Atypical symptoms of a heart attack
Atypical symptoms can massively impede the diagnosis of an existing heart attack. They usually occur in addition to the leading symptoms, but can also completely determine the clinical picture, making it difficult for the treating physicians to correctly assess the situation. Atypical symptoms usually refer to other parts of the body that are not directly associated with the heart.
Examples are complaints in the gastrointestinal tract (nausea, vomiting and diarrhea), increasing shortness of breath or abdominal pain. The symptoms occur in different ways. On the one hand, the infarct can irritate fibers of the vegetative (involuntary, physical) nervous system (sympathetic, parasympathetic), which can trigger the misregulation (such as vomiting and diarrhea) of various organ systems.
On the other hand, the anatomical proximity to other structures and the impairment of heart function also play a role. Upper abdominal pain is caused, for example, by pain projection (transmission, transfer) from the heart. Shortness of breath is one of the rather untypical signs of a heart attack.
While in men it is almost always a combination of angina pectoris and radiating pain, women in particular are more frequently affected by untypical symptoms such as shortness of breath. Furthermore, pain in the gastrointestinal tract is also among these atypical symptoms. To treat the shortness of breath or the feeling of suffocation, patients are administered a morphine drug.
This has a breath-soothing effect and thus suppresses the shortness of breath. Back pain is one of the most common accompanying pains associated with a heart attack. They are usually of a stabbing character, very intense, start suddenly and are localized in the upper half (thoracic spine).
The pain is a so-called transmission. Due to the anatomical proximity of the heart, the pain generated there is projected into other regions by co-exciting the corresponding pain fibers. A very important differential diagnosis (another diagnosis with similar symptoms) is aortic dissection.
Here the wall layers of the aorta detach from each other or, in the worst case, tear apart. This can result in massive, life-threatening bleeding, which is why this should always be considered in the case of sudden onset of severe back pain. The main symptom of a heart attack is sudden, very severe pain.
These are most often located in the chest and/or left arm. The third most common symptom is shoulder pain. This pain is also on the left side of the body and is similar in character to the other localizations.
Other causes of sudden onset of shoulder pain on the left side are damage to the muscle, tendon and bone structures or to nerve fibers, some of which run in thick bundles (e.g. brachial plexus) in anatomical proximity.In addition, however, this usually results in movement restrictions or movement-dependent pain, which would be rather untypical as accompanying symptoms of a heart attack. Heart palpitations are mainly caused by the dwindling pumping capacity and the falling blood pressure. During an infarction, a so-called cardiogenic (emanating from the heart) shock often occurs.
The blood pressure drops extremely and the heart tries to compensate by accelerating the frequency in order to ensure the supply of the body. Besides the shock symptoms, tachycardia also occurs as an early complication of heart attacks. Ventricular tachycardia (tachycardia of the ventricle) is found in 10-30% of cases of heart rhythm disturbance.
These can turn into ventricular fibrillation, which is a life-threatening condition that should be treated with electrical defibrillation. These complications are the reason why infarction patients have to be observed as inpatients for a while before they are discharged into the home environment – treated and medicated (if this is the patient’s wish). In addition to the pain and physical symptoms, a heart attack also represents an enormous psychological burden.
Many patients notice the changes at the moment of the heart attack: the tightness of the chest, stabbing pain, sweating, heart stumbling (palpitations), shortness of breath. All these accompanying symptoms understandably cause massive anxiety in many patients, which can sometimes increase to the point of mortal fear. A panic attack unconsciously intensifies the symptoms, as it is also characterized by similar symptoms. After such an experience, traumatization can occur, which can lead to problems even after recovery and professional medical care. Even the smallest changes in the body then lead to panic attacks, which can be counteracted with psychotherapeutic help.
