Dr.Google and certain TV dramas play a major part in people thinking they or another person may be having a heart attack.

In fairness, some signs that are being experienced by an individual may mimic a heart attack and when they describe those symptoms to the 999 operator, they may err on the side of caution and dispatch a first responder and ambulance as a matter of urgency.

It is easy to be cynical when upon arrival all is well and we suspect the patient may simply belooking for medical attention, but it is still likely that at the point of calling 999 they were experiencing severe chest pain and suspected a heart attack.

It would be very difficult, nearing on the impossible for even the most experienced clinician to rule out chest wall pains, gallbladder pains, angina pains etc in the brief time during the emergency call.

ECGs are a very good tool to indicate an active MI but symptoms could resolve after the pt’s pain/discomfort has resolved and the heart has gone back to NSR. The only true way to find out if an MI has occurred is by a troponin blood test usually done at 1-4-12hr intervals. This is why the crew is more likely to take chest pain pts to hospital as they are not kitted out to perform the test by the bedside. It is only on VERY rare occasions that crew will refer them to their GP. 

Below I have listed below some the main symptoms that may create the impression of a heart attack, and are considered to be false alarms. These are listed in alphabetical order not priority or popularity.

Arm pain, tingling, numbness
History taking may give clues that indicate the pain may not be related to heart condition. What were they doing prior to the pain, tingling and numbness? Example; taken a recent brisk walk. What action makes it worse or better? Example:It increases or decreases when the arm is rested over the back of a chair for a few minutes. It could be that this pain is caused by pressure on the nerves.

Chest wall pain
Often connected to muscular pain, ribs, intercostal nerves. Someone extending a reach may experience a chest wall pain and this activity may be highlighted during history taking.

Disorders related to gallbladder. This should not be taken lightly and during history taking it would be prudent to take a list of symptoms being experienced including family history of gallbladder disease.

Gastric disorders
Long and what seems to be relentless pain could easily be Indigestion and reflux esophagitis, hiatus hernia and spasms, acute gastritis. The other side of the coin is when a real heart attack is dismissed as a gastric disorder.

Lung infections
The patient may be experiencing pain,  fever and chills that are caused by the bacteria that attack the lung or the pleura. The cold sweats and chest pains may be pneumonia, pleurisy, etc.

Pericarditis
The inflammation of the heart’s coat – pericardium. This is often presented as very sharp pain and generally worsens when lying down yet improves for a few minutes sitting up.

This lis is far from comprehensivebut hopefully gives an insight into false indications of heart attack, but what is important they are serious conditions despite the fact that upon arrival the patient is over the pain and all appears well – spend that time in taking detailed history for handover.