What Does a Heart Attack Really Feel Like?

It may not be what you think
Older woman experiencing sweats and loss of breath

You know what a heart attack is supposed to feel like. It’s that sudden, intense, squeezing chest pain, like an elephant sitting on your chest. Right?

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That’s certainly the classic presentation, says cardiologist Venu Menon, MD. But that’s not what most heart attack patients actually experience, he says.

“A minority of patients have those classical symptoms,” says Dr. Menon. “Many others have symptoms that are more subtle and can be confused with other conditions.”

Symptoms you never suspected

So, what does a heart attack really feel like? According to Dr. Menon, patients most often report:

  • Heartburn-like chest pain. It’s quite common for heart attacks to feel like acid reflux.
  • Shortness of breath. Some heart attacks don’t cause pain at all. These “silent heart attacks” are most common in people with diabetes, older adults and those who have had bypass surgery.
  • Profound fatigue. This symptom is most common in elderly patients 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. These symptoms commonly accompany heart attacks to the inferior wall (bottom) of the heart.

When to call 911

Heartburn, breathlessness and other subtle symptoms aren’t always heart attacks. How can you tell a minor ailment from a heart attack?

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“It’s challenging,” admits Dr. Menon. “And that’s a big reason why people don’t get to the doctor sooner when they’re having a heart attack.”

In general, call 911 if:

  • Symptoms occur suddenly and persist for more than five to 10 minutes.
  • Shortness of breath and chest discomfort occur while you’re at rest.
  • You develop symptoms and are a middle-aged or older adult and have a history of smoking, diabetes or a strong family history of heart disease. Although premenopausal women are usually protected from heart attacks, younger women who smoke, have diabetes or have ovarian dysfunction also are vulnerable.

It will take a clinical evaluation along with blood tests and an electrocardiogram (EKG) to definitively diagnose a heart attack, says Dr. Menon.

Don’t drive to the ER

If you might be having heart attack symptoms, call 911 for an ambulance to take you to be evaluated. Don’t drive yourself or have a friend drive you to the emergency room.

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“About one in 300 people having heart attack symptoms end up developing a life-threatening arrhythmia on the way to the hospital,” says Dr. Menon. “If you’re in an ambulance, the emergency medical team will have you connected to an EKG and will be able to begin treatment right away.”

What a heart attack doesn’t feel like

Not all chest pain is a heart attack symptom. 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.
  • Can be reproduced when you press on your chest or move your arm.
  • Radiates below your abdomen and into your legs.

The best way to guard yourself from a heart attack is to eat a healthy diet, do regular aerobic activity, avoid smoking, manage diabetes if you have it, have regular checkups with your primary care provider, and know and control your cholesterol levels, says Dr. Menon.

If you notice a sudden change in your ability to perform physical activity, get to a doctor right away.

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