Is pain a necessary symptom for a heart attack?

[zmonster]

I'm a 40 year old male in relatively good shape and moderately active.  However, I have a chronic problem of feeling fatigued, with shorter bouts of nausea and lightheadedness.  I rarely have "pain" in the chest area, and when I do it is either fleeting, or more of a tightness than anything else.  

What really bothers me is that I get very short of breath on occasion, and this is often coupled with a lightheaded feeling.  At the gym yesterday I ran for 20 minutes, felt fine, but then started getting really hot and flushed, and short of breath (more than the normal exercise short of breath).  I started walking and it quickly went away.  This happens a few times a year, not very frequently.

I've had an echo stress test and a heart monitor test in the past two years.  Everything always comes back normal, including EKGs.  What I would like to know is, am I more likely to be experiencing heart/blockage symptoms (with little/no pain), or is this more likely a nutritional/dehydration/nervous system issue?

Another question I have is, are some heart attacks "minor" in that a person can have several of them over the course of a few years and barely notice it, or is it a situation where you "know" you're having one and there's absolutely no question?

[sprkssms1993]

the symptoms you described are heart attack symptoms. but it could also be low blood pressure I get all of those symptoms but my problem is low blood pressure. hypoxia is also another possibility and blood test would be a wise choice. If you have a cardiologist ask him/her to do a eccocardiogram/  high resolution of the heart area. I also have an enlarged aorta, leaky pulmonary valve, and leaky mitro valve let me know the results

[blueyankee44]

Pain is not always in the form of direct pain as you may expect.There are many ways to
realize you have had an attack,but if I begin describing them here,many may disgree and its a big chance with all the skeptics.You can e-mail to me at ***@****.

[ed34]

I would get some blood tests done and especially check for anemia, this certainly can cause problems as you describe. Obviously red corpuscles carry oxygen around in the blood and if you are low on these, you will be low on oxygen. Are you getting enough iron in your diet?
Have you had a stress test? to ensure your blood pressure is adjusting correctly?

[kenkeith]

Hypoxia is a condition were the heart cells are not receiving a good supply of blood.  Usually that condition is caused by occluded vessels and apparently your tests have ruled out any vessel lesions.

Hypoxia can be due to anemia, respiiratory disorder, pulmonary thrombosis (clot in the pulmonary vessel, thyroid,etc. and more likely a nutritional/dehydration/nervous system issue?

Q:Another question I have is, are some heart attacks "minor" in that a person can have several of them over the course of a few years and barely notice it, or is it a situation where you "know" you're having one and there's absolutely no question?

>>>>It can be either. I had silent ischemia (lack of blood flow) for a period of time and that caused the heart wall to be impaired and the heart was not able to pump adequately.  The end result is a low cardiac output and heart failure.  That is when i experienced symptoms and signs of shortness of breath, fast heart rate. low blood pressure, etc.  For some individuals there is no doubt of a serious heart event, and there can be something less.

It may be a good idea to have a regular annual physical exam.  Thanks for sharing, and if you have any further questions or comments you are welcome to respond.  Take care.