When heart attacks go unrecognized

A high pain tolerance may account for some "silent" heart attacks. But failing to recognize atypical symptoms is a more likely explanation.


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Nearly half of people who have a heart attack don't realize it at the time. These so-called silent heart attacks are only diagnosed after the event, when a recording of the heart's electrical activity (an electrocardiogram, or ECG) or another test reveals evidence of damage to the heart.

What's behind this surprising phenomenon? One explanation may be a higher-than-average tolerance for pain, as a recent study suggests (see "Does a high pain tolerance mask heart attack symptoms?"). Other people mistake their symptoms as indigestion or muscle pain. Still others may feel pain, but in parts of their upper body other than the center of the chest, says Dr. Kenneth Rosenfield, who heads the vascular medicine and intervention section at Harvard-affiliated Massachusetts General Hospital.

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