency room if you have: –

• Arm, shoulder or back pain that comes on suddenly, is severe, or occurs with pressure, fullness or squeezing in your chest. This may be a symptom of a heart attack.
• An unusual angle to your arm, shoulder or wrist or if you can see bone, especially if you have bleeding or other injuries.

How do you tell if you’re having a heart attack in your left arm?

Can You Recognize a Heart Attack or Stroke? What To Do When Every Moment Counts How would you react to a medical emergency? When it comes to life-threatening conditions like heart attack or stroke, every minute counts. Get to know the signs and symptoms of these health threats.

• If you think you or someone else might be having a heart attack or stroke, get medical help right away.
• Acting fast could save your life or someone else’s.
• Heart disease and stroke are 2 of the top killers among both women and men in the U.S.
• Nationwide, someone dies from a heart attack about every 90 seconds, and stroke kills someone about every 4 minutes, according to the U.S.

Centers for Disease Control and Prevention. Quick medical help could prevent many of these deaths. Fast action can also limit permanent damage to the body. Heart attack and stroke are caused by interruptions to the normal flow of blood to the heart or brain—2 organs that are essential to life.

Without access to oxygen-rich blood and nutrients, heart or brain cells begin to malfunction and die. This cell death can set off a series of harmful effects throughout the body. The changes ultimately lead to the familiar symptoms of a heart or brain emergency. You might know the most common symptoms of heart attack: sustained, crushing chest pain and difficulty breathing.

A heart attack might also cause cold sweats, a racing heart, pain down the left arm, jaw stiffness, or shoulder pain. Many don’t know that women often have different heart attack symptoms than men. For instance, instead of having chest pain during a heart attack, women may feel extremely exhausted and fatigued or have indigestion and nausea.

1. Many women have a vague sense of gloom and doom, a sense of ‘I just don’t feel quite right and don’t know why,’ ” says Dr.
2. Patrice Desvigne-Nickens, an NIH expert in heart health.
3. The symptoms of stroke include sudden difficulty seeing, speaking, or walking, and feelings of weakness, numbness, dizziness, and confusion.

“Some people get a severe headache that’s immediate and strong, different from any kind you’ve ever had,” says Dr. Salina Waddy, an NIH stroke expert. At the first sign of any of these symptoms, fast action by you, someone you know, or a passerby can make a huge difference.

• NIH-funded research has helped ensure that more people survive heart attacks and strokes every year.
• We now have medicines, procedures, and devices that can help limit heart and brain damage following an attack, as long as medical help arrives quickly.
• If the heart is starved for blood for too long—generally more than 20 minutes—heart muscle can be irreversibly damaged, Desvigne-Nickens says.

“You need to be in the hospital because there’s a risk of cardiac arrest,” which could be deadly. At the hospital, doctors can administer clot-busting drugs and other emergency procedures. With stroke, Waddy says, “The longer you wait, the more brain cells are dying,” and the greater the chance for permanent damage or disability.

Emergency treatment for stroke depends on the kind of stroke. The most common type, ischemic stroke, is caused by a clot that clogs a blood vessel in the brain. The clot-dissolving drug tPA works best when given soon after symptoms begin. NIH research shows that patients who received tPA within 3 hours of stroke onset were more likely to recover fully.

Other strokes are caused by a hemorrhage—when a blood vessel breaks and bleeds into the brain. “The patient can have a larger hemorrhage within the first 3 hours,” Waddy says. A hospital medical team can help contain the bleeding, so every moment counts.

• Even if you’re unsure, don’t feel embarrassed or hesitate to call 9-1-1 if you suspect a heart attack or stroke.
• You should not go get your car keys.
• Your spouse shouldn’t be driving you to the hospital,” advises Desvigne-Nickens.
• The emergency crew is trained to treat these symptoms, and it could mean the difference between life and death.” Heart attack or stroke can happen to anyone, but your risk increases with age.

A family or personal history of heart attack or stroke also raises your risk. But some risk factors for heart attack and stroke are within your control. Treating them can dramatically reduce your risk. “If you have high blood pressure, high cholesterol, or diabetes, work with your doctor to get these conditions under control,” Waddy says.

• Now your numbers and what they mean.” You can also prepare for a medical emergency, to some degree.
• A hospital may not have access to your medical records when you arrive.
• Eep important health information handy, such as the medicines you’re taking, allergies, and emergency contacts.
• It would be important for the medical team to know, for example, if you’ve been taking anticoagulants to help prevent blood clots; these blood thinners put you at increased risk of bleeding.

You might consider carrying an NIH that lists heart attack symptoms and has room for your personal medical information. NIH researchers are studying new drugs and procedures to help the heart and brain repair themselves and improve organ function. “But there is absolutely nothing that will save both your time and health as well as prevention,” says Dr.

Jeremy Brown, director of NIH’s Office of Emergency Care Research. Studies show that making healthy lifestyle choices can help prevent these medical emergencies from happening in the first place. Eat a healthy diet rich in protein, whole grains, and fruits and vegetables, and low in saturated fat. Get regular physical activity and don’t smoke.

“I think one of the most important things we can do is to take a basic CPR Cardiopulmonary resuscitation—a lifesaving procedure that’s performed when a person’s breathing or heartbeat has stopped. and first aid course,” recommends Brown. “We know the majority of cardiac arrests happen outside of hospitals and of that many, many can be saved if we get people with basic training on the scene quickly.

How long does your left arm hurt before a heart attack?

Take the EHAC Oath with us. – We encourage you to start taking care of your heart health today. We can kick this commitment off by taking the EHAC oath together. “I understand that heart attacks have beginnings and on occasion, signs of an impending heart attack may include chest discomfort, shortness of breath, shoulder and/or arm pain and weakness.