Unexplained 'pain' may be red herring in AMI

Ask about 'tightening,' other factors instead

Many people delay seeking help during an acute myocardial infarction because what they are feeling does not correspond to common notions of pain, a researcher concludes. "Medical advice that includes the word 'pain' is the single biggest problem" because it may prevent many from accurately recognizing the onset of heart attack, writes Tom Treasure, a professor of cardiothoracic surgery at St. George's Hospital in London.1 Treasure believes that standard medical guidelines which include phrases such as "a clutching pain" or "chest pain" as a warning sign of heart attack contribute to dangerous, treatment-delaying misconceptions.

When we touch something hot we have enough shared experience to identify and localize the experience and communicate it to others as pain, he explained. However, nature has not equipped us with sufficient consistency of sensation to ascribe correctly distressing sensations originating in the heart or other internal organs.

In talks with AMI survivors, Treasure notes that most avoid the use of the word "pain" when describing their attack. Instead, a range of words is used, including "tightening," "a lump in the throat," "pressure," "indigestion," and "a need to keep swallowing." Some told Treasure that they used the word "pain" because that was what they were asked about. Treasure believes the mass media is a major contributor to the belief that a sudden, sharp pain is a main indicator of heart attack. Television shows typically convey the wrong image of a heart attack, which is of a fat, red-faced man suddenly gasping and clutching at his tie, he writes. In reality, the majority of attacks occur with much less drama.


1. Treasure T. Pain is not the only feature of heart attack (Letter). British Medical Journal 1998;317:602-603.