Dr Paul Watson, Interventional Cardiologist, Ramsay Health:
Well that’s a very good question and unfortunately, to make my job difficult and to make it dangerous for some patients, people really do vary quite significantly in how they present or feel a heart attack. Now the classic crushing chest pain that you see on TV and that most people expect doesn’t really happen in everybody, and in fact in my experience I would only see that in about 60-70% of patients. So for other patients it can be subtle and it can be slightly unusual. Sometimes patients just don’t have many nerve fibres in their heart and they don’t feel it as a severe pain,it can be a tightness or a vague heaviness. Some patients don’t get any pain at all, but they might experience acute breathlessness or clamminess or excessive sweating.
The other trick with the pain is where people feel it. So again, not everybody feels it in the centre of their chest. For a lot of people they experience what we call referred pain, referred pain is just the brain mixing up where the signal is coming from. Because the nerve fibres for the throat and the arm and the back all enter the spinal cord at the same level as the heart nerve fibres do, the brain misreads the signal, so other symptoms can include heavy aching in the left arm or the right arm or both arms, some people experience it in the jaw, some people experience it though to the back. If that is occurring and it’s occurring in the same setting as acute breathlessness and clamminess, then that would certainly heighten somebody’s concern that they are experiencing a heart attack.