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Atypical vs. Typical: Recognizing the Signs of a Heart Attack

Chest pains … They’re complicated.

Many of us have experienced that moment: a twinge or uncomfortable strain in our chests after lifting weights or an erratic pulse and labored breathing during a panic attack. Maybe we just feel off—that something isn’t right. Moments like these may make us wonder if we’re having a heart attack or if these symptoms are normal.

While many people who experience cardiac chest pain are usually experiencing ischemic chest pain or angina, there are a number of people who experience atypical symptoms that can be concerning and worrisome.

“A surprisingly high percentage of chest pains, cardiac in origin, don’t present as a sharp, knife-like stabbing pain—but it certainly gets our attention,” said Joel Cooper, DO, a family medicine physician at Banner Urgent Care. “But chest pains always get the attention of patients having them, and they most certainly get the attention of doctors and other medical professionals evaluating them.”

What’s the difference between atypical and typical chest pains?

“Atypical chest pain is any chest pain that doesn’t meet criteria for a common or obvious diagnosis,” Dr. Cooper said. “It’s an oddball or grab bag diagnostic category—not very precise or helpful, actually.”

Typical chest pain is the chest pain expected with a certain diagnosis, such as a crushing substernal chest pain doctors expect to see with a heart attack.

“A more useful way to think about it is this: Is the chest pain dangerous to the patient? Is it a cause for concern? Can its cause be ascertained with further testing or diagnostic studies? Is there anything that can be done to help the patient?” Dr. Cooper said.

What are atypical symptoms?

Typical symptoms of a heart attack include chest pain or pressure, heart palpitations, cold sweats and shortness of breath. For others—most commonly among women, the elderly and diabetics—their symptoms may be more subtle or don’t involve the chest at all.

“Rather than having crushing substernal chest pains or a feeling of ‘an elephant sitting on my chest’ seen in men, women may present differently,” Dr. Cooper said.

Atypical symptoms of a heart attack may include fatigue, shortness of breath, discomfort in the throat, jaw, neck, arms, back and stomach—a feeling described almost like a muscle pull or pain. The problem may also present like indigestion or heartburn and can even mimic other gastrointestinal issues.

What are the causes for atypical chest pains?

Common causes for atypical chest pain include gastrointestinal, respiratory and musculoskeletal diseases. It is also not uncommon for people with anxiety or panic attacks to think they’re having a heart attack.

“Diseases of the heart, aorta, lungs, esophagus, stomach, abdominal viscera and muscuskeletal system may all cause chest discomfort and pain,” Dr. Cooper said. “One of the most common musculoskeletal causes for atypical chest pain we see in adults is costochondritis.”

Costochondritis is an inflammation of the cartilage that connects your ribs to the breastbone. It causes tenderness or pain and can get worse with deep breaths or coughing.

That said, even if there is a less severe cause for atypical chest pains, in general, chest pain is a big deal in medicine—something you should never brush off or take lightly. Why? Because when it comes to a heart attack, time is tissue.

“The longer it takes to diagnose and treat an acute coronary syndrome or heart attack, the more permanent damage is done to the heart and the less likely the patient is to have a favorable outcome or even survive,” Dr. Cooper said. “Even if you have been in the ER 10 times before for a suspected heart attack, with nothing found except anxiety, it’s a heart attack until proven otherwise.”

When should you seek medical attention?

If you’re older, if you’ve had a heart attack in the past, a family history of heart disease and if your chest pain is accompanied by other concerning symptoms, such as shortness of breath and dizziness, call 911 or get to the ER right away. If you’re young and healthy, with no history of heart disease, you should also check in with your healthcare provider.

“Bottom line: If you think you’re having a heart attack, you may very well be,” Dr. Cooper warned. “Because a heart attack can be deadly, you don’t want to roll the dice on this one. If it turns out your chest pains are due to something less serious—great! You will be reassured you aren’t having a heart attack. But at least you took the appropriate steps to find out.”

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