Is chest pain the only sign of a heart attack?

Chest Pain is Not the Only Sign of a Heart Attack

No, chest pain is not the only sign of a heart attack. Heart attack symptoms are highly individual and may appear as chest pain, oppression, dyspnea, heavy chest, or slight discomfort, and may also include radiation to the arm, jaw, neck, or back, as well as associated symptoms like cold sweat, nausea, vomiting, and fainting. 1

Common Heart Attack Symptoms

• Chest pain or discomfort (pressure, squeezing, fullness) is the most recognized symptom but is not present in all cases 1
• Pain or discomfort that may radiate to the arm(s), jaw, neck, or back 1
• Shortness of breath (dyspnea) 1
• Cold sweat, nausea, or vomiting 1
• Lightheadedness, dizziness, or fainting 1
• Anxiety or fear 1

Gender Differences in Heart Attack Symptoms

• Women may experience different symptoms than men 1
• Women more frequently report pain in the back, neck, and jaw 1
• Women use words like "tearing," "terrifying," "tiring," and "intolerable" more frequently to describe their symptoms 1
• Women experience nausea, vomiting, and dyspnea more frequently than men 1
• Men experience sweating more frequently than women 1

Atypical Presentations

• Approximately 33% of patients with confirmed myocardial infarction do not present with chest pain 2
• Patients without chest pain tend to be older (average 7 years older than those with chest pain) 2
• Higher proportion of women (49% vs 38%) and patients with diabetes (32.6% vs 25.4%) present without chest pain 2
• Patients without chest pain experience longer delays before seeking medical attention (mean 7.9 vs 5.3 hours) 2
• Higher in-hospital mortality rate for patients without chest pain (23.3% vs 9.3%) 2

Red Flags Indicating a Serious Condition

• Symptoms that interrupt normal activity 1, 3
• Presence of accompanying symptoms such as cold sweat, nausea, vomiting, fainting, or anxiety/fear 1, 3
• Severe, prolonged chest pain of acute onset 1, 3
• Diffuse pain over a wide area of the anterior chest wall rather than localized pain 1

Action Plan When Heart Attack is Suspected

• Immediately activate emergency medical services (call 911/999/local emergency number) 1, 3
• Take a fast-acting aspirin tablet (162-325 mg) if not allergic or contraindicated 1
• Do not wait for symptoms to disappear as they are poor indicators of risk 1
• Do not use private vehicle transport if possible (approximately 1 in 300 chest pain patients transported by private vehicle goes into cardiac arrest en route) 1, 3

Important Pitfalls to Avoid

• Relying solely on pain severity to determine urgency (severity is a poor predictor of complications) 3
• Delaying treatment while waiting for definitive diagnosis 3
• Assuming that absence of chest pain rules out a heart attack 2
• Failing to recognize atypical presentations in women, elderly patients, and those with diabetes 1, 2

Public Awareness and Education

• Public knowledge of heart attack symptoms remains deficient 4, 5
• Only about 50% of adults can correctly identify all five common heart attack symptoms 5
• Educational campaigns should emphasize that heart attack symptoms can be gradual rather than sudden in onset 1
• Special attention should be given to educating high-risk groups and socioeconomically disadvantaged populations 4

Remember that early recognition and prompt action are critical for improving survival in heart attacks. The heterogeneous nature of heart attack symptoms makes it essential to be aware of both typical and atypical presentations 1, 2.