The Typical Signs Of A Heart Attack Are Often Anything But Typical
Heart attacks may present with unusual symptoms or have no symptoms.
One of the first things taught us young doctors was the signs of a “typical” heart attack. The number one symptom was oppressive chest pressure. We were told that patients often described it like “an elephant sitting on their chest.” Although common, the truth is that other symptoms are also frequent and easy to miss.
My Story
In 2011, I experienced severe chest pain one evening. I was not doing anything strenuous. I do recall chest pressure in the center of my chest. Being a cardiologist, I knew these could be signs of a heart attack, and if true, I needed to act quickly. After a few moments of denial, I told my wife to call for an ambulance. I had no other associated common symptoms such as shortness of breath, sweating, or nausea.
In the emergency room, my electrocardiogram and cardiac enzymes (which often indicate a heart attack) were both normal. I was given some morphine intravenously and admitted. By this time, it was around three AM. My pain was gone, but I needed a diagnosis.
One of my partners saw me a few hours later, and we reviewed my history and negative findings. I was male, over the age of 60, had high cholesterol, and a strong family history of heart disease at an early age. I did, however, have a recent normal nuclear imaging stress test. I opted to have a cardiac cath or dye study of my heart. This test is nearly 100% accurate for diagnosing blocked heart arteries that cause heart attacks.
My dye study was normal. My pain was not my heart. It turns out that after some surgery, I had taken a lot of ibuprofen for pain and a short course of steroids. I had also been on daily low-dose aspirin. All of these medicines are harmful to the lining of the stomach. I was sent home with stomach medications, and a subsequent endoscopy (camera look into the stomach) showed I had a large ulcer that was close to bleeding.
I use this case to illustrate how tricky it can be to diagnose chest pain, even for a heart doctor. My pain was typical of a heart attack, but it was due to an ulcer.
Other Common Heart Attack Symptoms
Shortness of breath
Sweating
Light-headed or fainting
Pain in the left shoulder, arm, hand, or shoulder blade
Nausea and or vomiting
Indigestion
Pain in the middle of the belly
Pain in the jaw
Numbness of the arm
Less Common Symptoms
Palpitations
Back pain, particularly in the upper part of the back
Fatigue
Anxiety
Diseases That Can Mimic A Heart Attack
Ulcer
Gallbladder attack
GERD (gastroesophageal reflux disease) or indigestion
Pulmonary Embolus (lung clot)
Inflammation of the chest wall or ribs
Panic attack and hyperventilation
No Symptoms
A heart attack can be “silent” or occur with no symptoms. This happens more often in people with diabetes. These happen in 20 percent of all heart attacks. People only find out later that they have had a heart attack in the past when an electrocardiogram, echocardiogram (sound study of the heart), MRI, nuclear imaging, CT scan, or cardiac cath is done, which confirms it.
If the patient has one or more of these tests done confirming a past heart attack, they obviously survived. Many patients, however, are not so lucky. You probably have heard something like, “Joe collapsed at work and died suddenly. He was never sick and never complained of anything.” While this can certainly occur, it is also possible that many patients (particularly men) ignore mild symptoms and warning signs.
Women, on the other hand, are more likely than men to present with unusual symptoms as outlined above. It is unknown why the two sexes differ in this regard.
Just because a patient has a silent heart attack, it does not mean they have a better prognosis than the patient who presents to health providers with symptoms. It still means they likely have blocked arteries over their hearts and heart muscle damage.
Takeaways
Heart attacks don’t all present in the same fashion. Some symptoms are common, and others are not. Men tend to present later than women, most likely due to overly active macho-thinking. (“I don’t know what this is, but I can tough it out.”)
Women, on the other hand, may present quicker for care but have more unusual symptoms. Sadly, they may also be more commonly dismissed by health care providers or their symptoms attributed to something else.
Diabetic patients have more silent heart attacks than non-diabetics. However, of all heart attacks, one-fifth have no reported symptoms at the time.
It is crucial not to ignore any significant symptoms and seek care immediately. There is a short window for an intervention (usually a stent) that can stop the heart damage immediately.