Mild, slow heart attack symptoms may sneak up on residents with multiple health problems, delaying time to the emergency department by more than five hours, a new study has found.

People who have symptoms that worsen gradually take about eight hours to get medical help when compared with about three hours in people who have abrupt symptoms, according to University of Illinois at Chicago researchers. A delay beyond two hours is more likely to lead to serious complications and death. 

“Both are a medical emergency and require urgent help,” explained study author Sahereh Mirzaei, MSC, CCRN, University of Illinois at Chicago. “But our study shows that gradual symptoms are not taken seriously.”

Chest pain or discomfort should not be ignored, even when mild and slow, she said. Symptoms may also include pain in the throat, neck, back, stomach or shoulders, and may be accompanied by nausea, cold sweat, weakness, shortness of breath, or fear.

Nearly half the patients studied had slow onset symptoms, showing that this is not an uncommon occurrence, Mirzaei noted. In addition, strenuous activity was found to be a precursor to an attack in about half of the males studied, she said. 

“Men with ischemic heart disease or with multiple risk factors such as hypertension, diabetes, high cholesterol, or family history of heart disease should be aware that chest pain or discomfort after physical effort could be a heart attack,” Mirzaei reported. “Call an ambulance straight away; the sooner you get help, the better your prognosis.”

The study was published Wednesday in the European Journal of Cardiovascular Nursing.