Here’s a surprising fact: 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.

One explanation for this phenomenon may be a higher-than-average tolerance for pain. Some people mistake their symptoms as indigestion or muscle pain, while others may feel pain, but in parts of their upper body other than the center of the chest, says Kenneth Rosenfield, M.D., who heads the vascular medicine and intervention section at Harvard-affiliated Massachusetts General Hospital.

Different sensations?

“Many people don’t realize that during a heart attack, the classic symptom of chest pain happens only about half of the time,” he says.

People sometimes describe heart attack symptoms as chest discomfort or pressure, while others say they feel an intense, crushing sensation or a deep ache similar to a toothache.

Certain people are less sensitive to pain than others, or they may deny their pain and “tough it out” because they don’t want to appear to be weak. Not everyone has a good sense of their own pain tolerance, however, and a host of other factors (such as your emotional state) can affect pain perception. Of note: People with diabetes may be less sensitive to pain because the disease can deaden nerves (a condition known as diabetic neuropathy), theoretically raising their risk for a silent heart attack.

Where it may hurt

During a heart attack, the location of the pain can also vary quite a bit from person to person, notes Rosenfield. It may occur in the arm, shoulder, neck, jaw or
elsewhere in the upper half of
the body.

“I had one patient who had earlobe pain, and another who felt pain in his wrist,” says Rosenfield.

Other non-classic symptoms people often don’t attribute to a heart attack include nausea, vomiting and weakness.

During his career, Rosenfield has seen many thousands of people who’ve had heart attacks.

“There’s no question that women are more likely to experience nonclassic heart attack symptoms, but it’s important to remember that men can have those symptoms, too,” says Rosenfield.

Heart attack symptoms
Although the most common sign of a heart attack in both men and women is the classic one – discomfort in the center of the chest that spreads through the upper body – this symptom doesn’t always occur. Some people experience nonclassic symptoms, and these may be slightly more frequent in women and in older people.

Classic symptoms

  • Pressure, aching or tightness in the center of the chest
  • Pain or discomfort that radiates to the upper body, especially shoulders or neck and arms
  • Sweating

Nonclassic symptoms

  • Shortness of breath
  • Weakness
  • Nausea or vomiting
  • Dizziness
  • Back or jaw pain
  • Unexplained fatigue