The symptoms of a heart attack are often typical and easy to recognize. In some patients, however, symptoms can be so varied that both the patient and the doctor can be misled.
A. Type of Pain
People have unique feelings and sensations and use different words to describe similar symptoms. Heart attacks vary a great deal in their severity, and patients are not all alike. Thus, the characteristics of pain and the accompanying symptoms can be very different from one individual to another.
People experiencing a heart attack often have difficulty describing the type of pain or peculiar discomfort or distress. Some words used by various patients to describe the discomfort are in the following list.
• Crushing or compressing pain or a heaviness over the chest: The pain is most often described as ‘‘a crushing pain across my chest,’’ or the patient states that it feels like a very heavy weight or bar is resting on the center of the chest, especially over the breastbone (sternum). Another complaint is ‘‘it feels as if someone is crushing or walking on my chest.’’
• Viselike tightness, squeezing, constricting: It feels as if the chest is in a vise or as if a tight metal band is being lled around the chest. The constricting feeling is often described as a tightness. The patient tries to describe the tightness by clenching a fist. A disagreeable choking, strangling, sickening feeling in the center and across the chest: This type of sensation can occur in patients with anxiety and may not be due to a heart attack. The strangling sensation is, however, very important because it resembles the discomfort in patients with angina pectoris. Patients with angina can develop chest discomfort mainly on exertion due to a lack of blood supply to the heart muscle. If the strangling sensation comes on at rest and lasts for more than 30 minutes, and especially if it is accompanied by the associated symptoms of a heart attack, seek attention.

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