Symptoms and signs of a heart attack

It's vital to understand the importance of recognising the symptoms of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction.. Being aware of these symptoms could save your life, or that of a person close to you.

If you suspect that you or someone else is having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., you need to call an ambulance immediately. Abnormal heart rhythms can cause sudden death within an hour of having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..[1]

Research suggests that at least a quarter of all heart attacks go unrecognised. This may be because, in some people, the symptoms are minimal or not present at all; or because people simply fail to realise that their symptoms indicate a potentially life-threatening health problem.[2]

Read more below about 'Silent' heart attacks and Signs and examination.

The chest pain of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. is usually felt in the centre of the chest or beneath the breastbone. It has been described as a feeling of tightness or heaviness, or a pressing, constricting or oppressive pain.

While heart attacks are more common in older people, they can occur in younger people - under 45 - as well. Just because a person is younger or may not have the typical risk factors for a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., it is still important to consider whether he or she may be having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. if certain symptoms are present.[3]

The common symptoms of having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. are summarised below:[1,4]

  • Pain in the centre of the chest
  • Pallor (paleness)
  • Pain or pressure in the upper abdomenThe part of the body that contains the stomach, intestines, liver, gallbladder and other organs., jaw or arms
  • Breathlessness
  • Nausea and vomiting
  • Sweating, feeling clammy
  • Palpitations
  • Collapse or passing out
  • Strong sense of impending doom.

The chest pain of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. is usually felt in the centre of the chest or beneath the breastbone. It has been described as a feeling of tightness or heaviness, or a pressing, constricting or oppressive pain. The pain may spread from the chest to the neck, or to either the left or the right arm.[1,4-6]

The pain is felt in the same place as anginaA central chest pain caused by insufficient oxygen supply to the heart. pain, though it is usually more severe than anginaA central chest pain caused by insufficient oxygen supply to the heart., it usually lasts longer, and is not relieved by someone's usual medication. People who have not experienced anginaA central chest pain caused by insufficient oxygen supply to the heart. in the past may not recognise the pain of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. or realise that it is similar to that of anginaA central chest pain caused by insufficient oxygen supply to the heart..[1,4-6]

Having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. can cause irregular or abnormal heart rhythms. It can also cause a severe drop in bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure. Both of these effects can cause someone to collapse or pass out.[1]

'Silent' heart attacks

More often than not, chest pain is viewed as the key symptom of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction.. It is important to remember, though, that some people who have a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. will not feel much or any pain.[1]

Sometimes, other symptoms, such as breathlessness or nausea, are the main clues that someone is having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..[1] In fact, breathlessness is the most common symptom in someone who is having a so-called 'silent' heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. - in other words, a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. where there is no chest pain.[3]

This type of heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. is more common in people who:[2]

  • Have high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure
  • Are elderly
  • Have diabetes mellitusDisordered energy metabolism and high levels of glucose in the blood owing to a lack of insulin, or poor response of the body to insulin.
  • Are female.

Someone having a silent heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. may be slower to seek medical attention.[3] Women and older people are especially likely to delay attending hospital when having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction..

Furthermore, some researchers believe that having high blood pressure may interfere with a person's perception of the pain of a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction., as can having diabetes. This is thought to be because diabetes can damage the nerves that carry pain signals.[2]

Clues that somebody may be suffering a 'silent' heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. may include:[5,6]

  • Unusual breathlessness
  • Abdominal pain
  • Nausea and vomiting
  • Fainting
  • Confusion
  • Extreme fatigue.

Signs and examination

A doctor may not be able to tell that someone is having a heart attackThe death of a section of heart muscle caused by an interruption in its blood supply. Also called a myocardial infarction. from a physical examination alone. However, there may be important clues from the person's appearance, pulse, blood pressure and heart sounds heard through a stethoscope. The person may:[4,6]

  • Look pale and/or sweaty
  • Be anxious and distressed
  • Have a fast heart rate (or, sometimes, an abnormally slow heart rate)
  • Be having difficulty breathing
  • Have irregular or abnormal heart rhythms
  • Have abnormal heart sounds or murmurs on listening to the chest with a stethoscope
  • Have very low blood pressure The pressure of blood within the arteries.(or, sometimes, high bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure).

Read more about what a doctor listens for with a stethoscope.

References: 
  1. Boon NA, Colledge NR and Walker BR. Davidson's Principles and Practice of Medicine. Churchill Livingstone Elsevier. 2006; 20th edition.
  2. Unrecognized myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Sheifer SE, Manolio TA, Gersh BJ et al. Ann Intern Med. 2001;135:801-11.
  3. Diagnosis and management of ST elevation myocardial infarctionDeath of an area of heart muscle due to poor blood supply.: a review of the recent literature and practice guidelines.  Hahn SA, Chandler C. The Mount Sinai Journal of Medicine. 2006;73:469-81.
  4. Longmore M, Wilkinson I, Török E. Oxford Handbook of Clinical Medicine. 2002; 5th edition.
  5. Signs and symptoms in diagnosing acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply. and acute coronary syndromeA range of clinical conditions caused by coronary artery disease: it encompasses the full spectrum from unstable angina to heart attack.: a diagnostic meta-analysis. Bruyninckx R, Aertgeerts B, Bruyninckx P et al. Br J Gen Pract. 2008;58:105-11.
  6. Improving the early diagnosisThe process of determining which condition a patient may have. of acuteHas a sudden onset. myocardial infarctionDeath of an area of heart muscle due to poor blood supply.. Banerjee A. Postgrad Med J. 1996; 72: 705-8.