Heart Attack Symptoms in Men and Women: Warning Signs and What to Do Immediately

A heart attack (myocardial infarction) occurs when blood flow to part of the heart muscle is suddenly blocked, usually by a clot forming on fatty plaque in a coronary artery. Heart muscle begins to die within minutes, so fast treatment saves life and limits damage. Knowing the symptoms, including the less typical ones, is essential for everyone, especially adults with diabetes, high blood pressure, high cholesterol or a family history.

Classic symptoms

• Chest pain or discomfort: pressure, squeezing, tightness, fullness or heaviness, usually in the centre or left of the chest, lasting more than 10-15 minutes or coming and going
• Pain spreading to the left arm, both arms, shoulder, neck, jaw, teeth or back
• Shortness of breath, with or without chest discomfort
• Cold sweat, pale or clammy skin
• Nausea or vomiting
• Light-headedness, fainting or a sense of doom

Pain is often not sharp or stabbing and does not change with breathing or pressing the chest wall.

Symptoms in women, older adults and people with diabetes

These groups more often have "atypical" symptoms:

• Unusual or extreme tiredness that is new
• Breathlessness on minor effort or at rest
• Discomfort in the upper abdomen, mistaken for indigestion
• Pain in the jaw, neck or back
• Nausea, dizziness or cold sweats

People with diabetes may feel little pain because of nerve damage ("silent heart attack"). Any new, unexplained symptom that feels different from your usual self should be checked. Read our guide on chest pain or acidity if you are unsure.

Warning signs before a heart attack

Some people have angina, chest tightness on exertion that eases with rest, for weeks before. Angina that is new, more frequent, comes at rest or lasts longer (unstable angina) is a warning that needs urgent medical review.

What to do: act in minutes

1. Call for an ambulance immediately (1990 in Sri Lanka). Do not wait to see if the pain goes away.
2. Stop activity and sit or lie in a comfortable position, such as half-sitting with knees bent.
3. Chew aspirin (one 300 mg tablet) if advised by the emergency operator, and only if you are not allergic and have no known bleeding problem. Do not take it if you suspect a stroke.
4. If prescribed, use glyceryl trinitrate (GTN) under the tongue as directed, but not if your blood pressure is very low or you have taken erectile dysfunction medicines recently.
5. Loosen tight clothing and stay calm. Unlock the door for the paramedics.
6. Do not drive yourself to hospital unless there is no other option.
7. Be ready to start CPR if the person collapses and stops breathing normally.

Cardiac arrest and CPR

If someone collapses, does not respond and is not breathing or only gasping:

1. Call emergency services and ask someone to find a defibrillator (AED) if available.
2. Push hard and fast in the centre of the chest, about 5-6 cm deep, at 100-120 compressions per minute. If untrained, hands-only CPR is fine.
3. Continue until help arrives or the person recovers. Use an AED as soon as it is available, following its voice instructions.

Learning CPR takes about two hours and can save a family member's life.

Treatment in hospital

• ECG and blood tests (troponin) to confirm the diagnosis
• Opening the blocked artery: emergency angioplasty with a stent, or clot-dissolving medicine where angioplasty is not available
• Medicines: antiplatelets, blood thinners, beta-blockers, statins and others
• Cardiac rehabilitation: supervised exercise, education and risk-factor control

Treatment is most effective within the first hours. Each 30-minute delay raises the risk of death.

Risk factors you can change

• High blood pressure, high cholesterol and diabetes
• Smoking, including chewing tobacco and betel with tobacco
• Obesity, especially abdominal fat, and inactivity
• Unhealthy diet high in salt, sugar, refined starch and fried food
• Heavy alcohol use and chronic stress

South Asians have a high rate of heart attacks at younger ages. Screening from the 30s, healthy eating and waist control are important. Use our BMI calculator and diabetes risk calculator.

After a heart attack

Take medicines every day, attend cardiac rehabilitation, stop smoking, eat a heart-healthy diet (see our heart-healthy diet guide), and return to activity gradually. Depression and anxiety are common and treatable. Ask your doctor when you can return to work, drive, travel and resume sex.

When to see a doctor

Call for emergency help for chest discomfort lasting more than a few minutes, especially with sweating, breathlessness or nausea. See your doctor soon if you have chest tightness on exertion, a family history of early heart disease, or risk factors and want a heart risk check.

References

• European Society of Cardiology: guidelines for acute coronary syndromes
• American Heart Association / American College of Cardiology: chest pain guideline
• NICE guideline NG185: acute coronary syndromes
• World Health Organization: cardiovascular diseases fact sheet