Not every heart attack starts with crushing chest pain: Why acidity and fatigue are commonly dismissed

A misconception is that heart attacks always start with intense, crushing chest pain. But we often see patients with symptoms that are much less severe. Some of these symptoms include heaviness, shortness of breath, sweating, nausea, and discomfort in the upper abdomen with a feeling of uneasiness.

Sadly, it often takes several hours before some of these patients finally seek treatment.

Heart attacks commonly present with an ache or pressure in the chest, often described as a feeling of heaviness, squeezing, or tightness. This discomfort may radiate to the left or both arms, shoulders, jaw, or back. Not everyone exhibits all these symptoms. Some patients complain of a burning feeling in the chest or upper abdominal discomfort. Some assume that the burning is from digestive issues like gas or heartburn and decide to take an antacid.

In fact, one of our patients presented with repeated belching as his main complaint. On evaluation, he was found to have a tight stenosis in the LAD, one of the major arteries supplying the heart. Fortunately, the condition was caught early, and he could be treated in time. This is a good example of how seemingly ordinary digestive symptoms can sometimes be a warning sign of significant heart disease.

This thinking is especially dangerous for people in India, particularly those at higher risk for heart disease. People tend to wait for their discomfort to go away by taking an antacid. If any individual is experiencing discomfort resembling gas or heartburn, especially during activity or when associated with sweating, shortness of breath, or nausea, it should not be ignored.

Women and older people may also have heart attacks without the classic crushing chest pain. Their symptoms may include shortness of breath, unexplained weakness or fatigue, dizziness, nausea, sweating, general uneasiness, and sometimes poor appetite. People with diabetes may also have reduced perception of pain and can sometimes experience a heart attack with very little or even no chest pain.

Most heart attacks occur when blood flow through a coronary artery is suddenly reduced or blocked, often because of a blood clot forming over a ruptured plaque. The longer the artery remains blocked, the greater the amount of heart muscle is at risk of permanent damage. Prompt diagnosis and reopening of the artery with emergency angioplasty, when indicated, can save heart function and, more importantly, life.

From the perspective of cardiologists, we would much rather have a patient come to the Emergency Department with suspicious symptoms and eventually discover that the heart is normal than have a patient come in many hours after a heart attack because the symptoms were initially mistaken for acidity.

It is also important to recognise cardiovascular risk factors at an early stage. Diabetes, high blood pressure, dyslipidemia, smoking, obesity, a sedentary lifestyle, and a family history of early heart disease raise the chances of coronary artery disease. Indians and South Asians in general are known to have an increased cardiometabolic risk, and hence significant coronary artery disease can occur even in younger individuals.

Thus, do not depend on the severity of chest pain to determine whether it could be a heart attack. Any new chest pressure, heaviness, or burning, especially when accompanied by sweating, breathlessness, nausea, dizziness, or pain radiating to the arm, jaw, or back, should prompt immediate medical evaluation.

Regular blood-pressure checks, testing for diabetes and cholesterol levels, quitting smoking, adopting an active lifestyle, and taking prescribed medications regularly continue to form the basis of heart disease prevention.

As we celebrate World Heart Day this year, here's a reminder: a heart attack may not present with excruciating chest pain. It may present with many subtler symptoms. Recognising them early and getting to the hospital quickly can make all the difference.

The author is a consultant cardiologist at Lilavati Hospital & Research Centre, Mumbai. 

 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.