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Coronary Artery Disease | Heart & Vascular Health

Beware the Silent Heart Attack

Pay attention to unusual heart symptoms

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.

Cleveland Clinic 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 uncertainly 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.” 

Tags: heart and vascular institute, heart attack, heart disease, heart health
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  • Fernando Domeniconi

    Mine was exactly like that, I had mild pain in the center of the chest for over a week (it was not a heart attack then, I was told it was only angina), the EKG came out normal until a day that I felt a strange feeling of doom (cannot find a better way to describe it) so I went to the ER and I was having the heart attack. Luckily, it was a minor one, no damage to the heart, but I have a stent.

  • Linda Sarangoulis

    Good article – however, I’ve been dealing with these exact symptoms for close to 20 years. I’ve had every test (including those mentioned) – multiple times. I see my cardiologist yearly (or more as needed)… Fernando mentioned a, “feeling of doom”… I know exactly what you mean – and you’re correct. I get chest pain, pain in my arm and jaw, and feel like my heart just isn’t in a good place. No other way to describe it. I have gone to the ER – just to be told I didn’t have a heart attack (good news)…but when you have these symptoms – you just want to know what is causing it – and FIX it!

    • Mona a

      It is funny, that I hate to say it but I am not alone.

  • Pamela Savage Martin

    If I went to the hospital every time I have had chest pains, weakness, feeling of doom. I would be there every night. How do you know when to go. There are nights I am sure it’s a heart attack, pain in the arm etc.. so horrible not knowing what to do and fearing you will die on your sleep.

    • Marjorie

      I went in for my annual check-up with my internist (who is very thorough) and was told that I had had a silent heart attack and my EKG showed it. It had happened 2 or 3 years before (I know, I skipped check-ups for 2-3 years!, my bad). So I was freaked because I could not tell you at what point I even thought I had one. I am prone to anxiety attacks so I deal with the symptoms and move on. Dr suggested a heart cath to look for blockage and the results showed very little in one and none in the others. Worrying about it gives me anxiety so I guess I will live with this and maybe someday die in my sleep! Could be worse ways to go!!

      • The_Beating_Edge_Team

        Hi Marjorie – make sure that you are managing your risk factors (don’t smoke, exercise, eat right, keep your blood pressure, blood sugar and lipids in control) – this will decrease your risk for further progression of heart disease.

    • The_Beating_Edge_Team

      That is a hard question to answer. The first step is to be evaluated when you are having those symptoms and see what the testing shows – if you are having a heart attack. Even if your emergency room (ER) tests comes back negative, it is important after that ER visit, to see a cardiologist for further evaluation. Then….. if all cardiac causes are ruled, out, it would be important to be evaluated for other causes of chest pain – http://my.clevelandclinic.org/heart/disorders/cad/causes-chest-pains.aspx .But – to answer your question, it is always best to be safe rather than sorry. So before all heart disease is ruled out – get checked when you have symptoms. betsyRN

    • Beckster

      Pamela, I am a cardiac RN! In answer to your question on how or when to know when you should go seek help: it is always error on the side of caution! Get checked out, they can do blood tests and EKG, then you will know!! There are other diagnosis that can cause those feelings too, it is best to let your doc check it out!!!

  • shweta

    Yesterday my grandmother is suffering from major heart attack…. Last month she was suffering from minor heart attack… What can I do know

  • Lew

    I had a major MI with 100% block in my LAD. Hollywood has done us all a major disservice to dramatize heart attack symptoms. I never felt pain. Just profuse sweating and dizziness. If I had been working out I would have put it down to working out too hard. For those of us who are silent ischemics get to know your limits and your signs. Push the limits to recover your strength but never forget the signs.

    • The_Beating_Edge_Team

      Thank you Lew for sharing this.

  • Ursula

    My internist at a Cleveland Clinic facility in a Southwest suburb of Cleveland never picked up on anything even though I did mention the tightening in the chest & fatique and several other symptoms. Last November I contacted him with a problem that was becoming very troublesome and painful, he sent me to a facility in an northeastern suburb to see a nurse practitioner in their walk in clinic. Closer to home for me. She did not listen to my symptoms, description of pain or location of pain. She treated me very badly, like a stupid, unclean and annoying old woman. Luckily a few days later after insistence by my daughter and husband I went to the emergency room at Euclid hospital. They found the problem within 2 hours, had a procedure the next day, was in the hospital almost a month and they saved my life. Needless to say, I now have new doctors. Still within the Cleveland Clinic system but they listen. To all doctors reading this, stop treating women, especially older ones, like foolish alarmists and listen to us. We may not be pretty any longer but we are still worth helping.

    • The_Beating_Edge_Team

      Thanks for your note Ursula. I am glad you were persistent in your quest for care. Sometimes we need to be our own health care advocate. If you have a doctor that does not listen – you need to find another doctor and I am glad you have found that. Let us know if you have any questions in the future. betsyRN http://www.clevelandclinic.org/heartnurse

  • Metzmar

    This is not helpful and frankly, a little bit ridiculous. The entire population can’t run to the emergency room every time they experience heartburn or a pain in an extremity. The cost would be enormous. It would fill emergency rooms with nonemergencies and potentially delay care to those who need immediate care.

    • http://www.danaseilhan.com Dana

      They said “new onset heartburn symptoms,” as in you have never had heartburn before. They didn’t say go every time you have it. And oftentimes when we have pain in extremities we can point to a reason why. Presumably whoever wrote this article means to get it checked out if you *can’t* identify why you’re suffering extremity pain. That OK with you? You want to know what’s really expensive? Open-heart surgery.

    • The_Beating_Edge_Team

      Metzmar – people who experience chest pain – until heart is ruled out need to be evaluated. The guidelines from the AHA and ACC recommend evaluation and calling of 911 or chest pain lasting longer than 5 minutes – http://my.americanheart.org/professional/StatementsGuidelines/Statements-Guidelines_UCM_316885_SubHomePage.jsp . Once heart causes are ruled out for symptoms, then one can proceed at a more leisurely pace. In addition, research has noted that for those who are discharged from the ED after an evaluation for chest pain, who follow up with their physician, have better outcomes – http://circ.ahajournals.org/content/127/13/1386.short

  • Regina Thompson Reighard

    I’ve been having occasional sweats you’d think I was having hot flashes but went thrum that 30 years ago. This has been happening only the past week and I am in AC.. and I mean sweat. No other symptoms.

    • The_Beating_Edge_Team

      If you are having new symptoms such as sweating – a good place to start would be with your family doctor or primary care doctor. There are actually many causes for this – and it should be evaluated. Here is a good page that may be helpful to you – http://www.nlm.nih.gov/medlineplus/ency/article/003218.htm

  • http://www.danaseilhan.com Dana

    When I was first old enough to imbibe alcohol legally, I developed a fondness for daquiris. That got nipped in the bud as I figured out I had to be careful with the fruity drinks because I reacted badly to a few of them. I was at a bar one evening with friends and developed unpleasant chest symptoms where I felt squeezed and couldn’t fill my lungs as fully when I breathed. I went outside to get fresh air and eventually it wore off. I also had that experience a time or two with wine coolers so I began avoiding them too. Reading about the symptoms here makes me wonder a little, but I was in my early 20s at the time and I have never had anyone tell me since then that my heart sounded funny in any way. No idea. (I’m 40 now.)

  • Windy

    My Daughter is 24 and has a pacemaker. She has been having pain for two days in her left arm. I feel so sorry for her. She is on so many medications. When she calls her Doctor he acts like she is just a worry wart. What should I do?

    • The_Beating_Edge_Team

      Windy – your daughter should be evaluated for her left arm pain by her cardiologist or primary care provider. It can be caused by many things, but if this is a new symptom, and she is uncomfortable, she should be evaluated. Here is a link to symptoms of coronary artery disease – http://my.clevelandclinic.org/heart/disorders/cad/cadsymptoms.aspx ; if it is in the same side as the pacemaker, there may be issues with the pacemaker generator placement putting pressure on a nerve or circulation; or, it may not be related to the heart condition at all – but may be related to nerve, muscle or circulation in that arm – in any case, she should see her doctor. betsyRN

  • Sunny

    wow – nervous reading this – I had pain in the middle of the chest and jaw hurts – went away – should I have gone to the er

    • The_Beating_Edge_Team

      If it lasts longer than 5 minutes – yes. If not – then you should schedule a visit with your doctor to talk about these new symptoms. betsyRN

  • Mia

    Wish I could afford to go to the doctor for basic care let alone run there every time something seemed amiss.
    Insurance is expensive and the copayment is ridiculous. Non insured get to suffer and die faster, I suppose. America.
    Home of the brave.

    • J

      Suppose you’d rather have me pay for it.

  • Mary

    I was just shopping and all of a sudden my upper back and chest started hurting, the chest eased up than my left side started, than left side eased up and chest started along with the upper back pain and jaw area started. Went to sit down and it all went away. Lasted for about 5 mins total. Came home and left arm felt a little sore but, no longer. I have called dr but, in meantime what are your thoughts on this? Thanks in advance.

    • The_Beating_Edge_Team

      Mary – you need to be evaluated as soon as possible. If this discomfort returns in any of the locations, or you begin to have other symptoms such as shortness of breath, dizziness, extreme fatigue, or the symptoms listed at http://my.clevelandclinic.org/services/heart/disorders/cad/cadsymptoms, please seek emergency treatment. Your pain is very suspicious of heart pain. Even if it does not come back, you need to see your doctor for an evaluation. betsyRN