Speed makes a difference. Heart-attack victims who don't experience chest pain typically put off going to the hospital--by an average of two hours, the JAMA study found. When these patients finally show up at the emergency room, it often takes doctors longer to make the right diagnosis. All the while, their heart isn't getting potentially life-saving treatment with clot-busting drugs, beta-blockers or emergency angioplasty. These delays, says Dr. John Canto, the study's lead author and a cardiologist at the University of Alabama at Birmingham, help explain why a heart-attack patient who doesn't experience chest pains is twice as likely to die at the hospital as someone who does. "Time is [heart] muscle," he notes. "And muscle is life."
By studying a computerized database of more than 430,000 people who suffered heart attacks across the U.S., Canto and his colleagues determined that there are six major risk factors that increase the chances that any heart attack you suffer will be atypical: having a weak heart (from congestive heart disease), diabetes or a history of stroke; being 65 or older, female or from a minority group. The increased risk is cumulative: if a 75-year-old black woman has a heart attack, her chances of experiencing chest pain are less than 50%.
Apparently diabetics feel less pain because of nerve damage caused by their condition, but no one knows why women or the elderly are more likely to suffer painless heart attacks.
So what, besides chest pain, should you watch for? Probably the next biggest tip-off is extreme shortness of breath. Indeed, many cardiologists consider difficulty breathing to be as good an indicator of a possible heart attack as chest pain. Other less specific signs include nausea, profuse sweating and fainting. Some heart-attack victims describe a sudden, overwhelming sense of doom or feel pain under their scapula--the "wing" bones in the back.
Be particularly suspicious of any "heartburn" that gets worse if you walk around or otherwise exert yourself physically. "One of my [heart attack] patients ordered out for miso soup to treat her 'indigestion,'" says Dr. Marianne Legato, director of the Partnership for Women's Health at Columbia in New York City and author of The Female Heart. "Fortunately, her daughter stopped by, noticed her ashen color and slurred speech and got her to the hospital."
Don't try to drive yourself to the hospital. Call an ambulance. Then, if you think of it, chew on an aspirin; 325 mg is the recommended dose, and chewing gets the drug into the bloodstream faster. A single tablet can stave off some of the damage. Above all, don't tell yourself, "I can't be having a heart attack, I'm not feeling any chest pains." Let a doctor make the final call. For more information on heart attacks, visit . E-mail Christine at email@example.com