Features February 2017 Issue

Do You Know the Less-Common Symptoms of a Heart Attack?

Chest pain is the most recognizable indicator of a cardiac event, but there are several symptoms that are often misinterpreted as signs of other medical conditions.

If you were to list symptoms of a heart attack, you’d probably start with chest pain. You might follow that up with shortness of breath and nausea. These are all correct, but they don’t tell the whole story. A comprehensive list of heart attack signs includes many symptoms that the average person probably wouldn’t associate with heart trouble.

“Vomiting, sweating, and left arm pain are common symptoms, but they’re not ones that people immediately associate with a heart attack,” says Leslie Cho, MD, co-section head of Preventive Cardiology and Rehabilitation at Cleveland Clinic.

While understanding these and other symptoms of a heart attack is important for everyone, it’s particularly vital for those at high risk for a heart attack.

The Main Symptoms

chest pain

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Chest pain or pressure may be the most common sign of a heart attack, but there are many others you should know.

Chest discomfort in some form is typical during a heart attack. But it’s not always a sudden sharp pain, as it’s often portrayed in movies and on television.

“Most people describe it as chest pressure and not pain,” Dr. Cho says.

And while we tend to associate heart attack pain, pressure or tightness in the center of the chest or just left of the center, it’s possible to feel discomfort on the right side of the chest or across the chest from armpit to armpit.

The discomfort may start in the chest and spread to other parts of the body. And keep in mind that every heart attack is different. One person may have excruciating pain, while someone else may have only mild pressure—so slight that he or she may not even think to call 911.

There are other very typical symptoms of a heart attack that have nothing to do with chest pain or pressure. These are signs that may or may not appear with chest discomfort.

“Along with chest pressure, significant shortness of breath and nausea are also common in many heart attacks,” Dr. Cho says.

Shortness of breath, also called dyspnea, is often felt before any chest pain. You may find yourself unable to take a deep breath, or you may feel like you can’t catch your breath. You may pant or take rapid breaths, trying to fill your lungs.

Some heart attack patients feel nausea more than any other single symptom. If there are no other noticeable symptoms, you may mistakenly ascribe your upset stomach to the flu or ordinary indigestion.

Less Common Signs

As Dr. Cho notes, vomiting, sweating, arm pain are often present during a heart attack. You may also feel pain in your neck, jaw or back. Women especially are vulnerable to pain and pressure in these areas.

Unfortunately, nausea and vomiting are symptoms of other conditions, such as the flu, food poisoning, extreme stress or anxiety, some forms of cancer, eating disorders, and even some medication side effects. But in most of those cases, you can pinpoint the cause of your gastrointestinal distress. Or you can often eliminate potential causes based on other symptoms you’re experiencing. You’ll usually feel different during a heart attack than you will with a bad case of the flu, for example, Dr. Cho explains.

“Nausea and vomiting with a heart attack are usually associated with sweating and not with diarrhea,” she says. “Most of the time, heart attack patients really feel terrible, and what they’re feeling is different from typical flu symptoms.”

Lightheadedness is another one of those symptoms that can often occur during a heart attack, but can also be a sign of many other health problems, such as low blood glucose or low blood pressure. If you experience lightheadedness along with more traditional heart attack symptoms, consider it one more sign confirming a possible heart attack.

Other symptoms of a heart attack you may not readily associate with a coronary event include rapid or irregular heartbeats. These tends to come on before the onset of chest pain and other symptoms. Many heart attack patients also get a vague feeling of doom. They describe feeling anxious, that something is wrong, but they can’t explain why.

How to Respond

Symptoms of a heart attack often come on gradually. The feelings may be subtle. However, remember that every heart attack is different. You may have experienced an event in which symptoms developed suddenly. It’s just important to keep in mind that chest pressure and nausea may progress slowly without your taking much notice.

You may be tempted to ignore the signs if they disappear after a few minutes. If they come back, however, take that as a sign to call 911. If symptoms appear and disappear several times within a relatively short amount of time, get to a hospital.

“Symptoms can definitely come and go,” Dr. Cho says. “But the important thing is that they keep returning.”

The other key point is to respond quickly. Don’t wait an hour hoping the symptoms will pass. If you’re having chest pressure and other symptoms of a heart attack for more than five minutes, get to an emergency room. This is one time when it’s better to be safe than sorry.

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