Writing a Heart Attack

By Jenny Powell MD

Let’s talk about heart attacks!

Or myocardial infarctions, if you prefer a term that doesn’t rhyme with ‘Cadillac-ac-ac-ac-ac-ac.’

While everybody may experience heart pain differently, there are some common signs that can help us distinguish between a heart-related incident or esophageal or lung issue. I’ve even had patients who were just on the verge of a shingles outbreak that was mistaken for a heart attack.

Let’s consider what a myocardial infarction (affectionately referred to as an “MI”) is. Usually caused by some kind of blockage of one of the arteries supplying blood to the muscles of the heart, the tissue downstream of the blockage doesn’t get the necessary blood and a portion of the muscle gets choked off. This is the definition of an “infarction,” which can cause permanent damage if the tissue does not get re-perfused rapidly. When that portion of muscle isn’t working, it may affect how the heart squeezes the blood out. Mind you, the blockage can be from a build-up of plaque, from an embolism (a piece of a blood clot that breaks loose and ends up damming up a cardiac artery), or from a spasm of the muscle inside the artery. Depending on where the blockage is, it could cause a “silent heart attack” or it can cause the entire heart to stop pumping, which, as I am sure you can imagine, is not a happy scenario for the rest of the body. The heart is an electric pump. If something goes wrong with the wiring or the mechanics of the pump, bad things are bound to happen to those organs (which is all of them) that require the pump to supply the required oxygen.

Crushing chest pain is a primary symptom. When describing it, folks often use a fist to indicate where it hurts. If they use an open hand, it is generally not cardiac (This is not a hard and fast rule, but if you use it in your writing, your physician readers will think you are a genius. You could even use it as cocktail-party banter). “Crushing” is a term often used, because they may relate it to something heavy on their chest – an elephant, for instance – which makes it hard to breathe. Well, it IS hard to breathe, because the lungs are intimately related to the heart, and any issue in the heart will affect the lungs almost immediately. Thus, the typical symptoms may (or may not) include crushing chest pain, shortness of breath, diaphoresis (sweating, usually from the chest up), pain or numbness radiating to the jaw and/or left arm, and what is poetically referred to as “a sense of impending doom.” Nausea with or without vomiting is common as well.

Women may not have any of these symptoms but will experience dyspnea (“shortness of breath.”) This may be the only symptom. “A little bit of pressure” is something else I have heard from women who we find later have had damage to the heart.

If you want the character to die from the heart attack, it’s best they are alone, don’t have Life Alert, and don’t have their cell phone in their hand. If you want them to live, they should have someone there who can call 911, give them an aspirin, check the pulse and breathing if they pass out or are found unresponsive. To have the rescuer know CPR is great, too. If it’s been years since you had any CPR training, it’s no longer the ABCs. You might want to take an updated course yourself, because they teach you how to use the AEDs you see everywhere. Who knows? You might kill off a fictional character but get to save a real life.

Jenny Powell MD is a family physician, thanks to a call from the Holy Spirit, with a unique practice style and two busy offices, available to her patients 24/7. When not writing prescriptions, she works on her unpublished manuscripts, reads a lot of novels, and supports ACFW writers. Visit Jenny on her website and Instagram @jpowellmdauthor.