Drama surrounds a Hollywood heart attack. The doomed character on screen typically clutches at their chest as pain paints their face. Then, they stagger and collapse in a twisted heap. (End scene.)
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But in real life, that’s not what most people typically experience during a myocardial infarction (aka, heart attack). Symptoms tend to be far more subtle. In some cases, in fact, people might not even realize their ticker is in trouble.
So, what are the signs of a heart attack? Let’s find out from cardiologist Leslie Cho, MD.
Signs of a heart attack
So, what does a heart attack really feel like? People most often report:
- Chest pressure or tightness. Imagine the feeling of someone sitting on your chest. That’s close to the sensation brought by a heart attack. “It can feel very oppressive,” says Dr. Cho.
- Heartburn-like discomfort. It’s quite common for heart attacks to feel like acid reflux. In fact, the symptoms can be nearly identical. (Learn how to tell the difference between a heart attack and heartburn.)
- Shortness of breath. Some heart attacks don’t cause pain at all. These “silent heart attacks” are most common in people with diabetes and older adults.
- Pain on the left side. Signs of a heart attack could include pain radiating up to the left side of your jaw or down your left arm. Some people complain of a backache, too.
- Fatigue. This symptom is most common in older people and can be misdiagnosed as a flu-like illness.
- Nausea and sweating. While these symptoms can come with heavy chest pain, they also can occur by themselves, especially in women or people assigned female at birth (AFAB).
Can heart attacks go unnoticed?
Some people only learn they’ve had a heart attack following a medical checkup that takes place weeks or even months after the cardiac event.
How could someone not know, you ask? Well, not all heart attacks are equal when it comes to bringing the hurt. “Mild” heart attacks can bring symptoms that mimic indigestion or general tiredness — feelings that might not set off alarms in your head.
Plus, nobody wants to believe that they’re having a heart attack. People often ignore their symptoms. “Denial is real when it comes to heart attacks,” states Dr. Cho. “You want to wish it away.”
It takes a clinical evaluation along with blood tests and an electrocardiogram (EKG) to definitively diagnose a heart attack.
Can symptoms differ between men and women?
For the most part, men and women experience similar heart attack symptoms. But about one-third of women (and people AFAB) experience different symptoms from men (and people assigned male at birth).
Women and people AFAB are more likely to experience:
- Shortness of breath, fatigue and insomnia that started before the heart attack.
- Pain in their back, shoulders, neck, arms or abdomen.
- Nausea and vomiting.
Women and people AFAB are less likely to experience:
- Chest pain, particularly in the center of their chest.
- Discomfort that feels like indigestion.
What a heart attack doesn’t feel like
Not all chest pain is a heart attack symptom, clarifies Dr. Cho. Pain is unlikely to be heart-related when it:
- Is momentary, lasting only for a few seconds.
- Feels like a pricking sensation.
- Is in a small, well-localized area of your chest.
- Gets better or worse with breathing or positional changes.
- Can be reproduced when you press on your chest or move your arm.
- Radiates below your abdomen and into your legs.
When to call 911 for a heart attack
Given the sometimes-subtle symptoms, it can be hard to know what’s a heart attack and what’s not. The best rule? If there’s any sense that what’s happening could be a heart attack, seek help immediately.
Any heart attack — even a minor one — can damage your heart muscle. Early treatment can minimize that damage.
“Every minute truly counts with a heart attack,” stresses Dr. Cho. “If you feel like something’s wrong, get seen. Don’t ignore chest pressure, shortness of breath or nausea that lasts for more than 10 minutes and seems to be getting worse. Listen to your body.”
In general, call 911 if:
- Symptoms occur suddenly and persist for more than 10 minutes.
- Shortness of breath and/or chest discomfort occurs while you’re at rest.
- You develop symptoms and are a middle-aged or older adult with risk factors such as past or present smoking; diabetes; or a family history of heart disease. Younger women who smoke or have diabetes, hypertension or ovarian dysfunction also are more vulnerable.
And it is important to call 911 for an ambulance. The reason? About 1 in 300 people having heart attack symptoms end up developing a life-threatening arrhythmia on the way to the hospital. If it happens in the ambulance, treatment can begin immediately.
Heart attack prevention
If you’ve read this far, you’re obviously concerned about the possibility of having a heart attack. Now the good news: You can take proactive steps to prevent a heart attack from ever happening.
“Even if you have the world’s worst family history, heart disease and heart attacks are largely preventable,” clarifies Dr. Cho. “You do that by controlling your blood pressure and cholesterol, exercising regularly, eating a healthy diet, managing your weight and never smoking.”
But if you’re among the more than 600,000 people a year in the United States who have their first heart attack, act swiftly to get treatment. “Getting seen right away can save your life,” emphasizes Dr. Cho. “Be proactive. Don’t wait if you have symptoms.”