Let's Talk About Heart Attack Signs and Symptoms
Men and women often have different kinds of heart attacks (that feel different, too). Learn to recognize the signs—and when to call for help.by Matt McMillen Health Writer
You don't need a website to tell you that heart attacks are life-threatening health emergencies. What you may not know is that spotting one isn't necessarily as easy as you think. Heart attacks are complicated, and the symptoms can not only vary dramatically from person to person, but also between men and women. And sometimes certain symptoms, like nausea, may not seem all that serious at all. That's why it critical for every person to know all the signs and symptoms of heart attack so you can get help as quickly as possible. Let’s take a look at the different ways your heart may tell you it’s in trouble.
Our Pro Panel
We went to some of the nation's top experts in heart attack to bring you the most up-to-date information possible.
Guy Mintz, M.D.
Director of Cardiovascular Health & Lipidology
Sandra Atlas Bass Heart Hospital
Michael Goyfman M.D., MPH
Director of Clinical Cardiology
Long Island Jewish Forest Hills
Dennis Bruemmer, M.D., Ph.D.
Director of Center for Cardiometabolic Health, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute
The two share some common symptoms, which may include chest pain, shortness of breath, sweating, and a racing heart. Symptoms usually last 20 to 30 minutes. Heart attack symptoms generally last longer and get worse over time. If you’re young and healthy and have had panic attacks previously, you likely are not having a heart attack. But if you’re not sure, play it safe and call 911.
It’s your doctor’s job to be sure. It’s your job to get help. Don’t waste time trying to diagnose yourself, search the Internet, or explain away symptoms. Just get to the hospital (with someone else driving). Or call for an ambulance. Don’t delay.
It sounds impossible, but do your best to remain calm. This will help lower your blood pressure and heart rate, which in turn will reduce the stress on your already vulnerable heart.
Know your risk factors, and make sure the medical team knows you have them. Are you a smoker? Do you have diabetes? Are heart attacks and heart disease common in your family? Say something. Don’t wait for a doctor to ask you.
What Is a Heart Attack, Anyway?
First, a brief refresher course on your heart’s anatomy and what happens during an attack:
If your heart had a catch phrase, it'd literally be "Get Pumped!" (We didn't say it would be a cool catch phrase.) That's because pumping oxygen- and nutrient-rich blood to every cell in your body is your heart's main job.
The blood flows through a system of arteries, veins, and capillaries known as your blood vessels; your heart even has its own arteries, called the coronary arteries.
When all is working as it should, your blood will flow unobstructed, and you’ll probably not give it a second thought. But things can go wrong. Your heart’s arteries can become clogged by plaque—a mix of cholesterol, fatty substances and other materials—that builds up during a process called atherosclerosis.
This eventually leads to coronary artery disease (CAD), a type of heart disease diagnosed in more than 80% of people who have a heart attack. One danger is that the plaque can rupture, or break apart. This causes your body’s self-defense system to form a protective clot around the damage. And it does more harm than good. The clot blocks the flow of blood, which starves your heart of oxygen. When that happens, the cells in your heart begin to die. This is a heart attack, a potentially deadly medical emergency that accounts for roughly seven million emergency room visits in the U.S. each year.
What Are the Types of Heart Attack?
Technically, there is only one "kind" of heart attack—the kind that damages heart muscle. But this damage can occur in a number of different ways. They include:
Complete blockage: An artery becomes completely blocked so that no blood can reach the heart. This is the far more dangerous type of heart attack, because permanent damage to the heart can develop quickly.
Partial blockage: Nearly two-thirds of heart attacks are caused by a partial blockage of the artery. While the heart does receive some blood, it requires more than it’s getting. This type of attack will damage your heart, just not as quickly as one caused by a complete blockage.
Coronary artery spasms: This is when your arteries spasm and dangerously narrow, causing a partial or complete blockage of the heart’s blood supply, which leads to heart attack. It’s not common, but it does sometimes happen, often with cocaine use.
Any one of these types of heart attacks can cause a range of symptoms, from chest pain to shortness of breath—or even cause no symptoms at all. These so-called silent heart attacks may seem like the ultimate oxymoron, but in fact as many as 45% of all heart attacks have either no obvious symptoms, or ones that are so mild and vague that they get brushed off as a strained chest muscle, the flu, or even a bad case of indigestion, according to the American Heart Association. People with diabetes are particularly at high-risk for having one due to impaired nerve endings associated with that condition. You won't know you've had a silent heart attack until you see your doc for a routine visit or for symptoms you didn't realize could be heart-related (more on these below).
What Are the Symptoms of a Heart Attack?
Despite the differences in severity, most heart attacks cause similar symptoms—though there are no hard and fast rules for what those symptoms will be. What you experience can vary and be influenced by your age, sex, and type of heart attack you have. Here are the ones to know about:
Chest Pain (Angina)
For both men and women, the most common symptom is some type of discomfort in the chest. You may experience a crushing pain, like an elephant sitting on your chest. Or you may feel squeezing or the sensation of pressure in your chest.
People with CAD, a frequent precursor to heart attack, are likely already familiar with the on-again, off-again chest pain caused by limited blood and oxygen to the heart. Officially called angina, that pain often goes away with rest, and it doesn’t lead to permanent damage of your heart muscle.
During a heart attack, however, rest does not ease the pain. The pain may last for only a few minutes, or it may continue for much longer. (But please note: Heart attacks can occur without chest pain. In fact, up to nearly half of all people report no experience of angina. This is particularly true for people with diabetes, who often have nerve damage and therefore may be less sensitive to this pain.)
Upper Body Pain
Whether or not you feel pain in your chest, you may experience discomfort elsewhere in your upper body, often in this order:
In your left shoulder
Radiating down your left arm
In your neck, jaw, and back as well as eventually in your right shoulder and arm
This pain is not sharp but rather gives off an aching sensation of heaviness or even numbness. Why? The reasons are not fully understood, but it’s likely because of the way your brain and nerves are wired. When a heart attack occurs, your heart sends signals to the brain, which then sends out a message—pain!—to nearby parts of the body that have nerves connected to network that's in your heart.
Shortness of Breath
This can come on suddenly, even while you’re at rest. Why? Because your arteries are blocked and your heart can’t get all of the oxygen it needs. Your heart also may not be able to pump enough blood through your lungs quickly enough to be oxygenated. It may also be caused when fluid backs up in the lungs (when your heart can't pump properly, that fluid has to go somewhere.) When this occurs, your breathing will become more difficult when lying down than when you sit up because of the way that the fluid collects in your lungs.
This can occur if your blood pressure drops during a heart attack. Combined with chest discomfort, a reduced BP may trigger your nervous system to respond by with a drenching sweat. Your skin also may become cold and clammy.
Nausea and Vomiting
Doctors aren't exactly sure why this occurs, but it's possible that a heart attack stimulates your vagus nerve, which runs from the brain down through the chest and into the abdomen. An overstimulated vagus can make you feel woozy.
Lightheadedness or Dizziness
There are several possible reasons for these symptoms, including a drop in blood pressure, decreased blood flow to your brain due to the blockage causing your heart attack, heart failure or damage to your heart’s valves that occur during a heart attack, and problems with your heart’s ability to maintain its proper rhythm.
Reduced blood flow to the heart can lead to fatigue that may come on suddenly, or build and worsen over time. Despite the fatigue, you may have trouble sleeping because it's hard to sleep when you're in pain and struggling to breathe comfortably.
Heart Attack Symptoms in Women vs. Men
For both men and women, the most common symptom of a heart attack will be chest pain—but women experience it far less frequently than men do. In fact, women are nearly 50% more likely to experience a heart attack without chest pain than their male counterparts.
That's because men are more likely to have a sudden and complete, or near complete, blockage of their arteries, called a plaque eruption. In these cases, there's usually a rupture in the plaque, which triggers a blood clot to form. That obstruction causes chest pain by quickly shutting off the heart’s oxygen supply.
Women, on the other hand, tend to experience plaque erosion instead of rupture, which can cause clots to form more slowly. These smaller clots also don't generally entirely interrupt blood flow either. The result? Women, especially those under 50, are less likely than men to have those very obvious and dramatic chest-clutching symptoms.
The causes of plaque erosion are not well understood, but they do seem to lead to what doctors call “atypical” symptoms. These include:
These symptoms may occur alongside chest pain, but you may experience them even if you have no chest pain at all.
Starting around age 65 to 70, women’s heart attacks—and, therefore, their heart attack symptoms—start to resemble those of men more closely. That’s likely because they no longer have the protective effect of estrogen, a hormone that women have in abundance prior to menopause but which drops significantly during menopause. Experts believe that estrogen helps to explain why women, on average, have heart attacks about 10 years later than men.
Women’s often vague symptoms may come and go in the days, weeks, or even months before the heart attack finally occurs. This may help explain why more women than men die of heart attacks, something that’s been true for the last 20 to 30 years. Because these symptoms often don’t appear to present an immediate threat, women may not associate them with heart disease or realize they’re harbingers of a heart attack.
The result: Women, on average, wait nearly 60 hours before seeking care. That’s four times longer than the average man waits.
Also, doctors may take longer to figure out that a woman’s shortness of breath, nausea, or other vague symptoms are signs a heart attack in underway. And in heart attack care, there’s a common refrain: Time is muscle, meaning that the faster treatment begins, the more heart muscle your medical team will be able to save.
Such differences between men and women don’t only have immediate consequences in the emergency room. According to the American Heart Association, women are also more likely to develop heart failure and have a stroke within five years following their first heart attack. The lesson here: Atypical symptoms, even if they’re vague, require immediate attention, particularly if you have significant risks of a heart attack. Take these symptoms seriously and get them evaluated quickly.
But really the bottom line is always this: If you're worried you're having attack, even if you're not sure, don’t wait another moment: Call 911.
About Heart Attack (1): Morrow, David Andrew, MD (editor). (2017). Myocardial Infarction: A Companion to Braunwald's Heart Disease. (textbook) elsevier.com/books/myocardial-infarction-a-companion-to-braunwalds-heart-disease/978-0-323-40174-6
About Heart Attack (2): Lilly, Leonard S. (2016): Pathophysiology of Heart Disease. (textbook) shop.lww.com/Pathophysiology-of-Heart-Disease/p/9781451192759
About Heart Attack (3): American Heart Association. (2016). “About Heart Attack.” heart.org/en/health-topics/heart-attack/about-heart-attacks
Heart Attack Symptoms (1): Mayo Clinic. (2018). “Heart attack.” mayoclinic.org/diseases-conditions/heart-attack/symptoms-causes/syc-20373106
Heart Attack Symptoms (2): Merck Manual. (2019). “Acute Coronary Syndromes (Heart Attack; Myocardial Infarction; Unstable Angina).” merckmanuals.com/home/heart-and-blood-vessel-disorders/coronary-artery-disease/acute-coronary-syndromes-heart-attack-myocardial-infarction-unstable-angina
Heart Attack Symptoms in Women (1): Circulation. (2016). “Acute Myocardial Infarction in Women.” ahajournals.org/doi/full/10.1161/CIR.0000000000000351
Heart Attack Symptoms in Women (2): American Heart Association. (2015). Heart Attack Symptoms in Women. heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women
Heart Attack Symptoms in Women (3): Harvard Medical School. (2016). “The heart attack gender gap.” health.harvard.edu/heart-health/the-heart-attack-gender-gap