Heart Attack Warning Signs: What to Recognise and What to Do Immediately
A heart attack happens when blood flow to part of the heart muscle is suddenly blocked, usually by a clot forming on a ruptured fatty plaque in a coronary artery. The muscle begins to die within minutes, so the speed of treatment largely decides how much of the heart is saved. Recognising the signs and acting at once is one of the most valuable pieces of health knowledge a person can have.
The classic symptoms
The best-known sign is chest discomfort, but patients rarely describe it as sharp pain. More often it is:
- Pressure, tightness, squeezing or heaviness in the centre or left of the chest
- Lasting more than a few minutes, or going away and returning
- Spreading to the left arm, both arms, shoulder, neck, jaw or back
- Accompanied by sweating, nausea, breathlessness or light-headedness
Some people say it feels like an elephant sitting on the chest, or severe indigestion that does not settle.
Symptoms that are easy to miss
Not every heart attack looks like the film version. Atypical presentations are common, especially in:
- Women, who may have jaw or back pain, unusual fatigue, nausea, breathlessness or a feeling of dread, sometimes with little or no chest pain
- Older adults, who may simply feel suddenly weak, confused or short of breath
- People with diabetes, whose nerves may dull the sensation of pain, producing a so-called silent heart attack
If something feels seriously wrong and is out of character, treat it as possibly cardiac, even without chest pain.
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What to do in the first minutes
- Call emergency services immediately. Do not wait to see whether it passes. Paramedics can begin treatment on the way and alert the hospital.
- Do not drive yourself. If you collapse at the wheel, you endanger others. Do not let someone drive you if an ambulance can reach you.
- Chew an aspirin (300 mg, or 325 mg in the United States) if you are not allergic, have not been told to avoid it, and emergency services advise it. Chewing absorbs it faster. Do not delay the call to find one.
- Sit down, stay calm and loosen tight clothing. Keep still.
- Unlock the door and, if possible, have someone wait outside to guide the crew.
- Be ready to start CPR. If the person becomes unresponsive and is not breathing normally, begin chest compressions at about 100 to 120 a minute, pushing hard in the centre of the chest, and use an automated external defibrillator (AED) if one is available.
What happens at hospital
An ECG is done within minutes. If it shows a complete blockage, known as a STEMI, the standard treatment is primary percutaneous coronary intervention: a thin catheter is threaded to the blocked artery, the clot is cleared and a stent holds the vessel open. Where that is not quickly available, clot-dissolving drugs are given. Blood tests for troponin, a protein released from damaged heart muscle, confirm injury in other types of heart attack. The saying “time is muscle” is literal, and treatment within the first hour gives the best results.
Risk factors
The main modifiable risks are high blood pressure, high LDL cholesterol, smoking, diabetes, obesity, physical inactivity and an unhealthy diet. Age, male sex and a family history of early heart disease also contribute. Chronic stress, heavy drinking and air pollution add to the risk.
Recovery and prevention
After a heart attack, most people are offered cardiac rehabilitation, a supervised programme of exercise, education and support that lowers the chance of another event. Standard medication includes antiplatelets such as aspirin plus a second agent for a period, a statin, a beta-blocker, an ACE inhibitor or similar, and treatment for diabetes and blood pressure. Stopping smoking, eating a Mediterranean-style diet, staying active and managing stress are central.
Many people experience anxiety or low mood afterwards. This is common and treatable, and it is part of recovery too.
Don’t wait
The most common and costly mistake is delay. People put symptoms down to indigestion, a pulled muscle or a fear of making a fuss. If you suspect a heart attack, call for help. A false alarm is far better than a lost heart.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.