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By now just about all of us know that a crushing pain the middle of the chest or in the left arm can be a symptom a heart attack is occurring. But many people still haven't heard that chronic fatigue can be a sign a heart attack is on its way.

For several weeks before his fatal heart attack, Jon felt tired all the time. He did not want to get up in the morning. He needed to go home and take a nap at noon. He fell asleep in front of the television set. And he lost interest in his wife, his kids, his friends, and his hobbies.

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On the day of his fatal heart attack, Jon said something about chest pain, but it was too late. Thinking Jon was just depressed, his wife didn't call for an ambulance. She had thought she could finally persuade him to get into mental health counseling.

Fatigue Is a Better Predictor of Heart Attack than Chest Pain

The simple reality is that many men and most women who have heart attacks don't get chest pain. In a study conducted in Korea, 57% of people admitted to hospital for myocardial infarction (heart attack) had the classic pain in the middle of the chest. In 28%, however, there was "pain all over", and 15% had little or no chest pain at all. A study of women who had had heart attacks conducted by researchers at the University of Arkansas found that 4% of women who had heart attacks had no symptoms at all and 36% had chest pain, but 73% reported unusual fatigue in the days and weeks leading to their heart attack.

The evidence is strong that severe fatigue is a better predictor of heart attack than chest pain. The problem is that people who feel fatigued are more likely just to go to bed than they are to call for emergency medical care.

Moreover, if you tell the ambulance driver "I just feel so tired," it's unlikely you will be transported to the hospital with lights and siren. People who have heart attacks with the stereotypical prodrome of chest pain and sweating are nearly 30% more likely to die even if they get treatment--probably because the majority of emergency medical personnel, emergency room physicians, and cardiologists simply do not take fatigue seriously.

Non-Invasive Tests Not Always Inclusive

If you report to a hospital with vague symptoms of a heart attack, you will almost certainly have blood drawn to test for an enzyme called troponin. You are also likely to be tested for another enzyme called CCK. This enzyme measures damage to your heart caused by loss of circulation, and it is used to diagnose a heart attack.

If your symptoms are just fatigue and vague aches and pains, however, especially if you don't have good health insurance, your cardiologist may just order a stress test or an ultrasound of your heart. These tests often detect clogged arteries that are causing a heart attack. In about 6% to 12% of cases, however, these non-invasive cardiovascular testing methods fail to detect arterial damage, and the patient is sent home without ever having the angiogram that could definitively detect disease. Without this now-common but somewhat expensive procedure, death often follows.

Continue reading after recommendations

  • Hwang SY, Ahn YG, Jeong MH. Atypical symptom cluster predicts a higher mortality in patients with first-time acute myocardial infarction. Korean Circ J. 2012 Jan. 42(1):16-22. doi: 10.4070/kcj.2012.42.1.16. Epub 2012 Jan 31.
  • McSweeney JC, O'Sullivan P, Cleves MA, Lefler LL, Cody M, Moser DK, Dunn K, Kovacs M, Crane PB, Ramer L, Messmer PR, Garvin BJ, Zhao W. Racial differences in women's prodromal and acute symptoms of myocardial infarction. Am J Crit Care. 2010 Jan. 19(1):63-73. doi: 10.4037/ajcc2010372.
  • Photo courtesy of paperdollimage on Flickr: www.flickr.com/photos/paperdollimages/5207086485

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