It's long been medical dogma - because that's what older studies found - that the cardinal sign of a heart attack is chest pain, especially "crushing" pain under the breast bone. Over the last few years, however, spurred on in part by the women's movement, researchers discovered that what happens in the typical middle-aged white man, by far the most common type of patient enrolled in most older heart attack studies, is not necessarily what happens in everyone else - especially women, of course.
So, we now know that some heart attack patients have symptoms besides crushing central chest pain, symptoms such as overwhelming nausea, intense sweating, irregular heartbeat, shortness of breath, even fainting. What we didn't know is how commonly this occurs, but we fixed that gap in our knowledge
with a study in the Journal of the American Medical Association that concluded that a staggering one-third of patients do not have chest pain when arriving at the hospital with a heart attack. The groups at highest risk for this "atypical" picture (although, if you ask me, if 33% of people have something, it's not that atypical) were women, people with chronic heart failure, those who had suffered a stroke, people with diabetes, the elderly, and members of minority ethnic groups.
What's so important about this news is that the quicker you act in a heart attack - even something as simple as taking an ASA at the first hint of trouble but also, of course, getting to a hospital ASAP to get those clot-busting, life-saving interventions that have to be given within 6 hours of the start of a heart attack - the better your prognosis, and the warning from this study is not to wait until you have chest pain before considering you might be suffering a heart attack, but if you have any suspicion at all, to throw in the towel and to get help - by calling 9-1-1 as soon as possible.