If I have diabetes, what symptoms might indicate a heart attack?

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Research suggests that about 25 percent of heart attacks are “silent,” either with no symptoms or symptoms that are not usually associated with a heart attack. But new research suggests that number may be even higher, especially in people who have diabetes, a major risk factor for heart disease.

Doctors don’t know why some patients get sweaty, with crushing chest pain, while others may feel nothing at all, says Abbe Rosenbaum, MD, a cardiologist at South Miami Heart Center. But they do know that people with diabetes are more likely to be among those who do not have classic symptoms. "Diabetes can alter pain perception,” says Jonathan Roberts, MD, an interventional cardiologist at Baptist Cardiac & Vascular Institute. “Many people with diabetes can step on a rock and not feel it because of peripheral neuropathy. The same can be true of the nerves that warn of a heart attack.”

Dr. Rosenbaum says that while some patients say they had no symptoms at all, many, “if questioned very carefully, did have symptoms of some kind.” “Maybe instead of an elephant on the chest, you just have an uncomfortable feeling like you’ve never had before,” says Dr. Roberts. “Maybe an unusual chest pain, bad indigestion, or a feeling of doom, or aching or vomiting or flu-like symptoms." "It’s tricky,” he says. “People should not be running to the emergency room at every little symptom, but any chest pain should be checked out. Beyond that, it is a good idea to report any unusual symptoms to your doctor and let him or her determine if a visit to the emergency room or to a cardiologist is a good idea.”

Dr. Rosenbaum says it is very important to know if you’ve had a heart attack, even if there were no symptoms. "The presence of a first heart attack alters treatment dramatically,” she says. “Treatment improves survival.”

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.