Heart Attack Symptoms: Warning Signs, What to Do, and When to Call Emergency

Quick Answer

• A heart attack happens when blood flow to part of the heart muscle is suddenly blocked.
• The most common sign is chest pain, pressure, tightness, or squeezing. It can spread to the arm, neck, jaw, back, or stomach.
• Other signs include shortness of breath, nausea, cold sweat, lightheadedness, and unusual tiredness. Not everyone has chest pain, and you do not need to have every symptom.
• If you suspect a heart attack, call emergency services immediately. Do not drive yourself.

What Is a Heart Attack?

A heart attack (myocardial infarction) occurs when blood flow to the heart becomes suddenly blocked. Without oxygen, part of the heart muscle can be damaged or die, and the heart muscle may die without prompt treatment. That is why speed matters: the sooner a suspected heart attack is treated, the more heart muscle can be protected.

Classic Warning Signs

• Chest discomfort in the centre or left side of the chest: pain, pressure, heaviness, tightness, squeezing, or fullness.
• Pain or discomfort spreading to one or both arms, the back, neck, jaw, or the upper stomach.
• Shortness of breath, with or without chest discomfort.
• Cold sweat, nausea, or lightheadedness.
• Pain that does not ease with rest. Heart attack pain can persist even when you are resting.

Early or Less Obvious Symptoms

• A feeling like indigestion, with burning in the chest, or a sense of fullness or bloating.
• Unusual tiredness, sometimes for days before the event.
• Irregular or pounding heartbeat.
• Pale, grey, or bluish skin.

Symptoms can come and go over several hours. Do not wait for them to become severe, and do not wait for them to match a list before you call for help.

Symptoms in Women and Men

Women are more likely than men to have less typical symptoms, such as unusual fatigue, shortness of breath, nausea or vomiting, and back or jaw pain. Women can also have typical chest pain, and men can have less typical symptoms too. Symptoms vary from person to person, so the same rule applies to everyone: act on any suspicion.

Heart Attack Without Chest Pain, and Silent Heart Attacks

Some people have a heart attack with little or no chest pain. Doctors call a heart attack with mild or no obvious symptoms a "silent" heart attack. The NHLBI notes that silent heart attacks are more common in older adults and in people with high blood sugar or diabetes.

The absence of chest pain does not rule out a heart attack. Silent heart attacks cannot be reliably identified at home, and some are found only later, on tests. Risk factors still matter even when there is no obvious symptom.

Heart Attack, Angina, and Cardiac Arrest

A heart attack can lead to cardiac arrest, which is one more reason not to wait. Angina that is new, lasts longer, or gets worse should be assessed by a cardiologist.

Heart Attack or Indigestion and Heartburn?

Burning and fullness like indigestion can be part of a heart attack. Heartburn that is new, comes on with exertion, or comes with sweating, breathlessness, nausea, or pain spreading to the arm, jaw, or back should be treated as a possible heart attack. Even heartburn you have had before can be a heart attack, and you cannot be sure from the feeling alone. If in doubt, call. For reflux symptoms in general, see our GERD symptoms guide.

Heart Attack or Panic Attack?

Panic attacks and heart attacks can feel alike. Both can cause chest discomfort, breathlessness, and feeling faint. Pain spreading to the jaw or back, pain that comes on with effort, sweating, or pain that persists despite rest raises the concern for a heart attack. You cannot reliably tell the two apart at home, and a panic attack is a diagnosis that a clinician makes only after heart causes are considered. So when chest discomfort is new or unexplained, do not use this comparison to decide whether to wait. Call emergency services.

When to Call Emergency Services

Call immediately if you have any of the following, especially if they are new, persistent, or getting worse:

• Chest pressure, pain, or tightness that lasts more than a few minutes, comes back, or does not ease with rest.
• Pain that spreads to the arm, neck, jaw, back, or stomach.
• Shortness of breath, cold sweat, nausea, lightheadedness, or fainting.
• Chest pain together with any of the above, even if you are unsure what is causing it.

The NHS advises calling 999 for sudden chest pain that does not go away. MedlinePlus advises calling emergency services even if you are not sure it is a heart attack. Emergency teams can begin treatment on the way to hospital, which is why you should not drive yourself.

What to Do While You Wait for Help

1. Call emergency services first. Say where you are and that you think it is a heart attack. 2. Do not drive yourself. Wait for the ambulance crew. 3. Follow the operator's advice on aspirin. Guidelines differ on the dose and timing, and some people must not take aspirin at all, for example if they are allergic to it, have a bleeding disorder, or take a blood thinner. Take aspirin only if the emergency operator or a clinician tells you to and you are not in one of those groups. 4. If you have been prescribed angina medicine, follow the plan your doctor gave you, and still call emergency services if pain persists. 5. If the person collapses, is unresponsive, and is not breathing normally, call emergency services and start hands-only CPR: push hard and fast in the centre of the chest. The American Heart Association recommends this for untrained bystanders.

Do not take anyone else's medicine, and do not wait to see whether the symptoms improve.

Risk Factors for Heart Attack

Changeable risk factors include smoking, high blood pressure, high cholesterol, diabetes, physical inactivity, obesity, and long-term stress. Factors that cannot be changed include age, sex, family history, and ethnicity. Heart attacks are usually caused by coronary artery disease. For guidance on managing these risks, see high blood pressure, cholesterol, and type 2 diabetes.

The WHO estimates that cardiovascular diseases caused about 19.8 million deaths in 2022, around 32% of all global deaths, and that 85% of those deaths were due to heart attacks and strokes.

How a Heart Attack Is Diagnosed

• ECG (electrocardiogram): the first test for anyone with acute chest pain. The 2021 AHA/ACC chest pain guideline recommends an ECG within 10 minutes of arrival. An ECG can show signs of a heart attack, but a normal ECG does not rule one out, so it may be repeated.
• Blood tests for cardiac troponin: a protein that leaks from damaged heart muscle. The 2021 AHA/ACC guideline recommends measuring troponin as soon as possible, and repeating it one to three hours later.

No single test confirms or excludes every heart attack. Doctors combine symptoms, ECG findings, and blood test results.

What Happens at the Hospital

The team checks your heart rhythm, takes an ECG and blood tests, and assesses your symptoms and other conditions. Treatment aims to restore blood flow to the heart as quickly as possible and to limit damage to the heart muscle. The exact treatment is decided by the medical team. After a heart attack, cardiac rehabilitation and long-term changes to risk factors are part of recovery, and medicines prescribed afterwards should not be stopped without medical advice.

Sources

• Heart attack — NHS
• Angina — NHS
• Heart Attack — MedlinePlus
• Heart attack symptoms — NHLBI
• 2021 AHA/ACC Guideline for the Evaluation and Diagnosis of Chest Pain
• Cardiovascular diseases (CVDs) — WHO fact sheet
• Essential Contact Numbers — Jordan Government Portal