Slow-onset heart attack: the trickster that fools us

~ Carolyn Thomas

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by Carolyn Thomas  ♥  @HeartSisters

As I’ve noted here previously, there were a number of very good reasons that I believed that Emergency Department physician who sent me home with an acid reflux misdiagnosis. Despite my textbook heart attack symptoms of central chest pain, nausea, sweating and pain down my left arm, these reasons included:

1.  He had the letters M.D. after his name;

2.  He misdiagnosed me in a decisively authoritative manner;

3.  I wanted to believe him because I’d much rather have indigestion than heart disease, thank you very much;

4.  The Emergency nurse scolded me privately about my questions to this doctor, warning me: “He is a very good doctor, and he does not like to be questioned!”  (The questions I’d been asking included, not surprisingly: “But Doctor, what about this pain down my left arm?”);

5.  Most of all, what I had always imagined a heart attack looking like (clutching one’s chest in agony, falling down unconscious, 911, ambulance, sirens, CPR) was not at all what I was experiencing. Instead, despite my alarming symptoms, I was still able to walk, talk, think and generally behave like a normally functioning person, i.e. one who is definitely NOT having a heart attack!*

So it all made sense to me as I was being sent home from Emergency that day, feeling very embarrassed because I had clearly been making a big fuss over nothing.

My experience, however, might have been what researchers in Ireland refer to as “slow-onset myocardial infarction”.  

Dr. Sharon O’Donnell, lead author of a study published in the Journal of Cardiovascular Nursing, interviewed heart attack survivors in Dublin between 2-4 days following their hospital admission. She explained in her paper that slow-onset MI is the gradual onset of relatively mild heart attack symptoms, while fast-onset MI describes the immediate onset of sudden, continuous, and severe heart attack symptoms, particularly chest pain. (1)

”      Over 60 per cent of our study’s participants experienced slow-onset MI, but had expected the severe symptoms associated with fast-onset MI. The mismatch of expected and experienced symptoms for participants with slow-onset MI led to both their mislabeling of symptoms to a non-cardiac cause, as well as protracted help-seeking delays.”

Study participants who had experienced the more severe symptoms of fast-onset MI, however, quickly chalked up their symptoms to a cardiac cause, which meant significantly faster decisions to seek medical help.

This makes perfect sense.  No wonder we wait far longer than we should in mid-heart attack when we’re experiencing non-severe or atypical cardiac symptoms. As Dr. O’Donnell explained:

“Educational information provided to the public needs to be reviewed. Slow-onset MI and fast-onset MI provide plausible definition alternatives, and possibly a more authentic version of real MI events than what is currently used. They also provide a unique ‘delay’ perspective which may inform future educational initiatives targeted at decision delay reduction.”

She also pointed out that both slow-onset and fast-onset presentations are associated with uniquely distinct behavioral patterns that significantly influence how long that important pre-hospital delay turns out to be. With slow-onset symptoms, patients can wait dangerously longer than they should (believing symptoms to be “nothing serious”) while in fast-onset, patients seek emergency help faster because severe symptoms convince them that “this IS serious!”

In a later follow-up study published in the Journal of Emergency Medicine, Dr. O’Donnell  looked at the phenomenon of slow-onset symptoms among patients presenting to hospital with Acute Coronary Syndrome (ACS) – a term used for any condition brought on by sudden, reduced blood flow to the heart muscle – including heart attack or unstable angina. (2)

Out of almost 900 ACS patients studied, she and her team found that 65% of them experienced slow-onset symptom presentation.  And just like her earlier study, this group of patients had been significantly more likely to wait longer at home before going to hospital to seek emergency help (3.5 hours, vs. 2 hours for those with fast-onset symptoms).
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I’m particularly interested in treatment-seeking delay, because I personally became the all-time unofficial poster child for this phenomenon.  After being misdiagnosed and sent home from hospital – embarrassed and humiliated – on that fateful day, it took me two full weeks before I finally returned to Emergency – and only because my increasingly debilitating bouts of continuing cardiac symptoms had by then become truly unbearable.  Well, that plus the fact that I could no longer walk five steps without having to stop because of pain.
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Most of us are socialized from childhood to not make a fuss over every little twinge or ache.  We regularly dismiss all kinds of suspicious symptoms because they frequently do get better on their own, or after a good night’s sleep.  Or we simply become used to putting up with symptoms as merely the annoyance of getting older. Or because a Real Life Doctor tells us we’re fine. (And really, if we rushed to Emergency over every single bubble and squeak, our health care systems would be even more impossibly overwhelmed).
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Careful consideration of new or puzzling symptoms is important – but so is knowing when to get help.
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Most heart attacks do start slowly. Most involve discomfort in the center of the chest that lasts more than a few minutes, or symptoms that go away and come back later over hours or even days as mine did. Cardiac symptoms can feel like uncomfortable pressure, squeezing, tightness, fullness as well as pain. Around 8-10% of women (some studies suggest that could even be as high as 40%) experience no chest symptoms at all in mid-heart attack – instead reporting signs like crushing fatigue, shortness of breath, pain in either or both arms, jaw, throat, shoulders, or nausea/vomiting.(3)
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Ironically, even the most painful cardiac symptoms don’t necessarily mean more serious heart muscle damage than less severe pain does.
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Not surprisingly, it’s very common for those people affected to feel unsure about what’s wrong with them, and then to wait too long before getting help.  See also: How women can tell if they’re headed for a heart attack
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So we silently monitor any new aches or pains, tallying them on an invisible abacus, ranking their severity on a secret leaderboard. It’s often only when we can no longer stand to quietly tolerate the intolerable that we force ourselves to pro-actively seek help. But this delay can be a dangerous and often deadly decision if those symptoms are due to a cardiac event.
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And those slow-onset symptoms are the easiest to ignore. When that Emergency physician told me to see my family physician for an antacid prescription, well, that was all I needed to hear.  Nobody had to tell me twice.  When I returned home that morning, I dutifully called my family doc’s office as directed, made an appointment for two weeks down the road when she’d be back from vacation, and then got right on with the rest of my life.
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And when the cardiac symptoms returned two days later (of course they did!), this time while sitting quietly at my desk at work, I knew instantly there was no way I was going back to Emergency. Hadn’t a highly trained, experienced physician told me in a decisively authoritative manner:
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“You’re in the right demographic for acid reflux!”
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And when those same cardiac symptoms kept on returning (of course they did!), I began to normalize them even as they grew increasingly debilitating: This must just be what acid reflux is like.  How can other people with acid reflux stand this?  Acid reflux is BRUTAL.  Where’s my Gaviscon . . . ?
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Most other studies that investigate treatment-seeking delay behaviours in heart patients have tended to overlook slow-onset symptoms.  See also: Downplaying symptoms: just pretend it’s NOT a heart attack
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 The bottom line:

If you are experiencing symptoms that might be signs of a heart attack (whether they’re slow- or fast-onset!), call 9-1-1 or your emergency response number. As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, unusual and extreme fatigue, nausea/vomiting, and back/throat/jaw pain. . Learn these signs, but remember this: even if you’re not sure it’s a heart attack, get checked out by a physician.
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(1) O’Donnell, S. et al.  Slow-Onset Myocardial Infarction and Its Influence on Help-Seeking Behaviors. Journal of Cardiovascular Nursing, August 2012. Volume 27  Number 4. Pages 334 – 344.
(2) O’Donnell, S. et al. Slow-onset and fast-onset symptom presentations in acute coronary syndrome (ACS): new perspectives on prehospital delay in patients with ACS. J Emerg Med. 2014 Apr 11; 46(4):507-15.
(3) S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 20–26.

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NOTE FROM CAROLYN:   I wrote much more about women’s heart attack symptoms (slow and otherwise) in Chapter 1 of my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use their code HTWN to save 30% off the list price).

 

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   Q:  Did you or somebody you care about wait too long before seeking help because of ‘slow-onset’ symptoms?

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* My own misconception about what a heart attack really looks like was actually more like sudden cardiac arrest (an electrical problem) than a heart attack (a plumbing problem!)
See also:

When heart attack symptoms disappear – and then return

This is NOT what a woman’s heart attack looks like

How to communicate your heart symptoms to your doctor

The symptomatic tipping point during heart attack

“You’ve done the right thing by coming here today”

The heart patient’s chronic lament: “Excuse me. I’m sorry. I don’t mean to be a bother…”

Why we ignore serious symptoms

Denial and its deadly role in surviving a heart attack

‘Knowing & Going’ – act fast when heart attack symptoms hit

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Published by Carolyn Thomas

109 thoughts on “Slow-onset heart attack: the trickster that fools us”

  1. I lost my boyfriend of 9 years one month ago today. The ICU cardiologist told me that he had had a massive coronary and ‘had been having one for some time’. (?)

    He had almost NO SYMPTOMS of any type of heart attack! This delayed him from going to a hospital until his pain became excruciating and by then, it was too late. He walked out of our home and walked into the E.R. in fact!

    However the next time I saw him was in the ICU on total life support. His inability to experience pain or other symptoms associated with heart attacks led to his delay in getting treatment. That delay resulted in multiple organ failure.

    The day of his ‘cardiac event’ he had an appetite and had eaten several meals. WHO DOES THAT?! I repeatedly asked.

    ‘Everyone is different’, I was repeatedly answered.

    But still, who takes time away from having a massive heart attack, to eat?!
    I can’t wrap my head around that still.

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    1. Oh Suzette, I am so sorry for your tragic loss. His death must have been an unspeakable shock to you. I’m guessing that you still cannot quite believe what has happened.

      It’s often hard to understand how somebody having a massive heart attack would be able to do anything at all – like enjoying a meal. That’s partly because of the mistaken stereotype many of us have (at least, I did before my own cardiac event) of what a heart attack looks like. We often believe that a massive heart attack would incapacitate us, make us clutch our chests in agony, and perhaps even fall down unconscious! Sometimes it looks like that, but as Dr. O’Donnell reported in her research, it often does not.

      Your boyfriend’s experience was, sadly, not at all unusual. We know for example that “time is muscle” when it comes to getting quick medical attention for a heart attack, but researchers tell us that fewer than 1 in 5 heart attack patients do get themselves to the hospital quickly. Denial plays a big role in this, as does trying to minimize symptoms, or not wanting to make a fuss in case this turns out to be “no big deal”. In that regard, your boyfriend was certainly not alone. It’s not surprising, really, when you consider the mismatch, as Dr. O’Donnell found, between what patients themselves think a heart attack “should” look like, and what they are actually experiencing.

      As I wrote in this article, “despite my own alarming symptoms, I was still able to walk, talk, think and generally behave like a normally functioning person”. For two weeks! I could not only enjoy my regular meals, I could go to work, drive my car, socialize with friends, fly across the country to help celebrate my mother’s 80th birthday. And the fact that I was able to go about my life, business as usual, helped to convince me that this was NOT my heart. And really, I thought at the time, would a person having a heart attack be able to do all these busy everyday things if it were a REAL heart attack?

      In slow-onset heart attacks, the answer might well be YES. Read more here.

      It’s important to remember that, as I learned much later at Mayo Clinic, it’s not necessarily true that really bad symptoms mean a higher risk of a really bad heart attack, or that mild symptoms (so easy to pass off as NON-cardiac) don’t mean a serious heart attack. At Mayo, for example, I met a heart attack survivor whose only symptom was a persistent cough, another whose only symptom was her lips turning numb. Who would even go see a doctor with those kinds of vague symptoms? Yet that’s the perverse nature of cardiovascular disease.

      I know that it may feel impossible right now to make sense out of something that makes no sense at all. My condolences to you once again as you try to get through this painful time.

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  2. I am a 71 year old woman, overweight. I had gas-like pain in my chest about 6:30, then it went away. It came back only worse. Finally after omeprozole didn’t help and two nitro 5 minutes apart, I went to the emergency room in pain.

    Cardiologist said It’s not a heart attack, that enzymes can rise a bit. But pain lasting from 6 to 2 wasn’t a heart attack. That something severe would have already happened but they would treat it like a heart attack.

    They did a test similar to an ultrasound. The guy barely caught it. In the back of my heart.
    I was due a heart Cath that morning. Pain had gone but enzymes began rising. They got me in quickly.

    It was a heart attack. One artery 100 percent closed and one almost. They put a stent in. Doc said it fooled him. It happened. Heart racing and chest pain was how my afibs started. Till one day it hurt real bad. My blood pressure was rising and falling.

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      1. Fab articles here. Shame I stubbornly looked for anything other than angina/heart attack on google instead of accepting that was what was going on. For nearly 5 days.

        Last Wed evening I came home from work tired, irritated and with an ‘aching front of my neck’ I said to my husband that I thought my hay fever must be starting as it feels like a cold is on its way for me.

        I woke up with it the next morning, but it went away. Until I walked my kids not far at all to meet friends. I crawled into the car and sat panting, gasping that I felt awful. It gradually went away. This continued thru Fri, Sat and Sunday, with the pain getting worse each time, and happening faster. The pain would start like over my Adam’s apple and radiate down across my chest. It felt like I’d run too far/fast at the onset, but then as it got worse felt a bit like if you swallow something too hot/cold or get a gas bubble in mid chest.

        Sunday morning I continued with my plan of painting the front door, and decided to let myself rest in front of TV for the afternoon. The pain made it impossible to sit any way but upright, slightly leaning forward.

        Time to cook dinner, ate it and enjoyed chocolate cake and ice cream pudding and the pain galloped in, would not settle. Tried to watch TV then read or play games on iPad. 2 bouts of Diarrhea and then arms felt heavy and weird. I FINALLY call ambulance.

        Full blockage of an artery, Cath lab and now the recovery starts.

        I KNEW all the atypical symptoms, I used to teach them in first aid. But I kept minimising, excusing and thinking as I had ‘ok moments’ it couldn’t be.

        It was. Listen to that little voice. It’s right.

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        1. What a story, Nic! Good example of how symptoms can start, then go away, then come back – for five days! Because we are able to FUNCTION throughout, however – going to work, painting the door, making dinner, normal stuff – it doesn’t scream HEART right away until symptoms become essentially unbearable. This is so common that researchers have a name for it: “Treatment-Seeking Delay Behaviour“.

          Great advice to LISTEN to that little voice! Hope you are feeling better by now.

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  3. This is what took my husband, kept thinking it was his gallbladder etc. He would not go to the dr. or hospital. He died in my arms on Mother’s Day 2015. We were married 34 years. He was only 64. He is so missed.

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  4. I quickly read through many of the posts…..really like this blog! Trying to be pro-active in my situation as well. I had a heart attack on New Years and am a “0 risk”…..a real head scratcher since my arteries are “beautiful” I was told after my heart cath. Doc attributed it to “broken heart syndrome” and that really didn’t seem to apply to ME.

    So I have to consider maybe artery spasms or microvascular spasms……reason being is I have had mild chest pain and pressure radiating at times to jaw and arms for about a week now…..cardio isn’t proactive and hasn’t even put me through any additional tests like stress or even a holter monitor! I am 53. These symptoms do mildly mimic my HA pain which was classic by the book….a NSTEMI and left hospital with a defibrillator vest and 35% ej. I am up to 50% as of last echo. Would be great to hear anyone’s info concerning spasms….

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    1. What a way to kick off the New Year, Susan! I’m not a physician but I can make a couple of general observations: first, symptoms between heart attacks are not necessarily the same (e.g. we can experience severe symptoms with HA#1 yet relatively mild symptoms with HA#2) Secondly, something is causing your current symptoms and you are smart to try to figure out what that is. Right now, you simply don’t know if they’re heart-related or not. If I were in your shoes, I’d return to your cardio. If unsatisfactory, don’t hesitate to seek a second opinion. Don’t be heroic and wait out these symptoms. Meanwhile, you may have read this already but here’s a link to more on spasm/MVD symptoms. Good luck to you…

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  5. How many nitro tablets can one take during the day and into the night? I’ve had bad back ache at 5-7 at night. My main problem with my heart failure is not being able to walk more than a half a block before I feel a cold burning ache in my chest. When I sit down it goes away quickly? Very disturbing to me. Other than that I feel pretty darn good most of the day. Any suggestions?

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    1. Hi Bob – I’m not a physician so cannot comment on your specific situation, but I can say very generally that many heart patients find it works best when they take their nitro preventively (for example, take it 10-15 minutes BEFORE you go for your walk, rather than waiting until chest pain hits during your walk). If you haven’t read this post with pioneer cardiologist Dr. Bernard Lown’s advice on how to take nitro, please do so!

      My understanding is that it’s not the number of nitro doses over a full day or night that matter as much as how many doses you need during a single angina attack e.g. take one dose (pill or spray), wait five minutes; take a second dose if pain persists, wait five more minutes. If these two doses do not get rid of the pain, you can take a third dose after another five minute, but you’d better be calling 911 at the same time.

      When I’m having a ‘bad day’, I may have to take several doses, but spaced very far apart – i.e. hours, not minutes. If the nitro works in 1-2 doses five minutes apart, I know I can relax. Sometimes angina starts up again, but if that episode also responds to 1-2 doses, I continue to relax. IT’s often only at bedtime where I look back and say wow, I had a lot of nitro today. Some patients with chronic severe angina have a nitro ‘patch’ prescribed that releases a steady dose of nitro all day long.

      Every patient is different – please chat with your cardiologist about this! Best of luck to you…

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      1. Thank you Carolyn. Took 1 tablet on the way to work and 1 about 5:30 after work. Felt good all day. Regimen seems good. Took plavix, magnesium tablet and furosemide in the morning and then the nitro. Then another nitro when I got home. Then at 8:30 my BP was 151/77, so I took 50mg of losartan and a furosemide tablet.

        I think I’ll stick to this regularly. No side effects. Feel almost normal. I have no trouble relaxing.

        Thank you again. The nitro info has really helped. The BIG helper was when the cardiologist told me to take Lasix. That took away the shortness of breath in one day. What a tremendous relief this has been.

        Thank you again.

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  6. During your trips to ER, were the usual EKG, ECHO, X-rays, blood work done? I am having chest pain that comes and goes with racing heart rate… rest normally subsides it. Because all my tests have been fine, my cardiologist appt is not until April 19…..Were your tests normal as well?

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    1. Yes, my tests (EKG, cardiac enzyme blood tests, treadmill stress test) were all “normal” (not surprising for many women, especially those who are sent home from the ER within 5 hours of the onset of symptoms. My advice to you while you’re waiting for your appointment next month is this: if your symptoms worsen, do not hesitate to seek medical help (which is what I didn’t do for two whole weeks).

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      1. Carolyn, I was kept overnight and monitored (telemetry)….I was told I was in sinus rhythm the entire time. I actually felt fine about an hour after I arrived and the rest of the night and the next day. I was doing nothing but laying in bed at the hospital.

        I have issues every day. Racing heart..sometimes pounding…and sometimes my chest feels like it does after a long hard cry…an ache or tiredness but sometimes it is full fledge pain that I can feel through my back… it’s all a mystery and I feel like ER, hospital or my primary(which I went to yesterday) act like they truly don’t “get” what I’m saying. I am told to be encouraged by my test results…

        Also, it seems any activity… cooking, walking around in house, doing laundry sends my heart racing…Sometimes I can slow it with breathing technique before it goes “pain-ward) but not often.

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  7. I’m 36 now and have had heart trouble for years after losing at least 70% of my liver at 18. Nobody ever checked my heart. Well, I had a heart attack, but I didn’t go to the ER. I went to a physician who took me seriously after I told him it felt like my heart “fisted up” and I nearly passed out. He said go to the ER next time.

    I continued to have symptoms and went to the ER. A nurse came in the room and said, “Stop whatever you’re doing that’s elevating your heart rate like that.” It was very insulting and I was released.

    I’ve had a lot of heart and health trouble since then. I believe I had another less severe heart attack and many doctors did not take me seriously.

    Well today, I know I had a heart attack. I complained to my boss a few days ago that I feel they are working me to death. Today was not an exception, and it happened fast. Unlike before, I had pain in my chest into my stomach. Both my arms hurt, especially the left. My jaw was tight, my whole chest, neck, shoulders were tight. I had pain in my back and left shoulder blade. I felt very sick and weak and it was a miracle of God that I had a new trainee come over and start making my drinks for the sake of training. Because I couldn’t do it. But my shift was just about over and then I went home. Why? Because I don’t have insurance. Hours later my painful symptoms have mostly subsided. I’m still having pain in my left arm. I still have a slight headache. Some tightness, but it’s not as debilitating as earlier. I debated going to the ER but after so many years of my symptoms being dismissed, including the swelling in my stomach and legs, and no insurance, it doesn’t seem worth the risk of going.

    Go, just to be sent home with an anxiety diagnosis and pay a million dollars for that? I’ll just go the doctor Monday.

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    1. Hello Amber – I’m sorry you’re experiencing these distressing symptoms. I’m not a physician, so of course can’t comment specifically on your case (except to say that it’s criminal, in my opinion, that patients in your country refuse to go to the ER because of no insurance).

      I’m glad you’re seeing your doctor on Monday. Right now, you simply don’t know if your symptoms are heart-related or not (it’s entirely possible that they aren’t – even though you seem quite sure that they are – about 85% of all patients already admitted to hospital for chest pain, for example, turn out not to be heart-related after all). But SOMETHING is causing these symptoms and you need to find out what. Good luck to you…

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      1. I had all the typical heart attack symptoms on and off for several months and went to the ER 4 times, I think. I was always diagnosed with either heartburn or bronchitis, and sent home. I eventually went to an gastroenterologist who did both a colonoscopy and endoscopy and I was diagnosed as having a stomach bacterial infection. I was given two antibiotics for it.

        After they began working, I stopped having all the symptoms that I had been having. That was over a year and a half ago. I haven’t had any symptoms since.

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        1. Hello Shannan – thanks for the reminder that symptoms can often mimic heart attack even when they’re not heart-related at all. I’m glad you were finally appropriately diagnosed.

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  8. I’m a 25 year old woman. I am overweight and I’ve been having pain in my chest, it goes from one spot on the left to right where my heart is. Then after yesterday I’ve been having pain in both arms but mostly my left. My throat started hurting tonight for a bit felt like it was closing on me, now just hurts. The pain has also started hurting in my back just under my left shoulder blade.

    Could this be a heart attack or am I just freaking myself out??

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  9. I am finding this information to be encouraging. Please help me! I have congestive heart failure. My bloods, weight, blood pressure and cholesterol are normal. I take lisinopil, Carvedilol and furosemide. My lungs are filling with fluid, and I can have a gain of four or five pounds. I watch my sodium and weigh daily. I eat no more than 1600 calories. Most of what I am consuming is plant-based.

    My doctor wants to increase the diuretic. I am not willing to do this. My chest is heavy and the flesh between my lungs is tender. I experience extreme fatigue.
    What should I do?

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    1. Hello Lynn – I’m sorry you are experiencing all of this. I’m not a physician so can’t tell you what to do. It seems that you’re doing everything you possibly can to help your condition – except increasing your diuretic. Please make an immediate appointment with your physician to review your case. Best of luck to you…

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  10. My heart attack unfolded over a period of weeks. I was diagnosed with anxiety at the Drs office. I couldn’t walk more than a few steps without terrible pain. Back to the Dr. My ECG was fine, they said. A few days later, went to E.R. I was having a long, slow heart attack. Had bypass surgery two days later. I’m surprised I’m still alive.

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  11. January 19, went to ER, after spending 6 hours on EKG blood chemistry, and searching for enzymes, checked out. Having been told it was probably heartburn I’m slightly encouraged.
    Pain seems to come and go. Very confusing.

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    1. Hello Ray – it IS confusing! So much of medicine is simply trying to rule out what the problem is NOT. If symptoms come and go, I usually recommend keeping a Symptom Journal – just jot down the date, time of day, what you were doing/feeling in the few hours leading up to symptoms. This may reveal a pattern that will be helpful for your physician to figure out the culprit.

      If your heartburn diagnosis is correct, your future symptoms should respond to heartburn meds. If they don’t, seek medical help again. Hope you’re doing well…

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      1. Hello Carolyn, I am Widow Maker survivor, 2 years plus now. I have not commented on your site for awhile now, but here goes.

        The information you put out is a great help to many, including myself. I have not followed all of your postings for awhile so if you have covered this, forgive me.

        Carolyn, you are correct. If a person is going along in their normal routine and something starts not to feel right, they need to make note of it. Somethings up. It is your body trying to tell you something, that it needs help. I agree there are many onsets to a heart attack, some real — some not real.

        What people need to remember is most of the time it’s not your heart. Many times it’s Cardio Vascular Disease. Your arteries clogging up, restricting the blood flow to the heart. The “heart attack” is the result of the heart hurting and dying from lack of life giving blood to it. I truly believe that there is not enough education on Cardio Vascular Disease, there are so many variables.

        It sometimes is all in your genes, weather you are predisposed to CVD, your arteries clogging up. No matter your heath or lifestyle you need to listen to your body. Don’t dismiss that chest pain as gastritis, as I did. Don’t put off that arm pain that came out of no where, as I did. Call your Doctor ASAP. Make an appointment. Time is muscle. Your playing with your life. Listen

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        1. Thanks for your comment, Bryon. Good advice at the end for anybody experiencing unusual symptoms that do not feel “normal” for them.

          Just to clarify, cardiovascular disease is a very broad umbrella term that includes not only narrowed or blocked coronary arteries that can lead to a heart attack, but also other heart conditions that affect the heart’s muscle, valves or rhythm.

          So if it’s called cardiovascular disease, it IS about the heart.

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  12. Thank you again for this blog… you are shining a light to help others. I had 4 stents inserted 5 months ago and it’s been a challenge since then (but improving). I’ve highlighted your blog in these posts, here and here.

    Please keep up this good work.

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  13. Hi my name is Janet and I’m 17 years old. Yesterday morning my chest was feeling a little sore but it went away so I didn’t think much of it. In the afternoon though as I was sitting in class and suddenly got this extreme pain in the middle of my chest. It was the worst pain I’ve ever felt and started to feel dizzy and lightheaded but it suddenly stopped. A couple hours later I felt my heart beating really fast and had the same experience but it wasn’t as painful and once again went away in a flash. My heart still feels like it’s beating fast occasionally but I haven’t gotten any pain yet. Should I go to the ER ? Thank you !!!

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    1. Hi Janet – I’m not a physician so cannot comment on your specific case except to say that it would be very unusual for a person your age to be having a heart attack. But something is causing these puzzling symptoms – call your family doctor today for an appointment. You might be relieved to know that 85% of chest pain admissions to hospital end up being NOT heart-related. Here are some other potential reasons. Good luck to you…

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  14. I have been to the ER twice in the last two years with a chest pain on my right side. Both times two different Drs, same hospital. Have sent me home with Gastritis… I am definitely going to follow through with my Dr.

    Ps It took what seemed like forever to get pain medication.

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    1. Hello Edith – Something is causing your symptoms, but right now you do not know if they’re heart-related or not. If they are in fact due to gastritis, what treatments did the physicians recommend (e.g. antibiotics, histamine blockers, antacids, etc?) Chest pain can also be caused by non-cardiac conditions – more info on that here. Best of luck to you in solving the mystery…

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  15. Hello. It’s nice to see this particular website. My sister suffered a heart attack 2 days ago and she is 60 years of age. The doctor at first said it would take two to six months to recover and that she should stay very calm. Now a day later he says you can go back to work in 2 to 3 weeks. She is too weak to find a new doctor right now and we are trying to help but I’m not quite sure how..

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    1. Hello Cathy – sorry for the delay in responding (somehow your comment got buried on a busy day!) It may be premature to decide that your sister needs to find a new doctor. In a way, everything that her doctor said is correct, even though his advice may seem to make no sense. For example, when your sister can return to work depends on many factors (how severe her heart attack was, how much heart muscle was damaged, what kind of cardiac procedures she had, how much support she has at home and at work, the kind of job she’s returning to, etc). More on returning to work after a heart attack here.

      Many heart attack survivors who are perfectly able to return to work with no problems also say that it does take time to finally feel like they’ve completely recovered after a cardiac event; even when they return to work (or hobbies, sports, social activities, etc), it takes a while to get back to ‘normal’. There are often significant emotional and psychological issues following such a life-altering diagnosis.

      Your sister’s doctor was also correct in advising your sister to try to remain calm (that’s good advice for all of us, heart attack or not!) It does not mean she needs to lie on the couch scared to move a muscle all day. Just the opposite, in fact! She needs to get up and moving as much as possible! If she has not been referred to a supervised cardiac rehabilitation program, she needs to ask her doctor for a referral. Cardiac rehab has been proven to improve a heart patient’s quality of life, improve longterm outcomes, and reduce the risk of having a second heart attack.

      I’m guessing that your sister has a follow-up appointment booked with her doctor very soon; before she goes, she should make some written notes about any questions she has. She should never leave a doctor’s office from now on without understanding every word that the doctor says. Sometimes, patients prefer to sit quietly and nod as if we understand even when we don’t, so that we won’t take up too much time, or come across as not paying attention. But it’s the doctor’s job to explain what’s happening in clear, understandable language before the patient leaves the room. A freshly-diagnosed heart patient is often overwhelmed and afraid. That’s a very common way to feel.

      What can you do to help? Look for a book called “Thriving With Heart Disease” by Dr. Wayne Sotile to give to your sister. That book was a lifesaver for me in the early weeks/months after my own heart attack. My own book (“A Woman’s Guide to Living With Heart Disease” won’t be in the bookshops until November, but you can pre-order it now).

      (By the way, you may not have been told yet that your sister’s heart attack under the age of 65 means that you and your siblings – and any children your sister may have – are now considered to have a family history of heart disease). Best of luck to your sister and your whole family! She is lucky to have you as such a good sister…

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  16. I’m 42 and relatively healthy at least according to my last CBC and to my knowledge never had heart issues. However, I have been under an autoimmune umbrella for 15 yrs. I was adopted so I have no family history. 2 days ago I had significant pain in the middle of my chest and shortness of breath that lasted about 20 min. It dropped me to my knees and scared me as well as my 8 yr old who I muttered to call 911 if something happened but because I’ve never had heart issues, wouldn’t allow him to call to avoid an embarrassing ambulance ride to be told it was indigestion etc… I hadn’t recently eaten anything. After about 20 min the pain disappeared as quickly as it came and was able to restore my breathing although with the help of my inhaler. I didn’t have arm pain or tingling during the episode but woke up with a tight heaviness in the left side of my neck and arm. Post incident, I have searched the internet to research what I experienced.

    Although heart issue still seemed far fetched I also don’t think it was indigestion or reflux, I hadn’t recently eaten anything but yogurt about 2 hrs before. I decided to make an appointment with my doctor but can’t get in for another few weeks. I guess I’m just not sure what to think or what to do. Other than feeling very tired and having some wheezing and coughing I seem to be functioning fine. Pain in my chest nor heaviness or tightness in my arm have continued.

    In all the experience, research, and stories you’ve heard…does this sound familiar?

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    1. Hello Kasey – I’m not a physician so cannot comment on the specifics of your case, but I can tell you generally that something is causing these symptoms and you need to find out what. Good call to make an appointment with your own physician to get some help solving the mystery! Meanwhile, try keeping a symptom journal (details of symptom, date, time of day, what you were doing in the hours leading up to symptoms, how long did it last, what relieved it, etc) which might start to indicate a pattern that could be useful for your doc. Right now, you have no idea if any of your recent symptoms are heart-related or not (and the odds are in fact that they are NON-cardiac, but you don’t know that for sure). If your symptoms “drop you to your knees” again, call 911. Again, I’m not a physician; your doctor can help narrow this down to what the problem is NOT (so many medical issues are about the process of elimination). Best of luck to you…

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    2. Hello Kasey, It may be wise to have someone drive you to the ER if you can’t get in soon enough to see your Doctor. It may be nothing or it may be something. This is how it “SNEAKS” up on you.

      I remember the stabbing pain in the center of my chest, shortness of breath, forearm pain in both arms and being on my knees waiting for it to pass. I even used my wife’s inhaler to help me breathe. The symptoms came and went lasting 20 minute to half an hour. This went on for 2 weeks. I thought it was gastritis.

      Go to the ER, tell them you are having chest pains (lie if you have to!!!) Let them run some tests. Let the ER Doc admit you so they can do a work up. It may not be your heart but it may be one of your arteries clogging up. My LAD was clogging up in a big way. Go get checked out, DON’T WAIT. I did (2 weeks) and almost died of a major heart attack.

      God Bless,
      Bryon Haslam

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      1. Hi Bryon,
        Thanks for your comment. It would be a big mistake, however, to advise Kasey or anybody else to “LIE if you have to” about having chest pain. I’ve heard of people who say this just to be seen quicker in the ER. Those who do this, however, clog up limited ER resources (even at the expense of those who are actually having a heart attack behind them in line.

        It’s important to remember that 85% of all admissions to hospital for chest pain turn out not to be non-cardiac. If we start advising people to lie about chest pain in the ER, those numbers will explode.

        The ER is not a walk-in clinic, and any genuine symptoms that feel like heart attack should warrant an immediate call to 911.

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  17. Hi Carolyn,

    Can I just ask how is it you don’t have heart failure after having heart attack lasting two weeks? They say time is muscle, surely the amount of damaged muscle after all that time had to have been quite substantial?

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    1. Hello Rob – that’s what I asked myself as well. I used to think heart attacks were essentially like sudden cardiac arrest – BOOM! You get it and you are down on the ground, a single event. Dr. O’Donnell described slow-onset MI in her research, however, as: “a more authentic version of real MI events than what is currently used” – and especially for women. There’s no way to know for sure, of course, but my cardiologist now believes that my prior 19 years as a distance runner likely enhanced my collateral arteries, which may have helped them continue supplying some blood flow despite debilitating symptoms.

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      1. Hello Carolyn, I agree. Great article. I waited. Bad move. Thought it was Gastritis. Two weeks between onset of symptoms that came and went, ER visit, Cardio Doc visit, phone calls.

        The morning of the real heart attack, the pain and shortness of breath returned. I could deal with it. It hurt and I couldn’t breath properly but thought it would pass as always. I waited 4 hours before letting my son call an ambulance.

        Your article is spot on. It’s what happened to me.They got me to the hospital and saved my life. I am a Widow-maker survivor. (100% LAD blockage) The symptoms (not always the classic ones) leading up to the event is your body telling you it needs help. It’s your heart saying “Hey I’m starving for blood!” It’s not gas or heartburn!! It’s your arteries clogging up.

        Don’t wait. Don’t be embarrassed to call for help. Time is heart muscle that dies. Listen to your body. Stay well.

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        1. Oh my! Byron, that’s a cautionary tale for all of us who try to deny or dismiss distressing symptoms – despite the evidence! Thank goodness your son persisted in finally convincing you that you needed emergency help. Keep telling your story – every person you tell will remember it and your experience just might save other lives, too!

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          1. Can slow onset continue time and again, monthly 1 or 2 times for years and never be bad enough to go to the ER, especially when you’re about 70 years old? May go for hours and then take a nitrostat and finally gets rest and seems ok until the next time. Never goes to doctor to confirm heart issues..

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  18. Hi. I am 25 years old. I’m 5’6 , I am 275. I had slight chest pains. I have been to the ER 4 times already. I had an ekg, mri, and xray. they said all tests were fine. they said i had bronchitis because my bronchial tubes were swollen. i dont believe them. the medicine just isnt working. what should i do? should i go back again

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  19. I think you could boost this post – I read about 50 of your posts before hearing about slow onset. Sounds like what I was getting, which I was dismissing as just more slowing down due to my CFS.

    I’ve never heard about this before as a specific thing.

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  20. Who cares if the doctor likes to be questioned or not? They are human and make mistakes like the rest of us. At the end of their shift they can be tired like the rest of us. If you have questions, you should always ask them. That is why they say to get a second opinion on things. My wife had issues with acid reflux. With her they did an EKG because the symptons can mimic each other to some degree.

    But the pain down your left arm should have been the red flag to the ER doctor. He should have been questioned because he was ignoring a red flag sympton.

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    1. Thanks for your comment, Bo. Of course, in hindsight, I agree 100% with you. I’m not a doctor, but even I know that pain down your left arm is NOT a sign of indigestion… But given that my symptoms had already eased up that morning (not the end of his shift, but within an hour of starting his shift, actually!) – and I was already feeling embarrassed for wasting his very valuable time – and as I wrote, I’d much rather believe it was just acid reflux, not heart attack. I now tell the women in my heart health presentation audiences: “You know your body! You KNOW when something does not feel right!”

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