Is there a link between how mild or severe chest pain is, and how mild or massive a heart attack is?

Heart attacks often come with chest pain, but some come without or with just a little bit of discomfort.

It should not be surprising that for many people who’ve suffered a significant or massive heart attack, the chest pain was either mild or non-existent.

“Your body is often not good at identifying heart pain because it has not had any practice,” says  Christopher J. Hanifin, PA-C, who was previously a physician assistant in open heart surgery with Cardiothoracic Surgery of South Bend in South Bend, IN.

Hanifin explains, “Think about your thumb. You have spent your whole life touching it, twisting it, burning it, hitting it with a hammer, slamming it in the door, and getting splinters stuck in it.

“When something is wrong with your thumb, your body knows just what is going on.

“Contrast this with your heart. At least during your first episode, your nervous system has no experience identifying heart pain.

“When you start to have a heart attack, your body can have a hard time figuring out what is going on. The pain can radiate to either arm, your neck, your jaw and even your teeth.”

Study Shows No Connection Between Absence of Chest Pain and Severity of Heart Attack

A paper published in a Sept. 2013 JAMA Internal Medicine details a study of over a thousand women 55+ who had heart attacks – but reported no chest pain.

Dr. Louise Pilote, senior study author, urges people to get away from the perception that heart attacks usually mean an “older man clutching his chest.”

There are other symptoms to be acutely on the lookout for, such as shortness of breath, weakness and rapid pulse.

The so-called Hollywood Heart Attack creates the illusion that this event necessarily comes with enough pain to make someone clutch or grab their chest.

In the study, 20% of women suffering a heart attack did not experience chest pain. And, absence of chest pain was not associated with less severe heart attacks.

Don’t ever think, “Well, if I’m having a heart attack, it’s only mild because I don’t have any chest pain with this shortness of breath.”

The absence of chest pain may mean fewer symptoms altogether, but this does not mean that the disease state itself is less severe.

An exact diagnosis cannot be made based on presence or absence of symptoms.

“Another important factor to consider is that some patients who are at increased for heart attack generally have decreased pain sensation,” says Hanifin.

“Diabetes is a big risk factor for coronary artery disease.

“It’s pretty well-known that diabetics need to check their feet regularly and carefully because they can develop sores and injuries and not have the associated pain. The same thing can happen with heart pain.”

Christopher J. Hanifin, PA-C, is currently Department Chair and Assistant Professor, Department of Physician Assistant, Seton Hall University, NJ.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  


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