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Nearly 1 in 4 heart attacks may present with atypical symptoms, such as extreme fatigue, difficulty breathing, or abdominal pain, a new Danish study has found.
"Atypical symptoms were most common among older people, especially women, who called a non-emergency helpline for assistance," said study author Amalie Lykkemark Møller of Nordsjællands Hospital in Hillerød, Denmark. "This suggests that patients were unaware that their symptoms required urgent attention." Read on-and to ensure your health and the health of others, don't miss these Sure Signs You Had COVID and Didn't Know It.
24% had atypical symptoms, the most common being breathing problems
For the study, published May 6 in European Heart Journal-Acute Cardiovascular Care, researchers analyzed data on heart attack-related calls to a 24-hour medical helpline and an emergency number in Denmark between 2014 and 2018. Of 7,222 calls that were followed by a heart attack diagnosis within three days, chest pain was the most commonly recorded primary symptom, at 72%.
But 24% percent of patients had atypical symptoms, with the most common being breathing problems. Chest pain rates were highest among men aged 30 to 59 who called the emergency number; they were lowest among women over 79 who called the less urgent helpline. Atypical symptoms were reported most often by older patients, particularly women.
Seventy-six percent of helpline callers with chest pain were sent an ambulance, compared to 17% of those with atypical symptoms.
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Difference in death rates seen
Ultimately, 5% of patients with chest pain died within 30 days of calling the emergency number, as did 3% of those who called the medical helpline. That rate rose to 23% for emergency callers and 15% of helpline callers with atypical symptoms.
After accounting for variables like age, sex, education, diabetes, previous heart attack, heart failure, and chronic obstructive pulmonary disease, researchers calculated that 30-day death rates were 4.3% for patients with chest pain and 15.6% for those with atypical symptoms.
"Taken together, our results show that heart attack patients with chest pain were three times more likely to receive an emergency ambulance than those with other symptoms," said Moller in a statement.
"People with atypical symptoms more often called the helpline, which could indicate that their symptoms were milder, or they were not aware of the severity," she added. "Vague symptoms may contribute to health staff misinterpreting them as benign."
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Heart-related symptoms to watch for
Chest pain is the most commonly discussed sign of a heart attack. But according to the American Heart Association, symptoms of heart attack can include discomfort in the center of the chest (which may feel like uncomfortable pressure, squeezing, fullness or pain), discomfort in other areas of the upper body (such as the arm, jaw or back), shortness of breath, sweating, nausea or lightheadedness.
"Many cases [of heart attack] present with extremely atypical symptoms, and those of us in the ER are well trained to spot these common presentations," Kristin Hughes, MD, a board-certified emergency medicine physician based in Chicago, told Eat This Not That! Health. "When in doubt, it is absolutely the best thing to go in and get it checked out. It could mean the difference between life and death."