Posted on Oct 31, 2013

Many people assume that if they are having a heart attack they will automatically know it. Most know that a tightening in the chest or shooting pain down the left arm means they are having a heart attack. But are all heart attack symptoms that obvious?

Reuters reports not all signs of a heart attack are easy to detect. Surprisingly sometimes people do not realize when they are having a heart attack and do not immediately go to the hospital. Or even more surprisingly at times when a person does go to the hospital but does not have obvious symptoms they are not treated right away for a heart attack.

“When symptoms come on slowly, heart attack patients are less likely to get to a hospital quickly,” according to Reuters. The lead author of the study told Reuters, “We didn't know that most heart attacks start off with mild and slow symptoms. Nor had we realized that patients who experience a milder or slower onset of symptoms would also exhibit a distinct help-seeking behavioral pattern, i.e. they take much longer to reach the emergency department than those with fast-onset heart attacks because they don't call an ambulance, they call/visit their doctor or they wait to see if their symptoms would go away.”

Researchers were quite surprised by the difference in care that those with mild symptoms received versus those with severe symptoms. Reuters reports, “Those with slow symptoms tended to wait three and a half hours before going to the hospital, compared to two hours for those whose symptoms came on fast.

According to the U.S. National Heart, Lung and Blood Institute, among people who die from heart attacks, about half do so within an hour of having their first symptoms and before they reach the hospital.” People are also being urged to be mindful of the fact that mild symptoms do not indicate that the heart attack is not severe.


In a recent case I handled, a 47-year-old gentleman went to his physical medicine and rehabilitation doctor when he began to experience severe pain in his upper left back and left shoulder. The rehab doctor simply gave him a steroid injection telling him he would feel better soon. That didn't work.

The patient then went to another physical medicine and rehabilitation doctor seeking additional advice since these severe symptoms appeared to be muscular. The second doctor also give the patient a steroid injection thinking this was simply inflammation and irritation. It wasn't.

The following day, when the symptoms got worse the patient went to his primary care doctor with the same complaints. The primary care doctor examined him proclaimed that he was “Fine,” and was ready to send him out of his office.

The patient begged the doctor to do an EKG, also known as an electrocardiogram.

The doctor reluctantly agreed to do it, read it and interpreted the EKG and once again proclaimed the patient was fine and that his heart was perfect. Unbeknownst to the patient, it wasn't.

The following day, the patient actually called an ambulance and requested pain medication since he was in such excruciating pain. The patient told the ambulance attendant that just last night his primary care doctor proclaimed that his heart was perfectly fine and that this was all muscular. The ambulance attendant told the patient he could not give him pain medication and that his only real function was to stabilize him and get him to the closest emergency room.

Since the patient had been told by three separate physicians that he had no cardiac problem, he knew that by going to the hospital via ambulance he would be sitting and waiting for many hours in the emergency room before anyone came to address his complaints.

Rather than wait endlessly in the hospital emergency room, the patient decided to keep his scheduled appointment with another physical medicine doctor later that afternoon.

On arrival to that doctor's office an EKG was taken and the doctor realized immediately the patient was having a severe acute heart attack. He was rushed by ambulance to the closest emergency room for immediate treatment.

While at the hospital, it was revealed that the patient had significant damage to his heart and underwent immediate coronary angiography and insertion of two stents to open up one of the completely blocked coronary vessels that supplied blood to his heart.

When my cardiology expert reviewed this case he was able to determine that the patient was having this massive heart attack on the morning when he called the ambulance. Had his primary care doctor properly read and interpreted the EKG done the night before, which by the way was significantly abnormal, the patient would have been taken to the closest emergency room, had a cardiac catheterization and had stents put in which would have opened this clogged coronary artery.

Had this been done that evening, this patient never would have suffered a massive heart attack, causing him lifelong permanent injury.

The symptoms the patient was complaining of were somewhat unusual for a heart attack, but nevertheless warranted further investigation by qualified physicians. In this case the patient's primary care doctor failed to properly interpret and evaluate the EKG that he had performed when the patient came to him with severe pain in his shoulder. 


Read More About Warning: Heart Attack Signs can be Difficult to Detect...

Gerry Oginski
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NY Medical Malpractice & Personal Injury Trial Lawyer