Many people think that a heart attack is sudden and intense. However, many heart attacks start as a mild discomfort in the centre of the chest. So, even if you’re not sure it’s a heart attack, you should still seek medical health promptly. There are several types of cardiac emergencies where immediate action is required. So, symptoms and signs are very important as timely recognition can save the life of the person. The symptoms may vary from person to person. CHEST PAIN Chest pain can be very deceptive. It is a subjective discomfort experienced by the individual, which may be of cardiac or non-cardiac origin. In short, the safest course is to always assume that it is cardiac in origin. Crushing chest pain is the most obvious symptoms, but not all heart attacks begin with it. In fact, some heart attacks cause no symptoms at all. This is more common in people who have diabetes. Sometimes there may be mild chest pain and discomfort that can occur while one is doing some activity or at rest. Depending on one’s age, gender and other medical conditions, symptoms may be more or less severe. Chest discomfort that feels like pressure, fullness or a squeezing pain in the centre of your chest; that lasts for more than a few minutes, or goes away and comes back may be due to a heart attack. Pain and discomfort that extends beyond your chest to other parts of your upper body, such as one or both arms, back, neck, stomach, teeth and jaws.Whatever the reason, cardiac or non-cardiac, make sure that you seek treatment for chest pain.  SYMPTOMS Dyspnoea (difficulty in breathing): Dyspnoea can often be a clue that heart failure should be suspected, especially if the person has trouble while breathing in lying posture.  Palpitations: They are often described as a pounding in the chest or an awareness of rapid or skipped heartbeats. These sensations can be caused by a wide variety of cardiac arrhythmias (abnormal heart beating). Persistent palpitations should be evaluated to rule out life threatening arrhythmias.  Syncope (loss of consciousness): If a person has episodes of sudden dizziness, vertigo or brief loss of consciousness accompanied by weakness, it may be due to decreased perfusion to the brain. Also in such people Arrhythmias such as transient asystole (cardiac arrest), ventricular   fibrillation or tachycardia (life threatening abnormal heart beating), bradycardia (slow pulse rate) can be the culprits. Other causes may be pulmonary hypertension (increase in right sided heart pressures).  Coughing: Conditions related to heart that can lead to coughing could be pulmonary hypertension (right sided heart failure) or pulmonary edema (heart failure). The presence of bloody sputum can be due to heart failure.   Other symptoms, such as sudden onset of severe backache (upper part), cold sweats, nausea or vomiting, anxiety, indigestion and unexplained fatigue may also be present. One has to remember that chest pain and discomfort are the most common heart attack symptoms in both men and women. But women are more likely than men to experience other symptoms, too. These might include shortness of breath, nausea and vomiting, unexplained extreme fatigue, neck, shoulder, upper back or abdominal pain. SIGNS OF CARDIAC EMERGENCY Once the person has one of the above symptoms then the things one should look for in such persons is • Tachycardia (fast heart rate). • Elevated or low blood pressure. • Cyanosis (bluish discolouration seen in extremities) could be due to lack of oxygen supply. • Diaphoresis (profuse sweating) could be due to heart attack or heart failure. • Anxiety or confusion secondary to oxygen deprivation. • Pedal edema (swelling of the feet): When edema is present, it can indicate heart failure for which the cause has to be evaluated. • Engorged (visible veins), pulsatingneck veins (late signs) — when present indicate heart failure. • Sudden loss of responsiveness. No response to tapping on shoulders. These could be the signs of a cardiac arrest or cardiac arrhythmias. • Absence of normal breathing. If the victim does not take a normal breath when you tilt the head up, it could be due to heart failure. Call an ambulance immediately and rush the patient to the nearest heart facility if you see any of the above symptoms.