Atypical Myocardial Infarction Symptoms: Implications for Early Diagnosis and Management: A Narrative Review

Myocardial infarction (MI) does not always present with typical chest pain. Instead, many patients, particularly women, older adults, and those with chronic illnesses, may experience nonspecific symptoms such as shortness of breath, fatigue, epigastric discomfort, nausea, or dizziness. These atypical presentations often result in missed or delayed diagnoses, which can adversely affect clinical outcomes. This narrative review explores the clinical significance of atypical MI symptoms, the diagnostic challenges they pose, and evolving strategies for early recognition and effective management. A comprehensive literature search was performed across multiple databases, including PubMed, Scopus, Web of Science, and Google Scholar, for English-language publications from the past decade. The review focuses on understanding the variability in symptom expression, identifying barriers to timely diagnosis, and examining innovations in diagnostic tools and algorithms. It also discusses the implications for acute and long-term management, as well as the need for greater awareness among healthcare providers and the general public. Addressing these gaps is critical for reducing diagnostic delays, improving equity in cardiovascular care, and enhancing outcomes in high-risk populations. The findings underscore the importance of tailored diagnostic pathways and multidisciplinary approaches in the clinical evaluation of MI, especially when classical symptoms are absent.