Most people imagine a heart attack as a dramatic clutch-the-chest collapse. But a new study shows the common mental image of heart attack symptoms rarely reflects reality, and that misunderstanding could cost precious minutes when it matters most.
More than a few movies and popular television medical dramas have featured a character having a heart attack. Inevitably, the person experiences sudden and intense pain, firmly clutches their left chest, and then collapses.
The problem with the “Hollywood heart attack” commonly depicted on big and small screens is that it’s misleading and doesn’t necessarily reflect real life. Yet, many people think it does. It’s something that a recent study by Illinois State University (ISU) and the University of Texas at Arlington (UTA) has demonstrated.
“We did ourselves a disservice in the 1980s and 1990s with what’s known as ‘The Hollywood Heart Attack,’” said Dr Ann Eckhardt, a nursing professor and researcher at UTA and the study’s corresponding author. “That’s unfortunately not real life. It’s not always intense. Sometimes it’s just discomfort that doesn’t feel quite right, so people tend to wait to see a doctor. The longer you wait, the more likely you are to have negative consequences after your heart attack.”
The researchers sought to understand how the general public imagines or conceptualizes chest pain related to heart attacks, not actual symptom experiences. It focused on four aspects of the imagined chest pain: its quality, intensity, the distress it causes, and timing. The researchers also investigated whether there were gender differences in these conceptions.
They conducted an online survey of 597 US adults aged 35 and over, recruited from Amazon Mechanical Turk, a crowdsourcing platform, and ResearchMatch, a national not-for-profit research recruitment agency. Anyone with professional healthcare training was excluded. Participants completed the Chest Pain Conception Questionnaire (CPCQ), a validated instrument that measures beliefs about chest pain through descriptive scenarios and multiple-choice questions. The researchers also collected demographic information, information about exposure to heart attack education, and beliefs about chest pain descriptors (e.g., “pressure” vs. “indigestion”), intensity, and location.
Most participants reported having seen TV commercials or advertisements (74%) or news stories (71.4%) about heart attack symptoms. Fewer reported having a parent, sibling, or close friend who’d experienced a heart attack (48.1%), seen a social media post about heart attack symptoms (35%), or been taught about them by a healthcare professional (26.5%). About 10% had previously experienced a heart attack, which may have influenced their responses.
Most participants associated it with intense, distressing sensations, described as pressure, tightness, and squeezing. Fewer participants associated it with sensations like indigestion, burning, or dullness, even though these are common heart attack symptoms, especially in women. Participants most often believed that heart-attack-related chest pain would be in the left chest, center chest, and left arm. Women were slightly more likely than men to choose less common descriptors like fullness and indigestion, and believe that pain could present in the jaw, neck, or upper back – areas that women more frequently report pain during actual heart attacks. However, overall gender differences were minimal.
“We used to say that men have typical symptoms and women have atypical symptoms,” Eckhardt said. “We’re trying very hard to move away from that language now. The most common symptom for men and women is chest-related. We created confusion by saying that women are somehow completely different.”
Participants expected heart attack chest pain to be sudden and very intense, and thought it would severely affect their ability to perform daily activities. Most believed chest pain related to a heart attack would last 15 minutes or less. Pain occurring during activity was more likely to be seen as serious than pain at rest.
“We often tell people chest pain is a symptom of a heart attack, but what we don’t tell them is what they might actually feel,” said Eckhardt. “For a lot of people, it’s not pain in the traditional sense. It’s more discomfort, pressure, tightness. They just don’t feel quite right, but they can’t really put their finger on it.”
The study has some limitations. Principally, the use of self-reporting can introduce recall and social desirability biases, and although the sample included geographic, gender, racial, and ethnical diversity, it was not fully representative of the broader US population. Participants were also relatively well-educated and had a mean age of 54, limiting generalizability of the study’s findings to younger or less-educated groups. Also, restricting the study to participants without healthcare training may mean that the findings do not apply to medically informed individuals.
Despite its limitations, the study highlights the mismatch between the expected symptoms of a heart attack and reality, which can lead to delays in seeking care, especially if symptoms don’t align with expectations.
“The longer you wait, the more likely it is you’ll have irreversible damage to the heart,” Eckhardt said. “So, if we can determine what people think a heart attack will be like, perhaps we can help the medical community better triage and ask questions. It’s not just ‘Are you having chest pain?’; it’s also ‘Do you have any discomfort, pressure, tightness, squeezing?’”
The study was published in the journal Heart & Lung.
Source: UTA