DEAR DR. DONOHUE: My brother, who was only 43, died from a heart attack. I happened to be with him when it occurred. He never said a word about pain, only that he was tired and wanted to lie down. He did, and he died while he was asleep. How could I have recognized that he was in trouble? I need to know all the symptoms of a heart attack. – J.O.

ANSWER: Most heart attacks cause chest pain. People describe it as a heavy sensation, a pressure or a viselike grip around their chests. The location of the pain is usually behind the breastbone or on the left side of the chest. A few individuals feel pain only in their necks or jaws or arms, with the left arm more frequently the site of pain than the right. Or, a person can have chest pain that radiates to those locations.

Frequently people complain of being sick to their stomachs, and they often throw up.

Your brother was in a minority. About 20 percent have no pain when having a heart attack. Recognizing that they are having an attack is difficult for bystanders and for the people themselves.

They might complain of suddenly feeling short of breath, light-headed or weak. Such symptoms are quite subtle, and the ordinary layperson would not be expected to identify them as indicative of a heart attack. In some instances, people say they have an upset stomach and take an antacid for it. It takes a trained medical person to recognize that such signs and complaints could indicate a heart attack.

You cannot blame yourself for not recognizing what was happening to your brother. Quite often, heart attacks are preceded by a period of exertional chest pains. In the weeks or months prior to having an attack, people often get chest pain – angina – when they are rushing around or doing physical labor. Those pains serve as a warning that a heart attack could be in the offing. Your brother had no such warnings.

Heart attack is a vast subject that ought to be familiar to all. The heart attack pamphlet furnishes valuable information on recognizing attacks, treating them and preventing them. Readers can obtain a copy by writing: Dr. Donohue – No. 102, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.50 U.S./$6.50 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: Some friends of mine say I have scarlet fever. I say no. Would you tell me the symptoms of scarlet fever? – E.S.

ANSWER: Scarlet fever is a strep throat plus a red rash. Some strep germs produce a toxin that causes this kind of rash. Scarlet fever is not as common as it once was, but the reason why that is so is not clear.

First, the rash appears as facial redness that spares the skin around the lips. The lips look like they are highlighted by a halo of normal skin. In a day or so, the rash spreads to the chest, back, arms and legs. It is usually gone in six to nine days. At that time, the skin peels like it does with a sunburn.

What makes these people think you have scarlet fever? The chances that you do are slim to practically none.

DEAR DR. DONOHUE: Why do I put on weight during the day? In the morning I get on the scale and record my weight. By nighttime, I have gained 1 to 3 pounds. The next morning I am back to my starting weight. – B.J.

ANSWER: That fluctuation in weight must be from retaining fluid. During the night, you lose fluid through breath or through urine. I can’t explain it any other way.

Go for a whole day without any salt, neither adding it to your food nor eating any salty foods. Let me know if you still put on weight during that day. If you don’t, the fluid idea has legs to stand on.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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