More than 40% of heart attacks are not recognised by patients, according to the results of a study published in the European Heart Journal.

Researchers from the Erasmus Medical Center in Rotterdam, Holland, found that, in a study of more than 4,000 people, a third of male heart attacks and almost half of those in women were missed.

Commenting on the findings, Dr Eric Boersma, from Erasmus Medical Centre in Rotterdam, the Netherlands and a co-author of the study, said: “There is quite a proportion of myocardial infarctions clinically unrecognized by the patient him or herself, but also by the medical system.” And, highlighting the potential consequences of failing to spot a heart attack, he added: “We know from other research that unattended myocardial infarctions do have prognostic implications in the sense of lower life expectancy.”

According to the study authors, women may be less likely to suspect an attack as they do not experience many of the classic symptoms such chest pain. “Women may sense shoulder pain instead of chest pain, they may think they have severe flu that is taken a long time to recover from, and those with an inferior-wall infarction may complain of stomach pain,” according to Dr Boersma. "So women may hold back from reporting symptoms and doctors may also be in doubt whether or not to consider heart disease as a source of the complaints,” he explained.

Professor Peter Weissberg, medical director at the British Heart Foundation, was quoted by BBC News Online as saying: “Doctors have known for some time that certain patients, particularly the elderly and those with diabetes, can suffer a heart attack without knowing it.” But he also pointed out that the study was carried out in the 1990s, and that the situation is probably not quite as bad now as “we are far more vigilant in identifying patients at risk from heart disease and treating them.”