A heart attack is a common word to describe acute chest pain. It is most often used to describe manifestations of ischemic heart disease, such as myocardial damage caused by a lack or cessation of blood supply. IHD can be chronic or acute (myocardial infarction) in nature. ## Angina This condition manifests itself by pain under the chest, which often radiates to the back between the shoulder blades, left arm, and even lower jaw. It can happen during physical activity, in stressful situations, and when the heart is under heavier pressure and needs more oxygen. The oxygen is blocked by atherosclerotic plaques that develop in the cardiac arteries, as they narrow the lumen of blood vessels and lead to myocardial ischemia. Angina is easily identified by cessation of the attack as soon as the patient gets a chance to rest. What should you do? Those who never felt this pain before are advised to call for urgent medical help. In the case of recurrent attacks, it is necessary to have a blood test for sugar and [cholesterol](https://ul.orna.me/KOge/librarybiomarker?id=57) levels, have an exercise test or stress echocardiography, MSCT coronary angiography, or classical coronary angiography. People who are aware of their having angina should take extended-release nitrates or take a nitroglycerin tablet under the tongue at first symptoms. ## Myocardial infarction The symptoms of myocardial infarction resemble those of angina and differ by the acute, severe pain that doesn't disappear after rest and repeated intake of nitroglycerin. It is also accompanied by general weakness, cold and clammy sweat, and heart interruptions. What should you do? In the case of pain under the chest for longer than 15 minutes that doesn't disappear after intake of nitroglycerin, you should call for urgent medical help. ## Diagnosis by gestures The myocardial infarction or angina can be diagnosed when someone shows any of the following 'cardiac' gestures: - Slightly hits himself or herself in the center of the chest with a tightly clenched fist - Puts an open palm on the middle of the chest and then clasps it - Glides the hand along the chest from bottom to the top as if tying a tie - Wraps the chest with both hands ## How you can help If you are witnessing a heart attack, here is what you can do before the ambulance arrives: __Keep the patient in a cold place__ if it is summer or a warm place in winter. In many cases, the spasm of the coronary vessels occurs as a response to cold temperature and makes the attack more intense. Provide access to fresh air. __Ask patients if they regularly visit a cardiologist__, have had such attacks in the past, or have a nitroglycerin or nitroglycerin spray. __Get a tonometer and measure the arterial blood pressure.__ The nitrate-based drugs can lower it considerably, but if the blood pressure is already below 100/60 mmHg, it is better to wait for the ambulance. __When you call for urgent medical help__, inform the operator that you need a cardiological or resuscitation medical team.