Coronary artery disease is the leading killer of both men and women. On the positive side, mortality rates from coronary artery disease have significantly declined in industrialized countries over the past few decades, although they are on the rise in developing nations. When the necessary lifestyle changes are enacted in combination with appropriate medical or surgical treatments, a person suffering angina and heart disease has a good chance of living a normal life. Experts have believed, for example, that unstable angina indicates a very high risk for death after a heart attack, but a recent study indicated that after the first year of treatment, such a patient's risk for death is only 1.2% above the risk in the normal population. Much evidence exists, in fact, that onset of angina less than 48 hours before a heart attack is actually protective, possibly by conditioning the heart to resist the damage resulting from the attack. In one study, people without chest pain experienced much higher complication and mortality rates than those with pain.

Indications of a Heart Attack

Angina that does not clear up when medications are taken is a signal to go to the hospital. Typically, the pain before a heart attack is unexpected, worse than any experienced, and lasts longer than 20 minutes. The degree of pain indicating a possible heart attack varies greatly between individuals, however, and early warning symptoms for heart attacks may be overlooked because they are mild or may not even occur. Sweating, a feeling of indigestion or heartburn, nausea and vomiting are common. Some people report a great fear of impending death, a phenomena known as angor animi. Women are more likely than men to be nauseous and experience pain high in the abdomen or chest. Their first symptom may be extreme fatigue after physical activity rather than chest pain. It should be noted that because chest pain in men is more apt to signal a heart attack, while chest pain in women is more likely to be caused by other problems, physicians might not be as alert to a heart problem when a woman complains of chest pain. Any chest pain should always be taken seriously. Calling 911 should be the first action taken. The patient should chew an aspirin and be sure that emergency health providers are informed of this so an additional dose isn't given. Chest pain sufferers should go immediately to the nearest emergency room, preferably traveling by ambulance. They should not drive themselves.