Learn to Recognize Typical and Atypical Heart Attack Symptoms

Chest pain comes in different forms, but pain and discomfort can be felt throughout the body. And second heart attack symptoms may differ from those you felt the first time.


If you’ve never experienced a heart attack, you may rightly assume that when one does strike you’ll feel the first signs in your chest. That’s because chest pain or discomfort are among the most common heart attack symptoms.

However, it’s quite possible to have a heart attack and never have any chest pain. One study of more than 1 million heart attack patients found that as many as 42 percent of women and 30 percent of men went to the hospital for heart attacks without ever experiencing symptoms in their chest.

“Sometimes people can have a heart attack without any chest pain,” says Leslie Cho, MD, Section Head of Preventive Cardiology and Rehabilitation and Director of Cleveland Clinic’s Women’s Cardiovascular Center. “It is rare, but it can happen. Diabetics often have no chest pain but other vague symptoms.”

More Than Chest Pain

Heart attack

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Some of the other common heart attack symptoms include shortness of breath with minimal exertion, nausea, vomiting, and a cold sweat. “These occur suddenly and are not related to a cold or viral infection,” Dr. Cho says. “It has been said that dominant right coronary artery heart attacks are more likely to cause nausea, vomiting, and a cold sweat.”

It’s important to remember that heart attack symptoms, whether they include chest pain or not, usually come on without warning. You should also be aware that because symptoms such as nausea or shortness of breath can be signs of many different conditions, if they come on suddenly, you may be having a heart attack. They are more likely to be heart attack symptoms if you have no other illness at the time. If you have the flu or some other diagnosed condition, vague heart attack symptoms can be harder to decipher. In fact, when the symptoms don’t include chest pain, people often ignore them instead of seeking medical attention.

One such atypical heart attack sign is a feeling of dread or stress, especially when there is no obvious reason for such feelings. Heart attack survivors often say later that they had a feeling that “something was wrong,” but they couldn’t explain why.

Women and Heart Attack Symptoms

Women in particular are more likely than men to have non-traditional heart attack symptoms. As a result, these individuals may ultimately arrive at a hospital too late to receive life-saving treatment.

“Women do have chest pain, but they are more likely to have other symptoms,” Dr. Cho says. “Some people think it may be due to plaque erosion, which is more common in women, rather than plaque rupture.”

She adds that younger women are especially at risk of having atypical symptoms. One of the more subtle, but indicative signs of a heart attack, especially among women, is sudden fatigue. An exericse routine or household chores that leave you noticeably more tired than usual should be a red flag.

Heart Attack Basics

Most heart attacks occur when one or more coronary arteries (the arteries in the heart) become so narrowed by cholesterol plaque that blood flow becomes blocked. This can occur if the blockage is so great that blood can no longer move through the artery. More often, though, blood flow stops because a blood clot forms in the coronary artery and is blocking circulation.

Plaque rupture occurs when unstable arterial plaque breaks through the smooth arterial wall, triggering the release of white blood cells and other substances to the site. Plaque erosion occurs when the smooth lining inside the arteries wears down, but does not burst through the arterial wall.

Your heart may still beat during a heart attack, but damage to heart muscle tissue may be happening due to the loss of oxygenated blood flow through the artery.

If you have heart attack risk factors, talk with your doctor about typical and atypical symptoms you could experience. Learn what these symptoms are, how they’ll feel when they are related to a heart attack, and how you should respond if they develop.

Radiating Pain

Sometimes non-traditional heart attack symptoms, such as shortness of breath or a cold sweat, occur along with chest pain. This can give you some more confidence that what you’re experiencing is indeed a heart attack.

For some people, chest pain radiates out from the center of the chest. It may be felt most strongly on the left side of the chest or it may extend from one armpit to the other. Pain can also be felt in the neck or jaw or in the back or down one or both arms.

Dr. Cho says it’s not well understood why some people have heart attack pain in areas other than the chest. “Some people just experience things differently,” she says.

When Chest Pain Strikes

Though a heart attack can make itself known in a variety of ways, its most common sign is chest pain. It’s described variously as pressure, tightness, heaviness or a dull ache.

“Usually chest pain from a heart attack is not sharp, does not go away, and is accompanied by other symptoms, such as shortness of breath, sweating, or other signs,” Dr. Cho says.

And if you suspect that your chest pain or other heart attack symptoms are the real thing, make sure you or someone close to you calls 911. Heart attack survival rates are higher than ever, but a fast response is critical.


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