How Do You Know You Are Having a Heart Attack? Hidden Symptoms

When a heart attack is mentioned, the same scene comes to everyone’s mind: a person clutching their chest and collapsing to the ground. Yet in a significant proportion of the patients who come to our clinic the picture is not nearly so clear; sometimes the attack is insidious, and sometimes it shows itself with symptoms pointing to a completely different organ. I have addressed the general symptoms of cardiovascular blockage in a separate article; in this article I focus directly on the typical and “hidden” (atypical) symptoms of a heart attack, and especially on presentations that are confused with stomach pain.

Typical Heart Attack Symptoms: Pressure and Pain in the Chest

In the classic picture the patient describes pressure or tightness in the middle of the chest, or a heaviness of the kind “something is sitting on me”; this sensation may radiate to the left arm, the jaw or the back, and may be accompanied by cold sweating, nausea and shortness of breath. The pain usually lasts longer than 20 minutes and does not go away with rest; this duration and character are the most important features distinguishing it from stable angina, which comes on with exertion and passes with rest.

What Is a Silent Heart Attack (Silent MI)? In Whom Does It Occur?

In some of our patients a heart attack occurs without any chest pain at all, with only extreme fatigue, mild shortness of breath, or no symptoms whatsoever; we call this a “silent” heart attack or “silent ischaemia”. This picture is seen more often in diabetic patients, in advanced age and in people who have previously had a heart attack; damage to the nerve endings can prevent the pain signal from reaching the brain properly. An attack that has passed silently may only come to light years later, when an EKG or echocardiography reveals that it has left a trace in the past.

Stomach Pain or Heart Attack? How Are They Distinguished?

Especially when the vessel supplying the lower wall of the heart becomes blocked, the pain may be felt in the upper abdomen instead of the chest; the patient may mistake this for indigestion or an attack of gastritis and lose time by taking stomach medication. There is a situation here that genuinely makes this distinction difficult, but a few clues guide us: pain of stomach origin is usually related to meals and is partly relieved by antacids, whereas pain of cardiac origin appears with exertion or stress and carries accompanying findings such as cold sweating and shortness of breath. When we have any doubt, the right decision is not to try stomach medication but to have an EKG taken; because a vessel opened in time directly determines how much of the heart muscle will suffer permanent damage.

Frequently Asked Questions

Is a silent heart attack dangerous? Yes, sometimes it is even more dangerous; because the patient receives no warning at all, they may miss the chance of timely treatment and the damage may progress unnoticed.

I have stomach pain but I suspect a heart attack, what should I do? If there is a “stomach pain” related to exertion and accompanied by cold sweating or shortness of breath, we recommend that you seek urgent assessment instead of trying stomach medication.

How do we recognise a silent heart attack? Most of the time it is only understood later, when an EKG or imaging shows that it has left a trace in the past; this is why we place importance on regular cardiological check-ups in patients in the risk group.

Conclusion

Knowing that a heart attack does not always present as clear a picture as in films can save lives; in women, diabetic patients and people of advanced age in particular, the symptoms can be far more vague and insidious. Taking seriously every new, unexplained change that affects daily life is the safest approach.

If you have experienced exertion-related chest or upper abdominal discomfort, unexplained shortness of breath, or any of the symptoms I have described above, we recommend that you go to the emergency department without losing time so that you can be assessed.

References

1. Canto JG, Rogers WJ, Goldberg RJ, et al. Association of Age and Sex With Myocardial Infarction Symptom Presentation and In-Hospital Mortality. JAMA. 2012;307(8):813-822.
2. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain. Circulation. 2021;144(22):e368-e454.
3. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation. Eur Heart J. 2018;39(2):119-177.