Minor Pain Might Be a Heart Attack

It happens time and again. A person feels a pain in the jaw, the arm, or the chest and passes it off as insignificant. He or she assumes the chest pain is indigestion or doesn’t want the hassle of going to the hospital, assuming that wherever the pain is it will go away.

But it doesn’t always go away.

In actuality, said cardiologist Irving Loh, up to 40% of all people who suffer heart attacks either don’t feel them or don’t think the pain is particularly abnormal.

It is hard to comprehend how something as potentially devastating as a heart attack can present itself in so many different ways. To better understand why, one needs to know what a heart attack is.

“It is an imbalance between the oxygen demand of the heart and the supply in the coronary arteries,” Loh said. “There is either a significant imbalance or a blood vessel has actually closed over. It’s kind of a charley horse of the heart.”

These pains, said Loh, are often accompanied by nausea, shortness of breath and sweating.

There are usually three to four hours between the onset of the blockage and the beginning of serious heart damage, he said. The grace period allows victims to get to a hospital so a physician can dissolve the clot in the blood vessel, thereby salvaging a significant percentage of heart muscle.

“Undoubtedly you’re losing some heart tissue” during the first three to four hours, said Loh, “but it’s not complete. Some tissues along the outside get oxygen and nutrients, but not as much as they are used to. How you do depends on how much heart damage results.”

The three- to four-hour period is the maximum time to get to the hospital. The American Heart Assn. suggests getting treatment if symptoms last more than two minutes. That grace period is also just an estimate, beginning with the first pains. Those pains may not begin at the exact time as the blockage.

“Usually a person notices the pain very quickly. But there’s a lot going on before that,” said Loh. “Once you have an occlusion the heart cells use up all their reserves, and the heart muscle doesn’t have much of a reserve.”

All this action changes the chemistry of the heart, and the heart stops working properly.

“The heart may develop enough malfunction that the patient develops shortness of breath,” Loh said. “When the heart is not pumping enough, sometimes you feel pain, but there could be several moments before the pain.”

As the attack progresses, the heart rate goes up and the remaining heart muscle, already working overtime, is taxed even more.

Although pain is frightening and uncomfortable, it does tell a person that something is amiss. Up to 25% of people suffering a heart attack don’t even feel the pain, Loh said. And those who do, don’t necessarily feel it in their chests.

“People sometimes have defective pain sensors,” he said. “Pain receptors from the heart go back in the spine. That’s why there is arm pain when the problem is in the heart. People may have a heart attack and not notice, except that they don’t feel quite right.”

It’s important to remember that heart attacks may seem to occur suddenly but actually take years to develop.

Symptoms may not begin until an artery is 70% to 80% clogged.