Sudden chest pain or discomfort is a classic red flag for heart attack, but sometimes the symptoms start out mild and develop gradually. How do slower symptoms affect treatment and survival?

To find out, researchers recently looked at the time that elapsed between the first symptoms that occurred in 474 heart attack patients (average age 62) and their arrival at emergency departments (EDs) at various locations across the US.

The study, which was published in European Journal of Cardiovascular Nursing, found that people who experienced gradual symptoms, which tend to start with mild discomfort that slowly worsens, took eight hours, on average, to get to an ED versus 2.6 hours for those with abrupt symptoms that were characterized by sudden and severe pain from the beginning.

“Both are a medical emergency and require urgent help,” explained Sahereh Mirzaei, PhD, RN, study author and a clinical practitioner in the open-heart intensive care unit at the University of Illinois at Chicago. “But our study shows that gradual symptoms are not taken seriously.”

Other study findings…

  • Slow-to-develop symptoms are common. Even though 56% of the study participants experienced abrupt symptoms, including sudden chest pain, 44% suffered gradual symptoms, such as mild and slowly progressive chest discomfort or pain.
  • Abrupt symptoms are linked to physical activity. Sudden heart attack symptoms were more likely to occur after some type of exertion such as shoveling snow, climbing stairs, heavy gardening or jogging. This can signal a serious type of heart attack that requires prompt restoration of blood flow to blocked arteries.
  • Driving to the ED is a mistake. A major cause of delay for all patients was driving to the ED instead of calling for an ambulance. Only 45% of the study participants called for emergency medical services. Differences in delay time between men and women were not significant.
  • The uninsured are at greater risk. Being uninsured was linked with a longer delay.

Key takeaways…

Don’t delay. When medical care for heart attack symptoms is not sought promptly, there can be dire consequences. For example, the American Heart Association has set a goal of two hours for getting a patient with heart attack symptoms to the ED. Research has shown that every 30-minute delay reduces life expectancy by one year. After six hours, standard treatment with angioplasty, in which a catheter is inserted and the blocked artery is opened by inflating a tiny balloon, does little to reduce the rate of heart attack deaths.

Call 911. Driving to the hospital was linked to slower arrival times at the ED. Despite repeated warnings that driving is not safe and delays treatment, studies consistently show that most people with heart attacks arrive at the ED by car. Calling 911 has several advantages, according to the National Heart, Lung, and Blood Institute. For one, it allows the 911 operator to give you advice (such as taking an aspirin if you’re not allergic). Once emergency medical services (EMS) personnel arrive, they can assess your condition and start lifesaving medicines and other treatments right away. In addition, people who arrive by ambulance often receive faster treatment at the hospital.

Heart attack symptoms—either sudden or slow—are a medical emergency. They include…