OBJECTIVE To examine whether the association between expected symptoms of acute myocardial infarction and actual symptoms predicted delay in reaching hospital and help seeking behaviour.

DESIGN During hospital convalescence, participants completed a structured interview designed to measure symptom experience and help seeking behaviour following the onset of symptoms of acute myocardial infarction.

PATIENTS 88 patients admitted to hospital with their first myocardial infarction

MAIN OUTCOME MEASURES Delay in reaching hospital from onset of worst symptoms, obtained from ambulance and hospital records.

RESULTS The most common symptoms expected by patients with myocardial infarction were central chest pain (76%), radiating arm or shoulder pain (34%), and collapse (26%). The most common symptoms experienced were sweats or feeling feverish (78%), chest pain (64%), and arm, shoulder, or radiating pain (66%). A mismatch between symptoms experienced and those expected occurred in 58% of patients, and was associated with delay. Patients who experienced a mismatch between expectation and actual symptoms also were more likely to have a third party decide to call for help.

CONCLUSIONS The experience and interpretation of symptoms is an important source of delay and help seeking following onset of myocardial infarction symptoms.