Heart attacks occur when blood flow to the heart stops or slows, often because a plaque rupture causes a blood clot that blocks a coronary artery. Photo / Getty Images
Most people who have a heart attack will feel a tight, squeezing or aching chest pain, experts say. But not all heart attacks are the same, and there are other warning signs people don’t typically think of.
One night, Lindsay Shanks sat up in bed and felt a sharp pain.
“It felt like someone stabbed me right between my shoulder blades,” said Shanks, who was 37 at the time. “My hands started tingling, and I got really nauseous.”
Shanks, who lives outside Detroit, assumed she was having a panic attack or had a pinched nerve. When she got to the hospital, a nurse looked at her test results and ran out of the room. Shanks was having a heart attack.
“I became very popular very quickly,” she said. “It was very hectic.”
Ben Rennert, 40, a small-business owner from Oshkosh, Wisconsin, was picking up his children from school when he felt a tingle in his arms and “well over a hundred pounds of pressure” on his chest.
“I’ve never felt something that intense before,” he said about his heart attack in March. “It’s not pleasant, to say the least.”
Heart attacks occur when blood flow to the heart stops or slows, often because a plaque rupture causes a blood clot that blocks a coronary artery, cardiologists say.
The “vast majority of people” who have a heart attack will feel a tight, squeezing or aching chest pain, said William Brady, a professor of emergency and cardiovascular medicine at the University of Virginia School of Medicine.
But not all heart attacks are the same, and there are other warning signs people don’t typically think of, said Stacey Rosen, volunteer president of the American Heart Association and executive director at Northwell’s Katz Institute for Women’s Health. In particular, women are more likely to dismiss symptoms (or have them dismissed by others) as anxiety or stress.
The Washington Post asked cardiologists about the more surprising signs and symptoms of a heart attack. Their advice: if anything feels off, tell someone and call an ambulance. Don’t delay a trip to the hospital because the pain isn’t what you’d expect a heart attack to feel like.
“Delay can lead to irreversible heart damage,” Rosen said. “So, really, listen to your body.”
The aching discomfort or pain from a heart attack will often radiate to other parts of the body, said James de Lemos, chair of cardiology at UT Southwestern Medical Center. The symptoms can sometimes be subtle and “less impressive” than what you see on television.
“Some people will tell you it’s just my forearm that hurt - or I had really intense jaw pain that came out of nowhere,” de Lemos said.
Rosen said one of her patients met with dentist after dentist because she thought her aching jaw was because of a tooth - until one dentist suggested it could be because of her heart.
“And, in fact, it was,” Rosen said. The patient probably avoided a heart attack because of “a very intelligent and holistically thinking dentist”.
Pain from a heart attack can - but not always - travel to the left side of the body, on the same side as the heart, the cardiologists said.
Women experience chest pain more often in combination with symptoms such as back pain, nausea, dizziness or shortness of breath, Rosen said. And instead of calling it “chest pain”, they are more likely to describe their symptoms as discomfort or fatigue.
“When someone tells me their chest is aching, that elevates my concern,” said Clyde Yancy, chief of cardiology at the Northwestern University Feinberg School of Medicine.
Nausea, vomiting, acid reflux, belching and other forms of indigestion can be a sign of a heart attack, especially when the attack is affecting the lower portion - or inferior wall - of the heart, de Lemos said.
If the indigestion can’t be treated by an antacid, the gastrointestinal distress could be related to the heart, de Lemos said, particularly in a person who’s at risk for a heart attack.
A heart attack can also cause someone to feel a sense of impending doom, cardiologists said. All of a sudden, “you feel like you’re going to die”, Brady said.
It’s different from “pure anxiety”, said Seth Martin, a cardiologist at Johns Hopkins Medicine. It’s physical symptoms coupled with a persistent sense that “something is seriously wrong”.
“It can be just this awareness, just a sense that something doesn’t feel right,” Yancy said. “That’s sufficient to alert my senses that we need to evaluate the heart and blood vessels.”
A blockage in a coronary artery is an extraordinary stress on the body, Rosen said. And, when it happens, your sympathetic nervous system is overloaded, causing you to feel cold, clammy and sweaty.
If you’re carrying groceries in and your chest is suddenly tight, you’re short of breath and you’re breaking out in a sweat, these are signs of an impending heart attack, Brady said. Especially on fair-weather days when there’s no reason to perspire.
And if you find the discomfort goes away when you sit down and rest, that doesn’t mean you’re in the clear, Brady said. You should still see a doctor.
A heart attack limits the circulation of oxygen through the body and to the heart, which can cause you to feel fatigued or short of breath, Martin said.
You may feel foggy but can’t pinpoint why, Rosen said.
Some people think they’re just getting older and slowing down, said Anna Bortnick, an interventional cardiologist and associate professor of medicine at Montefiore Einstein Medical Center in the Bronx. Others delay going to the hospital because they’re taking care of kids or family members.
A person with early signs of heart problems may experience symptoms only when they’re walking or doing other forms of exercise. The heart requires more blood flow when we exert ourselves, but a blockage or a weakened heart muscle is preventing that from happening, Rosen said.
Sometimes, a heart attack is like a tree trunk falling across a river, blocking all blood flow to the heart, Rosen said.
Other times, “there can be stuttering symptoms that go on for days, that get worse when the artery is more blocked”, she said. “It’s really a dynamic process for many.”
You can’t replace heart muscle cells once the organ is damaged, Rosen said. If you don’t get treatment quickly enough to restore blood flow, the heart attack can affect the organ’s ability to pump blood. This could lead to heart failure, which is a chronic condition where the heart doesn’t function as well as it did.
Instead, cardiologists recommend you take steps to reduce your risk of a heart attack in the first place. Try to lower your blood pressure and cholesterol levels. Exercise regularly for at least 150 minutes a week, don’t smoke, limit how much alcohol you drink and build healthy eating habits.
Rennert, from Wisconsin, said he has physically recovered from his heart attack. Last week, he biked 15 miles around town with a friend.
“It was actually my first ride on this particular bike since the heart attack, and it felt good,” he said. “It was short - but it was still good to get out.”