Part C
Heart attack signs and what to do
A heart attack happens when blood flow to the heart is blocked. Learn the signs, including less typical ones, what to do at once and what recovery involves.
Overview
Many people picture a heart attack as sudden, dramatic chest pain, and some are. Others begin slowly, with mild discomfort that is easy to explain away, and that gap between expectation and reality costs time. This page sets out the typical and less typical signs, what to do, what the aspirin advice from the NHS says and how it is limited, what happens in hospital, how a heart attack differs from cardiac arrest and heart failure, and what recovery involves. It is general education and cannot assess anyone's symptoms.
The signs, typical and less typical
A heart attack happens when blood flow to the heart is blocked, so part of the heart muscle is starved of oxygen. The American Heart Association (AHA) says most people having one feel discomfort in the centre of the chest that can last more than a few minutes, or go away and come back. It may feel like uncomfortable pressure, squeezing, fullness or pain. The NHS describes it as feeling crushing or squeezing, and says the pain can spread to the arms, neck and jaw.
The AHA also lists discomfort in other parts of the upper body, including one or both arms, the back, the neck, the jaw and the stomach, and shortness of breath with or without chest discomfort. Other possible signs include a cold sweat, nausea, lightheadedness, feeling unusually tired and a rapid or irregular heartbeat. The NHS adds indigestion-like discomfort, vomiting and pale, blue or grey skin.
The AHA says women's most common symptom is also chest pain or discomfort, but that they may have signs less associated with a heart attack, such as shortness of breath, nausea, vomiting, upset stomach, pain in the shoulder, back or arm, anxiety and unusual tiredness and weakness. The US Centers for Disease Control and Prevention (CDC) similarly says women are more likely to have other symptoms such as unusual or unexplained tiredness and nausea or vomiting. The pages used here do not set out signs specific to older people, so none are claimed.
What to do: call and do not wait
Call your local emergency number immediately. Numbers differ by country: the NHS gives 999 for the United Kingdom, while the AHA and CDC give 911 for the United States. The AHA says not to wait to get help and that even if you are not sure it is a heart attack, you should get checked out. It adds that minutes matter and that calling is almost always the fastest way to get lifesaving treatment, because an ambulance team can begin treatment when it arrives.
The NHS says not to drive yourself to hospital, and that the person who answers the 999 call will give advice about what to do. Do not wait to see whether the discomfort passes.
Aspirin and what to do while waiting
The NHS page says that while waiting for help, a person can take aspirin (300mg) if they have any, and that aspirin should not be given to someone with an aspirin allergy. It also says to take glyceryl trinitrate (GTN) spray if you have angina and have it with you, to keep checking that someone who may be having a heart attack is responding and breathing, and to start CPR if they stop responding and stop breathing. The AHA and CDC pages used here make no statement about aspirin.
This is a description of one national service's advice, not an instruction for any reader. Aspirin is not suitable for everyone, and the emergency call handler or ambulance staff decide what is right in the moment, so tell them what is available and follow their instructions.
What happens in hospital, and the difference from similar terms
Treatment depends on severity. The NHS lists medicines to clear blockages and improve blood flow, angioplasty (opening arteries, often with a stent) and bypass surgery. It notes that a heart attack can be life-threatening and cannot always be treated successfully. Getting to an emergency room sooner means treatment can start sooner, which the CDC says can reduce heart muscle damage.
Three terms are often mixed up. A heart attack is a blockage of blood flow to the heart. A cardiac arrest is when the heart suddenly stops and the person loses consciousness, and the NHS says it is a different condition that needs different treatment. Heart failure, by the NHS definition, is when the heart cannot pump blood properly, and it does not mean the heart has stopped working or is about to stop.
Recovery and cardiac rehabilitation
The NHS says recovery varies, from several weeks to months or years, and that most people need rest and are referred to cardiac rehabilitation, which can be in person or done remotely. Most people can eventually return to normal activities. The CDC describes cardiac rehabilitation as a supervised programme that can include physical activity, education on healthy living and counselling for stress and mental health.
Prevention afterwards overlaps with everyday heart health. The CDC lists healthier eating, more physical activity, quitting smoking and managing stress, along with prescribed medicines. For background, see physical activity and the heart, cholesterol and blood fats and high blood pressure explained. A GP can help if anxiety or low mood follow, as the NHS notes.
When to see a clinician
Call your local emergency number straight away for chest pressure or pain, pain spreading to the arm, jaw or back, severe breathlessness, a cold sweat, or someone who passes out and does not respond normally. Do not drive yourself. For milder or recurring chest discomfort, see a clinician promptly; how quickly depends on your symptoms, and a call handler can advise.
In short
Heart attack signs include chest pressure, pain spreading to the arm, jaw or back, breathlessness, a cold sweat and nausea, and some people, particularly women, notice less typical signs. Call the local emergency number at once and do not wait. Aspirin advice exists in the NHS guidance, but emergency staff decide. Recovery usually includes cardiac rehabilitation.