Dr Muiris Houston, Medical Correspondent, warns that sometimes the signs of a heart attack can be quite subtle
YOU KNOW the feeling: it's late on Christmas Day and you're feeling lethargic. The feasting is over and you are thinking the perennial thought - I shouldn't have had that last portion of pudding.
So you settle onto the couch in the hope that a snooze might make the rumbling in your tummy go away. It doesn't.
Instead, you are aware of a growing discomfort in your chest. Heartburn, you think. Then as the discomfort becomes definite pain, you're not so sure. I couldn't be having a heart attack, could I?
The odds are that the pain is emanating from a protesting gastrointestinal system rather than a blockage in your coronary arteries.
But how can you tell the difference? When is it right to reach for an antacid? And when, despite your protestations, is it appropriate to let your family call for medical help?
Like lots of medical problems, the symptoms of a heart attack don't always follow the textbook description: pain in the centre of the chest, radiating from the chest into the jaw, shoulders or left arm; chest pain that is worsened by lifting or exertion; shortness of breath; and breaking into a cold sweat all strongly suggest a cardiac cause. Nausea and vomiting and not responding to the antacids you took some 30 minutes previously are other pointers to a cardiac cause.
But the signs of a heart attack can be subtle, especially in women and in older people. Chest pain can be much less intense in some patients. Pain radiating to the teeth may be cardiac in origin and the "classic" relationship of chest pain to exertion may be absent.
Heartburn is usually due to the reflux of acid into the gullet (reflux oesophagitis) or the activation of a duodenal ulcer. As the name suggests, the chest pain is usually burning and is felt right behind the breastbone; it gets worse when you lie flat or when you bend over.
Ulcer pain is usually felt in the pit of the stomach but can extend into the lower chest. This pain is often made better by food. And heartburn from any cause is usually relieved by a coating of antacid such as Maalox or Gaviscon.
Other causes of chest pain include muscle inflammation which gives a sharp, localised pain, made worse by particular movements.
If you are feeling especially stressed in the run-up to Christmas, this may cause your anxiety levels to rise; chest pain due to anxiety centres over the left breast and usually waxes and wanes.
In younger people, the chances of having a heart attack over the festive season are slim. In older people, those who smoke, do not exercise and are overweight, the possibility of cardiac chest pain rises.
The bottom line is this: if you suspect you might be having a heart attack, don't delay - call an ambulance immediately.