Beware the Silent Heart Attack

While a vast majority of people will have a heart attack with traditional symptoms (chest discomfort or pain, cold sweat, extreme weakness), there is a subgroup of people, around 20 to 30 percent, who will have atypical symptoms or no symptoms at all. It is most common for women and people with diabetes to have atypical heart attack symptoms, but it can happen to anyone. 

What are these unusual symptoms?

Some of the non-classic symptoms include unexplained fatigue, shortness of breath and/or discomfort in the throat, neck, jaw or a single extremity. Other patients will experience what feels like heartburn, and they will simply take medication to relieve the heartburn instead of recognizing that the pain could be coming from their heart.
Cardiologist Curtis Rimmerman, MD, says people think a heart attack should be pain on the left side of the chest, but it is most often not a sharp pain, but rather discomfort felt in the center of the chest with a squeezing or tightness. Given the way television and movies portray a heart attack as an obvious event, it is not surprising that these less common symptoms can pass without being noticed as a heart attack. 

Discovering the heart attack

Patients who have had an unrecognized heart attack may come to the doctor weeks or months after the event to find out about it. It is often recognized on the EKG during the patient’s yearly physical. “We can tell the size of the heart attack by how much heart muscle has been damaged, often by an electrocardiogram and even more precisely with a cardiac ultrasound known as an echocardiogram,” says Dr. Rimmerman.

Other patients will visit their doctors soon after an unrecognized heart attack because they are experiencing persistent symptoms such as fatigue and shortness of breath. In some cases, this can result from mitral valve leakage or other structural heart complications caused by scarring of the heart muscle from the heart attack. Serious developments can follow, including decompensated heart failure, heart rhythm disorders and a loss of consciousness. 

Do not ignore odd signs

“People who experience a heart attack without recognizing it and survive are very fortunate,” Dr. Rimmerman says. “If you feel sustained discomfort for a period of a few minutes, especially if the symptoms are new and without clear explanation, you should not ignore these concerns.”

Often people sense that something is wrong, but they do not want to believe it is a heart attack. They ignore symptoms or attribute them to something else. There was a recently documented case in which a patient thought he was experiencing food poisoning only to find out a couple of days later that he had, in fact, had a heart attack.

If you have new onset heartburn-like symptoms or any of the above symptoms, you should seek care. “If it turns out to be heartburn, at least you have excluded something less threatening,” he says. “Don’t let uncertainty lead to regret later for you or your family.

The bottom line is “you should not be your own physician,” warns Dr. Rimmerman. “If you experience a distinct change in how you feel, no matter how subtle, you should seek medical attention.”

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