What are the symptoms of a heart attack. How can you differentiate between a heart attack and angina. What causes heart attacks and how do they affect the heart muscle. Why is immediate medical attention crucial during a heart attack.

Understanding Heart Attacks: A Comprehensive Overview

A heart attack, medically known as a myocardial infarction (MI), occurs when blood flow to the heart is blocked, depriving the organ of oxygen and nutrients. This blockage can lead to severe damage or death of heart muscle tissue. The term “myocardial infarction” breaks down as follows: “myo” refers to muscle, “cardial” pertains to the heart, and “infarction” indicates tissue death due to inadequate blood supply.

Heart attacks are alarmingly common, with more than a million Americans experiencing them annually. According to the CDC, a heart attack occurs every 40 seconds in the United States. While the risk increases with age, various modifiable factors such as high blood pressure, elevated LDL cholesterol levels, diabetes, and smoking can contribute to heart attack risk.

Recognizing the Signs and Symptoms of a Heart Attack

Identifying the symptoms of a heart attack is crucial for seeking prompt medical attention. Common symptoms include:

• Chest discomfort, often described as pressure, heaviness, tightness, squeezing, or pain
• Pain or discomfort radiating to the arm, back, jaw, throat, or below the breastbone
• Sensations of fullness, indigestion, or choking (may be mistaken for heartburn)
• Sweating, nausea, vomiting, or dizziness
• Severe weakness, anxiety, fatigue, or shortness of breath
• Rapid or irregular heartbeat

It’s important to note that heart attack symptoms can vary from person to person and even between different heart attacks experienced by the same individual. Women, in particular, may experience some unique or less common symptoms:

• Unusual fatigue
• Shortness of breath
• Nausea or vomiting
• Dizziness or lightheadedness
• Discomfort in the gut, which may feel like indigestion
• Discomfort in the neck, shoulder, or upper back

In some cases, particularly among individuals with diabetes, a heart attack may occur without noticeable symptoms. This is referred to as a “silent” myocardial infarction.

Types of Heart Attacks: Understanding the Variations

Heart attacks can be classified into different types based on the extent and nature of the blockage:

STEMI (ST-Elevation Myocardial Infarction)

STEMI is a severe type of heart attack where a coronary artery is completely blocked. This results in extensive damage to a large area of the heart muscle.

NSTEMI (Non-ST-Elevation Myocardial Infarction)

In an NSTEMI, a coronary artery is significantly narrowed, greatly reducing blood flow but not completely blocked. While still serious, this type may cause less damage compared to a STEMI.

MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries)

MINOCA is a unique type of heart attack where no blockages are visible in the main coronary arteries. This condition requires specialized diagnostic approaches and treatments.

Differentiating Heart Attacks from Other Cardiac Events

It’s crucial to distinguish heart attacks from other cardiac events that may present similar symptoms:

Sudden Cardiac Arrest vs. Heart Attack

Contrary to common belief, sudden cardiac arrest is not the same as a heart attack. While a heart attack involves a blockage in the heart’s arteries, sudden cardiac arrest is an electrical malfunction causing the heart to stop pumping abruptly.

Angina vs. Heart Attack

Angina, characterized by chest pain, is a symptom rather than a distinct condition. It can occur during a heart attack but may also result from other causes. Angina sensations typically include:

• Pressure, pain, squeezing, or fullness in the center of the chest
• Discomfort in the shoulder, arm, back, neck, or jaw

Angina is classified as either stable or unstable:

1. Stable angina: The most common form, triggered by predictable factors such as strong emotions, physical activity, extreme temperatures, or heavy meals. Symptoms typically subside with rest or prescribed nitroglycerin.
2. Unstable angina: An emergency condition that may precede a heart attack. If angina worsens, lasts more than 5 minutes, or doesn’t improve with nitroglycerin, immediate medical attention is necessary.

The Underlying Causes of Heart Attacks

Understanding the mechanisms behind heart attacks is essential for prevention and treatment:

Coronary Artery Disease

The primary cause of heart attacks is coronary artery disease (CAD). In CAD, arteries supplying blood to the heart become narrow, restricting blood flow. This narrowing is due to the buildup of plaque, composed of fat, calcium, proteins, and inflammatory cells.

Plaque Rupture and Thrombosis

Plaques have a hard outer shell and a soft interior. When the outer shell cracks (ruptures), platelets rush to the site, forming blood clots. If a clot completely blocks an artery, it cuts off oxygen supply to the heart muscle, leading to tissue death.

Coronary Artery Spasm

In rare cases, a heart attack can result from a coronary artery spasm. During such spasms, arteries constrict intermittently, reducing blood flow to the heart. This can occur even in individuals without severe coronary artery disease and may happen during rest.

The Impact of Heart Attacks on Heart Muscle

The extent of damage caused by a heart attack depends on several factors:

• The size of the area supplied by the blocked artery
• The duration between the onset of the attack and treatment
• The specific coronary artery affected, as each supplies blood to different parts of the heart muscle

Heart muscle begins to heal soon after a heart attack, but the recovery process can be complex and varies among individuals.

Emergency Response and Immediate Actions During a Heart Attack

Recognizing a heart attack as a medical emergency is crucial. Here are the immediate steps to take:

1. Call emergency services (911 in the United States) immediately upon suspecting a heart attack.
2. Do not wait to see if symptoms subside; every minute counts in preserving heart muscle.
3. If prescribed, take nitroglycerin as directed by your healthcare provider.
4. Chew and swallow an aspirin, unless you’re allergic or have been advised against it by your doctor.
5. If the person loses consciousness and stops breathing, begin CPR if trained.

Quick action can significantly improve outcomes and reduce the risk of severe damage or death.

Prevention and Risk Reduction Strategies for Heart Attacks

While some risk factors for heart attacks are beyond our control, many can be modified through lifestyle changes and medical interventions:

Lifestyle Modifications

• Maintain a healthy diet rich in fruits, vegetables, whole grains, and lean proteins
• Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity exercise per week
• Quit smoking and avoid exposure to secondhand smoke
• Manage stress through relaxation techniques, meditation, or counseling
• Limit alcohol consumption to moderate levels

Medical Management

• Control high blood pressure through medication and lifestyle changes
• Manage cholesterol levels, particularly by reducing LDL (“bad”) cholesterol
• If diabetic, maintain tight glucose control through medication and diet
• Discuss the use of preventive medications, such as aspirin therapy, with your healthcare provider

Regular Health Screenings

Schedule regular check-ups with your healthcare provider to monitor cardiovascular health and assess risk factors. These may include:

• Blood pressure measurements
• Cholesterol level tests
• Blood glucose screenings
• Electrocardiograms (ECGs) or stress tests for those at higher risk

By understanding the symptoms, causes, and types of heart attacks, individuals can better prepare themselves to respond quickly and effectively in case of an emergency. Moreover, adopting a heart-healthy lifestyle and working closely with healthcare providers can significantly reduce the risk of experiencing a heart attack. Remember, prevention and early intervention are key to maintaining cardiovascular health and ensuring a better quality of life.

Symptoms, Causes, Treatment, and Prevention

A heart attack happens when something blocks the blood flow to your heart so it can’t get the oxygen it needs. It’s a medical emergency. Call 911 right away at the first sign of any symptoms. Don’t wait to see if the symptoms pass.

Heart attacks are also called myocardial infarctions (MIs). “Myo” means muscle, “cardial” refers to the heart, and “infarction” means death of tissue because of a lack of blood supply. This tissue death can cause lasting damage to your heart muscle..

Symptoms of a heart attack include:

• Discomfort, pressure, heaviness, tightness, squeezing, or pain in your chest or arm or below your breastbone
• Discomfort that goes into your back, jaw, throat, or arm
• Fullness, indigestion, or a choking feeling (it may feel like heartburn)
• Sweating, upset stomach, vomiting, or dizziness
• Severe weakness, anxiety, fatigue, or shortness of breath
• Fast or uneven heartbeat

Symptoms can be different from person to person or from one heart attack to another.  Women are more likely to have these heart attack symptoms:

• Unusual fatigue
• Shortness of breath
• Nausea or vomiting
• Dizziness or lightheadedness
• Discomfort in your gut. It may feel like indigestion.
• Discomfort in the neck, shoulder, or upper back

With some heart attacks, you won’t notice any symptoms (a “silent” myocardial infarction). This is more common in people who have diabetes.

More than a million Americans have heart attacks each year.  It happens every 40 seconds to someone in the U.S., according to the CDC. 

Heart attacks happen to both men and women. Although they are more likely as you get old, there are many risk factors – including high blood pressure, high levels of LDL (“bad”) cholesterol, diabetes, and whether you smoke – that you can change.

Types of heart attacks: When someone has a heart attack, you may hear some of these terms used:

• STEMI: A heart attack where a coronary artery is completely blocked 
• NSTEMI: A heart attack where a coronary artery is narrowed enough to greatly reduce blood flow but is not totally blocked
• MINOCA: A heart attack in which no blockages are seen in the main coronary arteries.  MINOCA stands for myocardial infarction with non-obstructive coronary arteries. 

A sudden cardiac arrest is actually not a heart attack. You can think of a heart attack as a problem within the heart’s arteries, and a sudden cardiac arrest as the heart’s electrical system suddenly not working right, causing the heart to stop pumping.

Angina also isn’t a heart attack. It’s a symptom, and sometimes it can signal a heart attack. It means chest pain. And while it can happen with a heart attack, it can also happen for other reasons. The sensations may occur with normal activities or exertion but then go away with rest or when you take nitroglycerin.

With angina, you may feel:

• Pressure, pain, squeezing, or a sense of fullness in the center of the chest
• Pain or discomfort in the shoulder, arm, back, neck, or jaw

Call 911 if it gets worse, lasts more than 5 minutes, or doesn’t improve after you’ve taken nitroglycerin. Doctors call that “unstable” angina, and it’s an emergency that could be related to a heart attack that is about to happen.

If you instead have “stable” angina, which is the most common kind, your symptoms usually happen with predictable triggers (such as a strong emotion, physical activity, extreme high or low temperatures, or even a heavy meal). The symptoms go away if you rest or take nitroglycerin that your doctor has prescribed. If not, call 911.

Your heart muscle needs a constant supply of oxygen-rich blood. Your coronary arteries give your heart this critical blood supply. If you have coronary artery disease, those arteries become narrow, and blood can’t flow as well as it should. When your blood supply is blocked, you have a heart attack.

Fat, calcium, proteins, and inflammatory cells build up in your arteries to form plaques. These plaque deposits are hard on the outside and soft and mushy on the inside.

When the plaque is hard, the outer shell cracks. This is called a rupture. Platelets (disc-shaped things in your blood that help it clot) come to the area, and blood clots form around the plaque. If a blood clot blocks your artery, your heart muscle becomes starved for oxygen. The muscle cells soon die, causing permanent damage.

Rarely, a spasm in your coronary artery can also cause a heart attack. During this coronary spasm, your arteries restrict or spasm on and off, cutting off the blood supply to your heart muscle (ischemia). It can happen while you’re at rest and even if you don’t have serious coronary artery disease.

Each coronary artery sends blood to a different part of your heart muscle. How much the muscle is damaged depends on the size of the area that the blocked artery supplies and the amount of time between the attack and treatment.

Your heart muscle starts to heal soon after a heart attack. This takes about 8 weeks. Just like a skin wound, a scar forms in the damaged area. But the new scar tissue doesn’t move the way it should. So your heart can’t pump as much after a heart attack. How much that ability to pump is affected depends on the size and location of the scar.

After a heart attack, you need quick treatment to open the blocked artery and lessen the damage. At the first signs of a heart attack, call 911. The best time to treat a heart attack is within 1 or 2 hours after symptoms begin. Waiting longer means more damage to your heart and a lower chance of survival.

If you’ve called emergency services and are waiting for them to arrive, chew an aspirin (325 milligrams). Aspirin is a potent inhibitor of blood clots and can lower the risk of death from a heart attack by 25%.

Call 911 and start CPR (cardiopulmonary resuscitation) if someone goes into cardiac arrest, which is when the heartbeat has stopped and the person isn’t responsive. CPR doesn’t restart the heart; but it keeps the person alive until medical help arrives.

An easy-to-use device called an AED (automated external defibrillator) is available in many public places and can be used by almost anyone to treat cardiac arrest. This device works by shocking the heart back into a normal rhythm.

Here’s how to use an AED:

1. Check responsiveness

• For an adult or older child, shout and shake the person to confirm whether they’re unconscious. Do not use AED on a conscious person.
• For an infant or young child, pinch their skin. Never shake a young child.
• Check breathing and pulse. If absent or uneven, prepare to use the AED as soon as possible.

2. Prepare to use the AED

• Make sure the person is in a dry area and away from puddles or water.
• Check for body piercings or outline of an implanted medical device, such as a pacemaker or implantable defibrillator.
• AED pads must be placed at least 1 inch away from piercings or implanted devices.

3. Use the AED

For newborns, infants, and children up to age 8, use a pediatric AED, if possible. If not, use an adult AED.

• Turn on the AED.
• Wipe the chest dry.
• Attach the pads.
• Plug in the connector, if necessary.
• Make sure no one is touching the person.
• Push the “Analyze” button.
• If a shock is advised, check again to make sure no one is touching the person.
• Push the “Shock” button.
• Start or resume compressions.
• Follow AED prompts.

4. Continue CPR

• After 2 minutes of CPR, check the person’s heart rhythm. If it’s still absent or uneven, give them another shock.
• If a shock isn’t needed, continue CPR until emergency help arrives or the person begins to move.
• Stay with the person until help arrives.

Emergency medical workers will ask you about your symptoms and do some tests.

Tests to diagnose a heart attack

Your doctor may order tests, including:

EKG: Also known as an electrocardiogram or ECG, this is a simple test that records the electrical activity of the heart. It can tell how much your heart muscle has been damaged and where. It can also monitor your heart rate and rhythm.

Blood tests: Several blood tests, often done every 4 to 8 hours, can help diagnose a heart attack and spot any ongoing heart damage. Different levels of cardiac enzymes in your blood can indicate heart muscle damage. These enzymes are usually inside the cells of your heart. When those cells are injured, their contents – including the enzymes – spill into your bloodstream. By measuring the levels of these enzymes, your doctor can find out the size of the heart attack and when it started. Tests can also measure troponin levels. Troponins are proteins inside heart cells that are released when the cells are damaged by the lack of blood supply to your heart.

Echocardiography: In this ultrasound test, sound waves are bounced off your heart to create images. It can be used during and after a heart attack to learn how your heart is pumping and what areas aren’t pumping the way they should. The “echo” can also tell whether any parts of your heart (valves, septum, etc.) have been injured in the heart attack.

Cardiac catheterization: You might need cardiac catheterization, also called cardiac cath, during the first hours of a heart attack if medications aren’t helping with the ischemia or symptoms. The cardiac cath can give an image of the blocked artery and help your doctor decide on a treatment.

In this procedure, a catheter (a thin, hollow tube) is inserted into a blood vessel in your groin or wrist and threaded up to your heart. Dye is used to highlight your heart’s arteries. Your doctor can then identify blockages, which are often treated with angioplasty or stents to open the artery and restore blood flow. Your doctor may do several tests to assess your heart. Intravenous blood thinner is an option to open the artery if cardiac catheterization is not available.

Stress testing: Your doctor can do a treadmill test or a radionuclide scan to check whether other areas of the heart are still at risk for another heart attack.

A heart attack is a medical emergency that needs care right away to prevent permanent heart damage or death. Treatment often begins in the ambulance if you called 911, or in the emergency room if someone else took you to the hospital.

What drugs are used to treat a heart attack?

At the emergency facility or hospital, you’ll quickly get drugs to prevent further blood clotting in the heart and ease the strain on the heart. Drug therapy aims to break up or prevent blood clots, stop platelets from collecting and sticking to the plaque, stabilize the plaque, and prevent more ischemia.

You should get these medications as soon as you can (within 1 or 2 hours from the start of your heart attack, if possible) to limit heart damage.

Drugs used during a heart attack may include:

• Aspirin to stop blood clotting that may make the heart attack worse
• Other antiplatelet drugs, such as clopidogrel (Plavix), prasugrel (Effient), or ticagrelor (Brilinta) to stop clotting
• Thrombolytic therapy (“clot busters”) to dissolve blood clots in your heart’s arteries
• Any combination of these

Other drugs given during or after a heart attack help your heart work better, widen your blood vessels, lower your pain, and help you avoid life-threatening heart rhythms.

Are there other treatments for a heart attack?

Treatment may also include a procedure to open the blocked arteries.

Cardiac catheterization: In addition to making a picture of your arteries, cardiac catheterization can be used for procedures (such as angiography or stent) to open narrowed or blocked arteries.

Balloon angioplasty: This treatment can be done, if needed, during cardiac catheterization. A balloon-tipped catheter (thin, hollow tube) is inserted into the blocked artery in the heart. The balloon is inflated gently to press plaque outward against the walls of the artery, to open the artery and improve blood flow. Most of the time, this is not done without putting in a stent.

Stent placement: In this procedure, a small tube is inserted through a catheter into a blocked artery to “prop” it open. The stent is usually made of metal and is permanent. It can also be made of a material that your body absorbs over time. Some stents have medicine that helps keep the artery from getting blocked again.

Bypass surgery: You might have bypass surgery in the days after a heart attack to restore the blood supply to your heart. Your surgeon will reroute blood flow around your blocked artery, usually using a blood vessel from your leg or chest. They can bypass multiple arteries.

What happens in the coronary care unit (CCU)?

If you’ve had a heart attack, you’ll usually stay in a CCU for at least 24 to 36 hours. Once past the critical phase, you’ll continue to get a variety of drugs, including:

• Beta-blockers to slow the heart
• Nitrates to increase heart blood flow
• Blood thinners such as aspirin, Brilinta, clopidogrel, Effient, heparin, or Plavix to prevent further clotting
• ACE inhibitors to help the heart muscle heal
• Statins – cholesterol-lowering drugs such as atorvastatin and simvastatin – to help the heart muscle heal and lower the risk of another heart attack

While you’re in the hospital, medical staff will constantly monitor your heart by EKG in case you get unusual heart rhythms.

Some people may need to be fitted with a pacemaker, a battery-powered device to help keep a steady heart rhythm. If you have a dangerous arrhythmia known as ventricular fibrillation, medical providers will give an electric shock to your chest.

Treatments don’t cure coronary artery disease. You can still have another heart attack. But you can take steps to make it less likely.

The goal after your heart attack is to keep your heart healthy and lower your risk of having another heart attack. Take your medications as directed, make healthy lifestyle changes, see your doctor for regular heart checkups, and consider a cardiac rehabilitation program.

Why do I need to take medications after a heart attack?

You might take certain drugs after a heart attack to:

• Prevent blood clots
• Help your heart work better
• Prevent plaques by lowering cholesterol

You might take medications that treat an uneven heartbeat, lower your blood pressure, control chest pain, and treat heart failure.

Know the names of your medications, what they’re used for, and when you need to take them. Go over your medications with your doctor or nurse. Keep a list of all your medications, and take it to each of your doctor visits. If you have questions about them, ask your doctor or pharmacist.

It sounds obvious, but don’t skip your medications. Many people don’t take their medications the way their doctor told them to. Figure out what keeps you from taking your medicine – it could be side effects, cost, or forgetfulness – and ask your doctor for help.

What lifestyle changes are needed after a heart attack?

To keep heart disease from getting worse and to head off another heart attack, follow your doctor’s advice. You might need to change your lifestyle. Here are some changes you can make that can cut your risk and put you on the path to a healthier life:

Stop smoking: Smoking dramatically raises your risk of both heart attacks and strokes. Talk to your doctor about how to quit. You’ll also be doing your friends and family a favor, since secondhand smoke can also lead to heart disease. You also can call the hotline 800-QUIT-NOW (800-784-8669) and visit the smokefree.gov website.

Keep a healthy body weight: If you’re overweight or obese, you don’t have to get thin to reduce your risk for a heart attack or stroke, but your doctor may recommend some weight loss. If you lose 5% to 10% of your weight, you’ll improve your cholesterol numbers and lower your blood pressure and blood sugar levels.

Follow an exercise plan: Moderate physical activity lowers your chances of a heart attack. It also can reduce your blood pressure and LDL or “bad” cholesterol, raise your HDL or “good” cholesterol, and help you stay at a healthy weight.

Aim for 30 minutes of exercise that gets your heart pumping at least 5 days a week. Brisk walking or swimming are some good choices. On the other 2 days, do strength training, like lifting weights. If you’ve got a tight schedule, break your exercise routine into small chunks.

Eat a heart-healthy diet: Fill your plate with different kinds of fruits, veggies, beans, and lean meats, such as poultry without the skin. Also up your intake of whole grains, like oatmeal, quinoa, and brown rice, and of fish, especially those with omega-3 fatty acids, such as salmon, trout, and herring.

Avocados, olive oil, and flaxseeds also have omega-3s, as do some nuts and seeds. Fat-free or low-fat dairy products such as milk, yogurt, and cheese also are better choices for your heart health than higher-fat versions. 

Cut back on unhealthy foods: Stay away from processed or prepared foods that often are high in salt and added sugar. They’re also filled with preservatives. Avoid fatty beef, butter, fried foods, and palm oil. All are high in saturated fats.

Skip sugary drinks like sodas and fruit punch, which can lead to weight gain. So can packaged baked goods such as cookies, cakes, and pies. They are high in trans fats and can raise your cholesterol levels.

Limit alcohol: If you don’t drink already, don’t start. If you do drink, limit how much you drink. The recommendation is no more than one drink a day if you are a woman and no more than two a day if you are a man. Drinking raises your heart rate and blood pressure. It also raises the level of fat in your blood and can cause weight gain.

Get regular checks of your cholesterol, blood pressure, and blood sugar (glucose) levels: If you have diabetes, make sure it’s controlled. Keeping a check on these numbers can help you be more aware of the changes you need to make to keep these levels within normal limits.

Control stress: You may feel anxious or frustrated at times. Open up to your family and friends about what’s going on. Support groups can help you learn how others adjusted to life after a heart attack or stroke.

You may want to talk to a mental health professional or ask your doctor about a stress management program. You can also reduce stress with plenty of physical activity and mind-body practices like meditation.

Pay attention to your symptoms: Don’t just hope they’ll go away. See your doctor if you feel anything unusual, like shortness of breath, changes in your heart rhythm, or extreme tiredness. Also, watch for pain in your jaw or back, nausea or vomiting, sweating, or flu-like symptoms.

Why should I take part in cardiac rehabilitation?

If you’ve had a heart attack or have been diagnosed with heart disease, your doctor may recommend cardiac rehabilitation. You’ll work with a team of experts to boost your health and avoid future problems.

Your team may include doctors and nurses, as well as specialists in exercise, nutrition, physical therapy, occupational therapy, and mental health. They’ll set up a program to fit your needs. They can also help you make changes in your daily life. If you stick with it, it can make a big difference in your recovery and overall well-being.

When will I see my doctor again after I leave the hospital?

Make a doctor’s appointment for 4 to 6 weeks after you leave the hospital following a heart attack. Your doctor will want to check your recovery. You might need an exercise stress test on a regular basis. These tests can help your doctor find or slow blockages in your coronary arteries and plan your treatment.

Call your doctor if you have symptoms, such as chest pain that happens more often, gets stronger, lasts longer, or spreads to other areas; shortness of breath, especially while you’re resting; dizziness; or uneven heartbeats.

Vomiting (for Parents) – Nemours KidsHealth

en español: Vómitos

Reviewed by: Mary L. Gavin, MD

What Is Vomiting?

Vomiting is the forceful throwing up of stomach contents. Most kids vomit from time to time, but it usually doesn’t last long and often gets better on its own.

What Causes Vomiting?

Many different things can make kids throw up. Most of the time, it’s due to gastroenteritis, an infection of the stomach and intestines. Gastroenteritis, often called the “stomach flu,” is usually caused by viruses. Other germs, like bacteria and parasites, can also cause gastroenteritis. Besides vomiting, people with gastroenteritis also may have nausea, belly pain, and diarrhea. Vomiting due to gastroenteritis usually lasts less than 24 hours and other symptoms get better in a few days.

What Else Can Cause Vomiting?

People can sometimes vomit from:

• food poisoning
• motion sickness
• migraine headaches
• pregnancy

Rarely, vomiting can be a sign of a serious problem, including:

• a blocked intestine, such as pyloric stenosis in infants
• other problems of the stomach and intestines, like gallstones, pancreatitis, or appendicitis
• increased pressure in the brain that can happen after a head injury or as a symptom of meningitis or a brain tumor

What Are the Signs & Symptoms of Vomiting?

Kids often feel nauseous and have belly pain before throwing up. Other symptoms may include:

• fever
• loss of appetite
• diarrhea

Frequent vomiting can lead to dehydration (not having enough water in the body). Signs of dehydration include peeing less often crying with few or no tears, having a dry mouth or cracked lips, feeling dizzy or lightheaded, acting very sleepy or less alert.

How Do Doctors Find the Cause of Vomiting?

Doctors usually can tell if vomiting if part of a stomach flu by hearing about the symptoms. Usually, no tests are needed. If a child is vomiting often or is very sick, the doctor may order a urine test, blood test, or other tests to check for dehydration and to find out what is causing the vomiting.

How Is Vomiting Treated?

Treatment for vomiting depends on the cause. Vomiting from gastroenteritis usually goes away on its own in less than 24 hours.

If your child has vomiting, help prevent dehydration by giving an oral rehydration solution (such as Pedialyte, Enfalyte, or a store brand). It has the right amounts of water, sugar, and salt to help with dehydration. You can buy it without a prescription at drugstores or supermarkets. If you can’t get oral rehydration solution, talk to your doctor.

If your child has mild dehydration and your doctor says it’s OK to start treatment at home:

• Start with small sips of the oral rehydration solution, about 1 or 2 teaspoons every few minutes.
• Babies can continue to breastfeed or take formula as long as they are not throwing up repeatedly.
• Don’t give babies plain water instead of oral rehydration solution. It doesn’t have the right nutrients for babies with dehydration.
• Older children can have frozen electrolyte popsicles.
• Don’t give medicines for vomiting unless your doctor recommends it.
• When your child stops vomiting, you can offer small amounts of solid foods, such as toast, crackers, rice, or mashed potatoes. Yogurt, fruits, vegetables, and lean meat, like chicken, are also OK.

Kids who continue to vomit or have more severe dehydration need treatment in the ER or hospital.  

When Should I Call the Doctor?

Call the doctor if your child:

• can’t drink for several hours
• has signs of dehydration, such as peeing less often, crying with few or no tears, having a dry mouth or cracked lips, feeling dizzy or lightheaded, acting very sleepy or less alert
• has a high fever
• is vomiting blood, or has green or brownish vomit
• has severe stomach or back pain
• has headache or stiff neck
• is vomiting after a head injury
• is vomiting for more than 24 hours 

Reviewed by: Mary L. Gavin, MD

Date reviewed: May 2021

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Nausea and Vomiting – KDLmed

Nausea is a painful sensation in the stomach and throat that may be accompanied by weakness, increased salivation, sweating and often precedes vomiting.

Vomiting is a sudden involuntary emptying of the stomach.

Nausea and vomiting are symptoms of many diseases and conditions, from pregnancy to serious pathologies such as brain tumors, epilepsy and myocardial infarction.

In most cases, nausea and vomiting are not harmful to the body. However, prolonged vomiting, often in combination with diarrhea, can lead to severe dehydration and, as a result, disruption of the cardiovascular system, brain, kidneys and other organs. This is especially true for young children, who themselves cannot control the manifestations of dehydration. Pregnant women may experience so-called excessive vomiting of pregnant women, which disrupts the balance of electrolytes in the blood and threatens the life of the mother and fetus.

There are medicines available that can reduce nausea. However, in any case, it is necessary to find out its cause.

English synonyms

Nausea, emesis, vomiting, vomitus, distaste, sickness, retching, bdelygmia.

Symptoms

The duration of nausea and vomiting, the timing of their onset, and the effect of eating on them depend on their underlying cause. For example, nausea and / or vomiting almost immediately after eating may indicate gastritis (inflammation of the gastric mucosa), within 1-8 hours after eating – poisoning.

Prolonged vomiting may cause signs of dehydration:

• dry mouth;
• thirst;
• sunken eyes;
• infrequent urination, decreased amount of urine, dark urine;
• in children, the fontanel can sink in – a soft area at the junction of the child’s cranial bones, which normally closes by 12-18 months of age.

There are also a number of symptoms that are signs of dangerous, life-threatening conditions and require immediate medical attention:

• admixture of blood in vomit;
• severe headache, confusion, impaired consciousness;
• abdominal pain;
• signs of dehydration;
• shortness of breath;
• Vomiting that lasts longer than a day (for children, if it lasts for several hours, especially in combination with diarrhea and fever).

Most often, vomiting and nausea resolve within 6-24 hours. If these symptoms recur within a week and if you suspect a possible pregnancy, you should also seek medical advice.

General information about the disease

Nausea occurs when there is a decrease or absence of gastric peristalsis with simultaneous tension of the initial part of the intestine – the duodenum, which is accompanied by the reflux of part of the contents of the duodenum into the stomach. With vomiting, there is a strong contraction of the diaphragm and muscles of the anterior abdominal wall, holding the breath and a sharp release of the contents of the stomach into the esophagus and further into the oral cavity. This may be accompanied by increased salivation, sweating, weakness, dizziness.

Specific centers in the brain are responsible for the occurrence of nausea and vomiting, which receive information from the organs of the gastrointestinal tract, vestibular apparatus, other parts of the brain, kidneys, and also react to the chemical composition of the blood, including toxins, drugs , metabolic products. These centers trigger and control the activity of the muscles involved in nausea and vomiting.

Causes of nausea and vomiting may be as follows.

• Irritation of the gastric mucosa. In this case, nausea and vomiting are protective reactions of the body aimed at eliminating the damaging agent.
• Intestinal infections – rotavirus, salmonellosis, botulism, dysentery, etc. – in addition to nausea and vomiting, are accompanied by pain in the abdomen, fever. The most common infection is rotavirus. It is especially common among children attending kindergartens and nurseries, and occurs with nausea, vomiting, diarrhea, which usually lasts 1-2 days. After the disease, immunity is formed.
• Food poisoning. In this case, vomiting occurs within a few hours after eating.
• Gastric ulcer – damage to a section of the gastric mucosa due to the action of gastric juice. May be accompanied by belching, heartburn, abdominal pain.
• Gastroesophageal reflux disease is a chronic disease in which there is a regular reflux of stomach contents into the esophagus with damage to the mucous membrane of the esophagus by acidic gastric juice.
• Irritation of the stomach by other substances: alcohol, nicotine, aspirin.
• Effects on the central nervous system and vestibular apparatus. In this case, nausea and vomiting are caused by irritation of certain centers of the brain.
• An increase in intracranial pressure in brain injuries, tumors, infections (meningitis, encephalitis) may be accompanied by nausea and vomiting.
• Stimulation of the vestibular apparatus. It includes labyrinthitis (inflammation of the inner ear), motion sickness in transport, and other diseases and conditions in which excessive irritation of the balance organ occurs.
• Headache, especially in migraine. Migraine is a neurological disease characterized by severe headache, usually on one side, which may be exacerbated by bright lights or loud noises and accompanied by nausea and vomiting.
• Sunstroke. A condition that occurs when the head is exposed to the sun for a long time. Often found in children. May be accompanied by lethargy, weakness, nausea, vomiting, pallor, disorientation, loss of consciousness.
• Diseases of other organs – diabetes mellitus, urolithiasis, hepatitis, pancreatitis, certain malignant neoplasms, mental illness (depression, anorexia, bulimia) and other diseases.
• Medicinal products used in the treatment of oncological diseases, radiation therapy.
• Pregnancy (first trimester).
• In children under one year old, vomiting may be a sign of pyloric stenosis, intestinal intussusception, and often accompanies viral diseases (influenza, SARS). Pyloric stenosis is a narrowing or complete obstruction of the opening between the stomach and the duodenum. Intestinal intussusception is a condition in which a segment of the intestine is embedded in the lumen of an adjacent section of the intestine, which leads to the development of intestinal obstruction.

In adults, the most common causes of vomiting and nausea are intestinal infections, food poisoning, motion sickness; in children, intestinal infections, food poisoning, overeating, as well as a severe cough and any illness with a high fever.

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