by Brian Tomasik
First written: Jan.-Feb. 2016; last update: 23 Feb. 2016

Summary

This piece explores the question of how painful it is for wild animals to die of starvation or dehydration. Since we know more about the subjective experiences of humans than non-human animals, I focus on accounts of human deaths from Voluntary Stopping of Eating and Drinking (VSED). While many pro-hospice accounts of VSED are positive, most pro-life accounts are negative; I suspect the truth is somewhere in the middle. Humans dying via VSED typically have access to pain killers, which means that the suffering endured during VSED probably understates the pain that a wild animal would experience. A common way that starvation ends a person's life is by causing heart problems. Based on anecdotal accounts, it seems that cardiac arrest may be among the better ways to die, while heart attacks are more protracted and can sometimes be intensely painful.

Introduction

It's commonly said that predation is important because otherwise prey will overpopulate and starve. I once heard someone claim confidence that starvation is much more painful than being eaten alive. How true is this?

More generally, how bad is death by starvation? One example where this information might be useful is if you find a fly trapped in your house. If you don't let it out, it may starve or dehydrate. But if you do let it out, it may breed and create more fly suffering in the future. (On the other hand, if it's already pregnant, keeping it inside may lead to many larvae that will then starve/dehydrate in your house.) Another option is to quickly squish the fly by placing it on a rough piece of paper, smashing a board against the paper, and dragging out the guts to make sure neural connectivity is destroyed throughout the fly's body. But is this more or less painful than starving?

This piece aims to illuminate the painfulness of starving and dehydrating to death, mainly based on accounts of these processes in the human case. Of course, different animals have different somatic physiology and neurophysiology, and this is especially true when comparing insects vs. humans. Still, information from the human case is better than nothing.

Starving animals

The Humane Society of the US says:

The pain of an animal who lingers with untreated illness or wounds, or without nourishment or shelter, can be tremendous -- sometimes even more so than those who are victims of directly inflicted violence, because their suffering is so prolonged. Animals who starve to death experience a myriad of painful symptoms throughout each stage of their physical deterioration.

Videos

Following are some videos of animals enduring starvation, along with my notes on how the animals seem to be faring.

Video title and link Does the animal seem to be suffering?
"Amazing transformation of starving street dog too sick to eat" The dog looks quite ill. It's hard to tell how much it suffers per minute. Our reactions might be somewhat biased by the fact that the dog's appearance looks sickening to us.
"Dog Left Behind to Starve" Dog is less active when emaciated than when recovered, but didn't seem to be suffering intensely per unit time when starved.
"Little starving fawn" The fawn doesn't look extremely thin, so I don't know for sure that the video author was correct in assessing its condition. Assuming the fawn was starving, it didn't seem to be suffering intensely -- rather, it seemed listless and unable to do much.
"Starving deer 2" Deer is emaciated but seems to be acting fairly normally.
"Fripp Island deer mangy/starving :(" Deer looks to the cameraman to get fed. Doesn't look to be in major pain.

How starvation works

This article says that

After a few days without food, chemicals known as ketones build up in the blood. These chemicals cause a mild euphoria that serves as an anesthetic.

The weakening brain also releases a surge of feel-good hormones called endorphins -- the same chemical that prompts the so-called "runner's high."

This piece explains:

Starvation wreaks havoc on the immune system, mostly on account of an extreme deficiency of vitamins and minerals. And in fact, some people will become weak and die of immune-related diseases during starvation.

[...] The end-stage of starvation typically brings with it one of two different diseases: marasmus and kwashiorkor.

Marasmus occurs on account of extreme energy deficiency, typically from inadequate amounts of protein and calories. At this point, body weight reaches dangerously low levels, and infections are common.

Kwashiorkor is a related disease that afflicts children who are protein-energy deficient, and can result in edema (fluidic inflammation) and an enlarged fatty liver — resulting in the counterintuitive distending of bellies, giving the illusory impression that starving children are well fed. [...]

People can die of starvation in as short as a three-week span, or as long as 70 days. During the Irish Hunger Strikes of 1981, for example, ten men survived without food (drinking only water) for periods ranging from 46 to 73 days.

This page says about animals: "An initial loss of body fat is followed by muscle loss and atrophy and, ultimately, organ failure. In long-term starvation, degeneration of the liver, cardiac changes, anemia, and skin lesions may develop."

How dehydration works

This page says:

As a person dies from dehydration, his or her mouth dries out and becomes caked or coated with thick material; lips become parched and cracked; the tongue swells and could crack; eyes recede back into their orbits; cheeks become hollow; lining of the nose might crack and cause the nose to bleed; skin begins to hang loose on the body and becomes dry and scaly; urine would become highly concentrated, leading to burning of the bladder; lining of the stomach dries out, likely causing the person to experience dry heaves and vomiting; body temperature can become very high; brain cells dry out, causing convulsions; respiratory tract also dries out causing thick secretions that could plug the lungs and cause death. At some point the person’s major organs, including the lungs, heart, and brain give out and death occurs.

This article explains that fluid loss disrupts electrolyte balance. "The brain, which relies on chemical signals to function properly, begins to deteriorate. So do the heart and other muscles, causing patients to feel lethargic."

Accounts from end-of-life care

VSED is used by some people to end their lives. Unfortunately, discussions of starvation/dehydration in hospice are very polarized. Pro-life groups tend to claim that the experiences are awful, while pro-hospice groups tend to claim that dying by such means is nearly painless.

Positive accounts

This piece profiles a 79-year-old man who stopped eating ~36 days before the writing of the article. "He said he feels no hunger or pain, although he smells food and sometimes dreams of it."

Marc Newhouse describes his mother's VSED experience:

I had been a nurse for a decade, and the traditional wisdom is that a death by dehydration is agonizing.

I did the research—there were reports that it had been done, and that it was not as uncomfortable as I had assumed. [...]

I had read that the body might produce endorphins after the third day of the fast. I had also read that the sensation of thirst and hunger fade and perhaps disappear after the third or fourth day.

My mother disputed that. But she also said, “it hasn’t been too bad,” when someone asked her what it was like, to be five days without food or drink.

The last week of her life had a serenity and depth that affected everybody—even the man who came to pick up her corpse; he heard the story, shook his head, and said, “that’s the way I want to go.”

She said farewell to her friends, she resolved three unfinished pieces of business, and then, on the eighth day of her fast, she fell into a coma.

And died three days later.

This article makes the sweeping claim that

Studies have shown that the majority of dying patients never experience hunger, and in those who do, small amounts of food and fluids, offered whenever the person wants, relieves the hunger.

And regarding dehydration:

Dehydration in a seriously ill person with a terminal condition, and in the frail elderly, is not painful. In fact, frail elderly persons have a blunted sense of thirst, which allows them to slip rather easily into a dehydrated state. This is generally characterized by increased sleepiness and less mental alertness without other signs of distress. In the dying patient, studies have shown that the majority never experience thirst, or only initially, and the thirst that occurs is easily alleviated by small amounts of fluids or ice chips given by mouth, and by lubricating the lips.

Even if these claims were true, it would remain unclear how they translate to non-elderly animals that are starving/dehydrating due to lack of food/water rather than while dying of old age. Moreover, the above quotes suggest that VSED patients may get small amounts of food and water when desired, while wild animals have no such luxury -- although I suppose that starving wild animals probably can also find bits of food here and there in many cases.

This study echoes the idea that elderly people may find VSED easier: "Anorexia, which occurs in some dying patients, may facilitate the choice to stop eating and drinking." So maybe dehydration / starvation would be more painful in younger people and animals.

VSED coach Judith Schwarz

read some medical literature on self-dehydration. She decided to pursue a Ph.D. in nursing so she could research other nurses’ experiences with the method. Preparing her dissertation, she learned that hospices and nursing homes were often skittish about helping patients with the process, but those that did go through with it usually seemed to have a comfortable and painless end.

Schwarz wrote in this article:

Other clinicians who have not witnessed a VSED death may fear that if they inform an already suffering patient about this option, they might indirectly encourage a dying process that is unduly painful, prolonged, and "inhumane." Such fears are not supported by clinical reality. Several small empirical studies and an increasing number of anecdotal reports suggest that VSED provides most patients with a peaceful and gentle death that is generally well tolerated and occurs within 2 weeks of beginning the fast.[8,9]

This page says of VSED:

Eventually, the individual cannot be aroused. For those who are at the end of a terminal illness, this coma state could occur as early as the second or third day of the fast. For those who are not terminally ill, it may take longer to completely lose consciousness. One study reports the average time to coma is six days, but there is no way to predict exactly what will happen in any individual case.

Each organ system in the body slowly begins to shut down. For a terminally ill patient, the average length of time before death occurs is ten days; for those without an underlying terminal illness the length of time varies from one to three weeks. [...]

As death nears, breathing becomes more shallow and irregular. Moaning may occur but is not believed to be an indication of pain or distress. Death from VSED is essentially a natural process that follows a fairly predictable pattern.a

This article describes a terminally ill woman who decided to stop eating and drinking:

Instead of feeling pain, the patient experienced the sense of euphoria that accompanies a complete lack of food and water. She was cogent for weeks, chatting with her caregivers in the nursing home and writing letters to family and friends. As her organs failed, she slipped painlessly into a coma and died. [...]

"What my patients have told me over the last 25 years is that when they stop eating and drinking, there's nothing unpleasant about it -- in fact, it can be quite blissful and euphoric," said Dr. Perry G. Fine, vice president of medical affairs at the National Hospice and Palliative Care Organization in Arlington, Va. "It's a very smooth, graceful and elegant way to go."

2003 study of nurses

This study surveyed nurses about experiences with VSED patients. It found:




"According to 84 nurses, the patients died a mean of 10±7 days after stopping food and fluids, and 71 patients (85 percent) died within 15 days."

Note that a few patients resumed eating and drinking due to discomfort. Out of 126 patients who started VSED, 102 completed it through until death, while 16 stopped. (The outcomes for the other 8 are unknown.) "Reasons for resuming food and fluids, which were coded from written comments by 11 nurses, included family pressure or encouragement to eat (five patients), hunger or discomfort (four), amelioration of depression (one), and alleviation of other concerns (one)." In the case of wild animals, stopping starvation is not an option, so those people who found starvation/dehydration too painful to continue undergoing should be included in an estimation of the average badness of starving/dehydrating. Fortunately, that fraction was relatively small.

Another caveat is that the set of people who did VSED might have differed from the set who requested and got physician-assisted suicide; this allows for potential confounders in the comparison. For example:

  • Maybe those who chose and were approved for euthanasia had more severe ailments? Consistent with such a hypothesis, the study notes that "Unbearable physical suffering did not appear to be an important reason for" the choice to use VSED.
  • Maybe those who chose VSED tended to be people who were less averse to hunger than the average person is. (This kind of selection bias wouldn't apply to starving wild animals, since starvation in nature is usually not voluntary.)

Table 1 of the study shows demographic traits of the VSED patients vs. the physician-assisted-suicide ones. VSED patients were an average of 10 years older than physician-assisted-suicide patients.

Negative accounts

While a right-to-die campaigner was starving/dehydrating herself, she said: "It is hell. I can’t tell you how hard it is. You wouldn’t decide this unless you thought your life was going to be so bad. It is intolerable." She continued with the process in part to make a statement about how euthanasia should be legal.

Terri Schiavo's brother wrote:

I watched my own sister, Terri Schiavo, anguish through almost two weeks without food or water and there are no words that can properly describe the inhumanity. In her last days, we would not permit our mother to visit Terri, in an effort to spare her additional torment, as blood pooled in Terri’s eyes, and her skin and lips were terribly cracked because her tissues were lacking any moisture. Terri’s body turned different colors of blue and yellow and her breathing became so rapid, it was as if she was outside sprinting.

This article reports:

Efstratia Tuson, an 85-year-old retired teacher from Middlesex, was terminally ill but her requests for a lethal dose of barbiturates were refused by her doctors.

She was told she would have to wait for a month for an appointment in a Swiss euthanasia clinic so began refusing food and drink in January. It took her five agonising days to die.

Mrs Tuson's daughter, Pamela, said: "Her body mass reduced, her face became drawn, her skin very dry. She was dying of thirst. It was like being in the desert. I feel my mother was tortured until she died."

But a 75-year-old from Scotland, who had advanced motor neurone disease, took 25 days to starve and dehydrate to death [...].

As the days turned into weeks, however, she used a communication aid to write: "You wouldn't put a dog through this. You would give it a lethal injection." [Perhaps the woman wrote this statement mainly to make a political point about euthanasia, rather than because she regretted her choice to starve/dehydrate??]

Dr Wilson, who was in contact with the woman, whose Christian name was Lily, said her agony had been prolonged by her sucking ice cubes and frequently rinsing her mouth with water.

This post describes a daughter watching her mother undergo VSED:

I answered [the nursing staff], she can feel: she's squeezing my hand, and if I try to take my hand out of hers, she squeezes tighter, and when I hold a little piece of gauze to her lips, she tries to suck the water out of it. She's thirsty! This is a horror; this is cruelty!

No, they said. She's not thirsty. It's just reflex. But, I tell them, I watched her clamp her lips on the gauze so tightly that I had to pull to get it out of her mouth.

She reacts when you touch her feet, her legs, and her hair. If she can feel that she can feel thirst, I plead with them.

It's not the same, they tell me. She's not in pain.

Confounding by pain relief

Since hospice patients may be given pain relievers, reports of the painfulness of starving or dehydrating may sound less severe than what an animal would experience without the luxury of pain relief.

This article says "death by VSED is described as a peaceful and comfortable death, and terminally ill patients dying of dehydration or starvation do not suffer if adequate palliative care is provided [16, 31, 40]." (emphasis added)

This article reports that the elderly man starving himself without pain was on a painkiller, though he only used it "sparingly".

This post says a woman dying of VSED had to be medicated when she became distressed.

This page says:

Rarely, as death nears, some clients experience agitation or delirium as a result of organ failure and dehydration. Access to hospice or other medical support is important to provide sedation should this occur.

This page says:

Many advocates of VSED say it is painless, however their claim is based on the requirement that individuals receive medical supervision including pain and symptom control as they dehydrate to death.8

For example, Virginia Eddy’s physician son arranged for her to receive “adequate medications to control discomfort.”9 Jane Gross also explained that her mother had received medical support such as sedatives as she died.10

Thaddeus Pope, an attorney who promotes VSED as an option that doctors should let patients know about, distinguishes between good and bad VSED with the latter described as death that is not accompanied with the comfort care “that is essential for a good death by dehydration.”11

Without powerful sedatives and other palliative measures (and, sometimes even with such measures), dehydration deaths have been described as horrific.

My experience with basically not eating for two months

In 2002, I developed a condition known as esophagitis for an unknown reason. I described the ordeal more here. When the esophagitis first developed, I felt excruciatingly nauseous for a few hours after eating, such that I could only squeeze my chair and pace around my room for hours on end waiting for the pain to subside. I soon learned to basically stop eating, except for a few oyster crackers every few hours. Going hungry was much less painful than the alternative.

The first night after I stopped eating, it took me several hours to get to sleep, because I was so hungry and therefore restless. But by the next night, I felt better. Soon, I mostly stopped feeling the pain of hunger per se and instead transitioned to a general feeling of achy listlessness. The best analogy to the feeling is what it's like to have a mild fever.

This article reinforces the idea that hunger subsides after a while:

After 24 hours without food, "the body goes into a different mode, and you're not hungry anymore," he said. "Total starvation is not painful or uncomfortable at all. When we were hunting rabbits millions of years ago, we had to have a backup mode because we didn't always get a rabbit. You can't go hunting if you're hungry."

After I ceased eating, I felt bad and had less energy, but I could still perform basic daily activities. In fact, my esophagitis flared up during the school year, so for about a month, I went to school hungry except for a few Wheaties that I could manage to eat during the day. I even continued participating in gym class, although I got excused from the required one-mile endurance run near the end of the school year.

My going hungry continued for 2-3 months. I had previously been overweight (as I am again now), but during this time, I lost ~15 kilograms.b Hunger per se was generally less of a concern to me than the continued nausea I felt when trying to eat here and there.

When I went to a nutritionist, she suggested that my eating 2-3 oyster crackers every hour might have been counterproductive to my recovery because that might have prevented me from getting hungry. And indeed, I found that forcing myself to delay eating did make me hungrier (although this was at the same time as I was taking Nexium to address my esophagitis, so causation here isn't clear). This point seems to contradict the following claim from this article:

That pain of hunger is only felt by those who subsist on small amounts of food and water -- victims of famine, for instance, or concentration camp inmates. They become ravenous as their bodies crave more fuel, Sullivan said.

Maybe I wasn't eating enough to have regular hunger cycles? And if eating small amounts does make one hungry, does this suggest that those wild animals that subsist on small amounts of food during famine do experience more substantial hunger?

My esophagitis experience is only one data point, but the firsthand nature of it gives me some confidence that at least the early stages of starvation may feel less bad than how they might look from the outside. Of course, I never got to the more serious stages where organ failure would occur. Presumably the last steps in the dying process are the most painful.

How starvation kills

This article says:

the body begins mining its muscles and stores of fat to get the carbohydrates and proteins it needs to make energy.

"If you mine too many proteins in the heart, it gets unstable," said Sullivan, a senior fellow at Duke's Center for the Study of Aging. That can give rise to an irregular heartbeat, which can cause the patient to die of cardiac arrest. Or, if the muscles in the chest wall become weak, the patient can end up with pneumonia, he said. [...]

They eventually descend into a coma and finally death. [...]

Heart problems

This piece says:

When death does finally arrive, its most immediate cause is by cardiac arrhythmia or a heart attack brought on by either extreme tissue degradation brought about by autophagy (notably diaphragm failure), or severe electrolyte imbalances.

This page says "the most common cause of death in anorexics is heart disease. Much of this is related to muscle deterioration." Lacey Smarr and Anna Wood died of heart attacks resulting from anorexia. Luisel Ramos and her sister Eliana both died of heart attacks probably resulting from anorexia. Jeanette Suros suffered a heart attack at age 17 due to anorexia but survived.

This page reports that

Heart disorders are the most common medical causes of death in people with severe anorexia nervosa. [...]

A primary danger to the heart is from imbalances of minerals, such as potassium, calcium, magnesium, and phosphate, which are normally dissolved in the body's fluid. The dehydration and starvation that occurs with anorexia can reduce fluid and mineral levels and produce a condition known as electrolyte imbalance. Certain electrolytes (especially calcium and potassium) are critical for maintaining the electric currents necessary for a normal heartbeat. An imbalance in these electrolytes can be very serious and even life threatening unless fluids and minerals are replaced.

This page says "heart disease is responsible for the death of many individuals who suffer from severe cases" of anorexia. Bradycardia, which commonly results from anorexia, can cause cardiac arrest.

This page notes that cardiac arrest is when the heart stops beating, while in heart attack, blood flow to the heart is cut off. Intuitively, I would think starvation would tend to cause cardiac arrest rather than heart attack, since why would electrolyte imbalance block blood flow through arteries? But many sources speak about "heart attack" resulting from anorexia, and I assume they're not all confusing "heart attack" with "cardiac arrest". So I mention both cardiac arrest and heart attack in the next section.

How painful is death from heart problems?

Given that starvation typically kills "by cardiac arrhythmia or a heart attack", we should ask how painful death is by those means.

Cardiac arrest and heart attacks are different. With cardiac arrest: "a person becomes unresponsive, is not breathing or is only gasping. Death occurs within minutes if the victim does not receive treatment." In contrast: "Symptoms of a heart attack may be immediate and may include intense discomfort in the chest or other areas of the upper body, shortness of breath, cold sweats, and/or nausea/vomiting. More often, though, symptoms start slowly and persist for hours, days or weeks before a heart attack."

Painfulness of cardiac arrest

Here are some comments from this thread from people with unknown credentials:

  • "very painful, but the pain may not prolong for more duration and death may come very soon."
  • "From the evidence of those that have suffered this condition and survived, it appears they know something has gone wrong but are unable to rationalise it before the lights go out. One person I read of said he felt he was running in someone else's body then he realised he was getting nearer the ground and it was getting darker, he felt his head bump the floor."
  • "The pain is likely to last only seconds or minutes at the most before the person passes out."

Following are some snippets from stories of people who survived cardiac arrest. Unfortunately, many of the people didn't remember what happened, which makes it hard to tell how much pain they experienced (if any) in the moment.

  • "All of a sudden, I felt my heart stop beating and I was waiting for that next beat, but it never came. I said “Oh, my God!” and the taillights of the car in front of me faded. I heard a loud noise and then I opened my eyes; everything was blurry and dark in front of me. As I focused, I could make out the airbag in front of me, the pungent fumes from my car, and the steady hum of the windshield wipers. It was then I realized I had passed out and crashed." (source)
  • "She was explaining to me what had happened over the weekend, and we were laughing when all of a sudden I stopped laughing and slumped over my desk. [...] After [initial treatments] I remained in a medically induced coma for 11 days". (source)
  • "I was about 2 minutes into cooling down from the treadmill when I toppled out of my chair. I woke up on the floor and became aware of my cardiologist and the test tech sitting beside me". (source)
  • "'All I remember is diving for a ball and throwing it back,' Sendelweck said. 'That's pretty much it.' [...] Sendelweck's dad was with her and he remembers seeing her collapse into a curtain hanging from the gym ceiling." (source)
  • "The clerks knew me as I'm in there all the time. They told me that I came to the counter saying I didn't feel well and– bam– I passed out." (source)
  • "I vaguely remember calling my mother, but from that point on have no recollection of what happened. Luckily, I was spared feeling too much pain." (source)
  • "During that break – in a room full of hundreds of people – I lost consciousness and collapsed on the floor. I went into cardiac arrest [...]. I have no recollection of what happened at that point". (source)
  • "The last thing I remember was telling my wife I felt dizzy and reaching out for the front door for support. I awoke in the intensive care unit (ICU) surrounded by my family and brothers from the fire department, having missed five days of my life!" (source)
  • "Arnie heard me struggling, and before he knew it I was blue. I wasn't breathing and I had no pulse. Arnie placed me on the floor and called 911." (source)
  • "Linda remembers handing her youngest a piece of paper for coloring, but nothing after that. She had fainted." (source)
  • "He said that before he noticed anything odd, painful, or unusual, he was already unconscious, and that right before he lost consciousness he felt a rush of placidity and calmness run through his body." (source)
  • "his last moments were probably very peaceful due to the fact that he would have lost conciousness due to lack of blood flow to his brain. He may have felt something he may have not. [...] Everyone I have talked with that has survived a cardiac arrest, and the number is pretty small, has no recollection of the event. My best guess is that he passed quickly and didn't suffer at all." (source)
  • "When your heart stops beating or only beats in a rhythm that doesn't produce a puls (which both may be the case in acute cardiac death) you might experience a weird feeling in your chest and maybe some lightheadedness. But most probably, there's no pain. After about 8 seconds, you'll pass out. It's terrible for those who are left behind, but for the person leaving, it's probably one of the least frightening and least painful ways to die. Don't worry about your father's last moments. He didn't suffer much and that little scary moment only lasted a few seconds." (source)

Painfulness of heart attack

The symptons of a heart attack are

chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it is in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. [...] At least one quarter of all MIs [heart attacks] are silent, without chest pain or other symptoms. [...] Estimates of the prevalence of silent MIs vary between 22 and 64%.

One account:

I know how a heart attack feels, and on that pain scale thing they have, mine were all at various numbers. I have had 3 c-sections and that first day pain was worse that two of my heart attacks but the third heart attack hurt the worst. [...]

The pain in my left arm was around my elbow and was dull but within seconds of rubbing it, the pain spread. The pain was rolling up my left arm, the waves began dull but the time it got halfway to my shoulder it was almost unbearable. [...]

I felt the need to vomit so I got up and headed to the bathroom. On the way which is a few feet I got light headed, but I managed to sit on the toilet before it came out both ends of me. [...]

All these things, the pain in my left arm, the short of breath, asthma attack, cold sweats, vomiting and runs all are classic symptoms of the dreaded heart attack. [...]

[During a later episode:] I felt like I was dying, and all I could say was that dreaded “f word” repeatedly. It hurt so bad this time.

Another account:

[First episode:] Suddenly the pain got worse. Initially I would have rated it a 3 on the pain scale from 1 to 10. Now it shot up to 5 or 6 and went through to my back and down my left arm. [...]

[Later episode:] We got in the car and poor Charlie drove while I writhed and gasped in the passenger seat. It was similar to birth labor pains that are so strong they take your breath away. If I didn’t breathe rhythmically in and out, the pain felt out of control.

This page includes many testimonials about how heart attacks feel. Following are some snippets:

  • "My first symptom was an odd squeezing sensation in my chest, as if someone reached out and grabbed my heart and squeezed it a few times. No pain – it really didn’t hurt. After my chest sensations went away, my upper back between my shoulder blades started to ache immensely."
  • "my first symptom was heartburn [...] then a sharp pain went through my back and I told my husband I felt like I was going to die – all in the matter of one minute from the initial symptom."
  • "My first big cardiac symptoms were a discomforting epigastric pain and a tightening chest pain that woke me up at 4 a.m. from my sleep. This gradually radiated down the left arm, a numbing sensation. I started sweating as the pain grew in intensity during my trip to the ER, which took about 25 minutes. I was restless every second, and the pain in my chest became unbearable and tight."
  • "I never had any chest pain at all until six months AFTER my heart attack."
  • "I also had numbness in my right shoulder radiating down my arm and felt as if the arm suddenly became weighted. Later, the same symptoms were manifested in my left shoulder and arm. Chest pain stayed, but the numbness in both arms gradually went away. This was replaced with blinding pain in between my shoulder blades. Once started, the back pain only got worse. I could no longer sit, stand, lie down or walk around. The pain was so intense it took my breath away."
  • "The pain felt as though someone was gripping me inside right in the center of the sternum and squeezing until I could hardly breathe. My left arm hurt from the shoulder to the elbow, then stopped and picked up hurting at my wrist into my hand. I started feeling very sick to my stomach and vomited until there was nothing left, but still continued retching. I was sweating like crazy."
  • Comparison with other pains

    This page says:

    I've never had anyone tell me that a heart attack is more painful than childbirth. In fact, cardiologists shy away from the word "pain," because the sensations associated with heart attacks are not sharp, nor do they come in intense waves like in childbirth.

    Heart attacks usually involve a steady discomfort that builds -- either quickly or more slowly -- from a lower intensity to high intensity. Patients describe the sensation as heaviness, achy-ness, pressure or burning.

    The top answer on this thread says:

    Heart attack pain may be so mild as to be unnoticed and there may be no pain related to stroke. If a woman has an epidural before childbirth, pain is not as bad as it could be with natural childbirth. For reliable excruciating pain, I'd say kidney stones would come first. The others would be entirely subjective depending on the person's symptoms at the time.

    This book notes that the same amount of morphine (4 mg intravenous or 10 mg intramuscular) may be used to relieve the agony of a heart attack as 2-4 hours of labor pain.

    This book says "In a survey of public attitudes toward cancer pain, an interview-based study found that cancer was rated significantly more painful than several other medical conditions, with the exception of migraine headache and heart attack [2]."

    Animal videos

    Here are some videos where animals apparently have heart problems (though I don't know if the authors of the videos correctly diagnosed the animals' afflictions):

    Video title and link How long does it last? How bad does the suffering look?
    "Snake had a heart attack | Snake heart attack happening" ~1 minute of pre-attack pain, ~25 seconds of writhing during the attack, at least another ~20 seconds of slow movement after the attack. Snake moves as though it's in severe pain.
    "Bear gets heart attack!! Caught on camera" Not sure when the heart problem starts, but the bear seems to die within ~15 seconds of falling over? Can't tell.

    Footnotes

    1. Many pages, like this one, confirm the claim that moaning is probably not painful: "At any time there may be an audible sigh or moan. These sounds are caused by air passing over the relaxed vocal cords causing them to vibrate and sound. This is not a sign of pain or distress."  (back)
    2. This is roughly the weight loss one would expect from eating almost nothing for ~2 months. Assume a basal metabolic rate of ~2000 calories per day. One pound of fat has ~3500 calories. So pounds lost over 60 days would be 60 * 2000 / 3500 = 34. This is ~16 kilograms.  (back)