Heart Attack Symptoms: Classic and Less Typical Warning Signs

Maybe you felt a strange pressure in your chest last week that went away. Maybe a family member had a heart attack and you want to know the signs. Heart attacks do not always look like they do in movies. This guide explains the classic signs, the less typical ones, and what to do.

What a heart attack is

A heart attack (myocardial infarction) happens when blood flow to part of the heart muscle is blocked. This is usually caused by a clot that forms on plaque in a coronary artery. Without blood, heart muscle starts to die [4]. The faster blood flow is restored, the more heart muscle can be saved [2].

Classic warning signs

The most common symptom is chest discomfort. This is true for both men and women [1] [3].

• Pressure, squeezing, fullness, heaviness, or pain in the centre or left side of the chest [1] [2].
• Discomfort that lasts more than a few minutes, or goes away and comes back [2].
• Pain or discomfort that spreads to one or both arms, the shoulders, the back, neck, or jaw [1] [2].
• Shortness of breath, with or without chest discomfort [2].
• A cold sweat [2].

Symptoms can start slowly and be mild. They can also come and go over several hours [1].

Less typical warning signs

Some people have other symptoms along with chest discomfort, or instead of it [1] [2]:

• Nausea or vomiting
• Light-headedness, sudden dizziness, or feeling faint
• Unusual tiredness for no clear reason, sometimes for days
• Discomfort in the upper belly, above the belly button
• Shortness of breath at rest or with very little activity
• A fast or irregular heartbeat

Women are more likely than men to have these other symptoms [2] [3]. Shortness of breath alone is more common in older adults [1].

Silent heart attacks

Some heart attacks cause very mild symptoms or none. These are called silent heart attacks. They are more common in older adults and in people with diabetes [1]. They are sometimes found later on an ECG.

What your doctor looks at

How clinicians describe chest pain

The 2021 US chest pain guideline from the AHA, ACC, and other groups made a point that matters to patients. It asked clinicians to stop calling chest pain "atypical" [3]. That word was often taken to mean "not from the heart", even when it was. The guideline suggests describing pain as cardiac, possibly cardiac, or non-cardiac instead [3]. It also says that heart pain can be felt in the shoulders, arms, neck, jaw, back, and upper belly, not only the chest [3].

Tests in the emergency department

When you arrive with possible heart symptoms, the team moves fast [3]:

• An ECG (electrocardiogram) within about 10 minutes of arrival, to look for a blocked artery.
• Blood tests for troponin, a protein released when heart muscle is damaged. A high-sensitivity troponin test is preferred, and it is often repeated after a short time.
• A risk assessment that combines your symptoms, ECG, and troponin.

Depending on the results, you may need urgent treatment to open the artery, more tests, or a safe plan to go home.

Angina compared with a heart attack

Stable angina is chest discomfort that comes with effort and goes away within a few minutes of rest or medicine [1]. A heart attack lasts longer, may happen at rest, and does not go away with rest [1]. New chest pain, or angina that is getting worse or happening at rest, needs urgent care.

Who is at higher risk

Risk factors include [2]:

• High blood pressure
• High cholesterol
• Smoking
• Diabetes
• Older age and a family history of early heart disease
• Overweight, low activity, and an unhealthy diet

After a heart attack

Recovery starts in the hospital and continues for months. Your care team will usually talk with you about:

• Medicines that lower the risk of another heart attack, such as antiplatelet drugs and statins
• Cardiac rehabilitation, a supervised program of exercise, education, and support
• Blood pressure, cholesterol, and diabetes control
• Quitting smoking
• When you can return to work, driving, and sex
• Your mood, because depression is common after a heart attack

You also have a higher chance of another heart attack or a stroke, so the warning signs above matter even more [2].

Questions to ask your clinician

• Based on my risk factors, how likely is heart disease for me?
• Which symptoms should make me call 911 right away?
• Should I carry nitroglycerin, and how should I use it?
• What is my 10-year heart risk?
• Do I need any tests, such as a stress test or a calcium scan?
• If I have diabetes, how might my symptoms be different?
• Should my family learn CPR?

When to get care quickly

Call 911 right away for any heart attack warning sign, even if you are not sure [1].

• Do not drive yourself, and do not have someone drive you. Ambulance teams can start tests and treatment right away [1].
• People who arrive by ambulance often get faster treatment at the hospital [1].
• The 911 dispatcher may tell you to chew an aspirin. Follow their advice.
• If someone collapses and is not breathing normally, start CPR and use a defibrillator (AED) if one is nearby [2].

Do not wait to see if symptoms pass. Every minute matters.

Bottom line

Chest pressure or pain is the most common heart attack symptom in both men and women. Other signs, such as shortness of breath, nausea, sweating, dizziness, or unusual tiredness, can come with it or appear alone. If you think it could be a heart attack, call 911 and let the experts decide.

Primary AI can show you the guideline and study sources behind this topic in plain language, so you can bring better questions to your appointment.