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The notion that chest pain is the only warning sign of an impending heart attack is a common misconception. While chest pain is indeed a prevalent symptom, it's crucial to recognise that not all chest pains signal a heart attack, and conversely, not all heart attacks present with chest pain.
Heart Attack: A Complex Condition
A heart attack, or myocardial infarction, occurs when the blood supply to a portion of the heart muscle is blocked, causing damage or death of the affected area. According to medical experts, approximately two-thirds of patients who experience a heart attack report chest pain as a symptom. However, this statistic also implies that one-third of heart attack patients may not exhibit chest pain at all.
Chest Pain: Not Always a Heart Attack
Of the patients who visit emergency departments with chest pain, only about 5.1 per cent are diagnosed with a heart attack. This staggering difference highlights the importance of thorough evaluation and diagnosis. Chest pain can stem from various non-cardiac causes, such as musculoskeletal issues, respiratory problems, or gastrointestinal concerns.
Recognising Heart-Related Chest Pain
Heart-related chest pain, known as angina, typically manifests as:
- Squeezing or pressure sensation
- Heaviness or tightness
- Pain radiating to the neck, jaw, or one or both shoulders
- Exertion-exacerbated pain relieved by rest or sublingual nitrate
Angina usually lasts for several minutes and may recur over time.
Beyond Chest Pain: Other Heart Attack Symptoms
A heart attack can present with various symptoms beyond chest pain, including:
- Shortness of breath
- Unexplained sweating
- Giddiness or fainting
- Fatigue
These symptoms are often referred to as "anginal equivalents," as they may indicate cardiac distress without accompanying chest pain.
Duration of Heart Pain
Typically, heart-related chest pain lasts between a few minutes and up to 24 hours continuously. Pain lasting less than a minute or persisting for more than 24 hours may suggest alternative causes.
Non-Cardiac Chest Pain Characteristics
Certain characteristics may indicate non-cardiac causes of chest pain:
- Well-localised pain pinpointed by the tip of a finger
- Pain that increases upon pressing the affected area
- Pinprick-like pain
- Sharp, short, lightning-type pain exacerbated by coughing or deep breathing
- Pain that worsens with movement of the chest wall
- Pain above the ear lobes or below the umbilical area
The Overlap of Cardiac and Non-Cardiac Chest Pain
There is considerable overlap between cardiac and non-cardiac causes of chest pain, making accurate diagnosis challenging. Medical professionals rely on a combination of:
- Patient history
- Physical examination
- Electrocardiogram (ECG)
- Blood tests (e.g., troponin levels)
- Imaging studies (e.g., echocardiogram or stress test)
to determine the underlying cause of chest pain.
Chest pain is not the sole indicator of a heart attack, and its absence doesn't rule out cardiac distress. Recognising the diverse symptoms and characteristics of heart attacks can facilitate timely medical attention and improve outcomes. If you or someone you know experiences unusual or persistent chest pain or other concerning symptoms, seek medical evaluation promptly.
The author is MD General Medicine, DM Cardiology., DNB Cardiology, FSCAI (USA), Senior Consultant and Interventional Cardiologist, Apollo Hospitals, BG Road, Bangalore
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