A few years ago, a friend of mine was walking in the woods behind her home — something she did nearly every day — when she felt a squeezing pain in her chest. She didn’t think she was having a heart attack, but the pain wouldn’t go away and she was scared to death that it was a warning sign.
Signs of a heart attack
For some people, there will be no doubt that they’re having a heart attack because the pain will be sudden and intense. But many times, a heart attack starts slowly with only mild discomfort. Either way, it’s important to get medical care right away.
Here are the most common heart attack symptoms:
- Chest pain or discomfort
- Usually in the center of the chest
- Lasts more than a few minutes or comes and goes
- Can feel like uncomfortable pressure, squeezing, fullness or pain
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach
- Shortness of breath (with or without chest discomfort)
- Unusual fatigue
- Breaking out in a cold sweat or feeling nauseous or lightheaded
The #1 symptom in men and women is chest pain or discomfort. According to the American Heart Association, women are somewhat more likely than men to also experience other common symptoms, especially shortness of breath, nausea/vomiting, and back or jaw pain. Someone with diabetes may have very mild or even no symptoms. Whatever your symptoms, if you have a concern, err on the side of caution and call 9-1-1.
Think you’re having a heart attack? Don’t waste valuable time debating the issue.
Call 9-1-1.
In the ER
My friend went to the ER where the doctor asked her a lot of questions about her symptoms, lifestyle, level of daily activity, and her medical and family history. There happens to be a strong history of heart disease on one side of her family.
She had an electrocardiogram (EKG), which can show if there’s any damage to the heart — where and how much. It also measures the heart’s electrical activity.
They tested her blood. If the heart muscle is damaged, enzymes and proteins inside its cells are released into the bloodstream. Higher than normal levels of proteins in the blood may indicate a heart attack. Measuring the enzymes can help determine the size of an attack and approximately when it started.
Some other tests that might be done include an echocardiogram, MRI, CT scan, and/or heart catheterization.
The tests my friend underwent showed she wasn’t having a heart attack, but the ER doctor decided to keep her overnight for observation. He also ordered a morning stress test. Thankfully, she passed it with flying colors.
What causes heart attacks?
Most heart attacks happen because an artery to the heart is blocked by a buildup of plaque — something that happens gradually over time.
The more blocked the artery becomes, the less blood can flow to that part of the heart.
If the plaque ruptures or breaks open, a blood clot can form at the site and totally block the artery.
Some people will experience warning signs that an artery is narrowing — the first one is usually angina (chest pain). But you may not have any symptoms at all until you are having a heart attack.
An ounce of prevention
Thanks to years of research, we know quite a bit about heart attack risk factors. Some risk factors you can’t change. For instance, you can’t change your age (risk increases with age), sex (more heart attacks in men), or family history, but there are a number of things you can do to lower your risk of developing heart disease and having a heart attack.
- If you smoke, quit!
- Avoid second-hand smoke
- Control high blood pressure
- Eat foods that are low in saturated fat, trans fat, cholesterol and salt
- Be physically active
- Maintain a healthy weight
- If you have diabetes, keep your glucose under control
What about aspirin?
Taking a low-dose aspirin every day may lower your risk of heart attack, but you should always check with your doctor first. According to the American Heart Association, you shouldn’t do it if you:
- Have an aspirin allergy or intolerance
- Are at risk for gastrointestinal bleeding or hemorrhagic stroke
- Drink alcohol regularly
- Are undergoing any simple medical or dental procedures
- Take other medications that could interact with aspirin
In the fall of 2021, the U.S. Preventive Services Task Force added to those guidelines, stating that you should not take a low-dose aspirin every day if:
- You’ve never had any heart-related problems or events, such as a stent or heart attack
- You have an increased risk of bleeding
- You’re over age 60 and aren’t already taking daily aspirin.
As for taking aspirin if you think you’re having a heart attack — your first step should always be to call 9-1-1. Never take an aspirin and then wait to see if your symptoms go away before calling for help.
No excuses
Aspirin or not, some people decide to wait things out at home, but the delay could cause serious damage to your heart if you are having a heart attack. It might even make the difference between life and death.
My friend thought about waiting. Here are some of the “good reasons” she came up with:
- It’s probably nothing
- If I tell my husband, he’ll be worried
- I don’t want to waste the ER’s time
- I can go in tomorrow if it’s not any better
In the end, she was so alarmed by her symptoms, she went to the ER. It was the right thing to do. She needed further testing to figure out what caused her pain, but she had peace of mind knowing that her heart was healthy.
Please, if you think you’re having a heart attack or you’re with someone who may be having one, forget the excuses. Call 9-1-1.
And take a second to share this valuable advice with others.
I’ve experienced those symptoms several times in the past — chest discomfort/tightness, discomfort/tightness/tingling in arms/neck/back/jaw, cold sweat, lightheadedness — and in most cases it was so sudden and so alarming that I went to the ER. They were always able to rule out a heart attack but were never able to tell me what was causing the symptoms. Eventually I stopped going to the ER when these “attacks” happened because I didn’t want to spend 4-6 hours in the ER just to have them tell me that it was “nothing” and send me home with a huge bill. My doctor suspects that these attacks might be esophageal spasms, which apparently can mimic the symptoms of a heart attack.
So here’s my question: is there any way to differentiate esophageal spasms from a heart attack, short of having an EKG and cardiac enzyme tests?
Adrian, I don’t have an answer, but I will ask a cardiologist and an upper GI specialist and see what they have to say.
i have the same problem as Adrian. I have had all these symptoms for years but passed a stress test and ekg so I don’t go anymore. If I went every time they’d label me a nut and I would be broke.
I have had chest pain and pressure for awhile now. I get “twinges” like a bee sting in my chest wall and palpitations too. I went to my DR and was pretty much written off as “depression” because it was just after my husband passed away. Of course I was depressed, but I wasn’t imagining the pain. Since my brother and father died from heart attacks I was concerned so I went to the ER a few days later. They did lab work and an EKG & said everything was normal.
That was 18 months ago and I still get the pains.
So I have been changing my diet and exercising (ironically by shoveling snow, which is usually the cause of chest pain). I also have bloating on a regular basis and sometimes arm pain. I have lost 17 lbs and feel better but not normal.
I was feeling much like Adrian wondering, how do you know? I sure can’t go to the ER every time I feel this. I would be bankrupt in no time. But on the other hand …
I should add that they were able to rule out anxiety/panic attacks in my case because these episodes usually happen to me when I’m perfectly calm and content, such as reading a good book, listening to music, etc.
Adrian and Linda,
I posed your questions to some doctors and they all said basically the same thing:
The safest thing to do if a heart attack is suspected in to have an EKG and cardiac enzyme testing. Since it was ruled out for both of you, the next step would be to work with your primary doctor to figure out another cause. Adrian, you mentioned esophageal spasms — there are tests/procedures that could help determine it that’s your problem.
I hope you are both able to figure things out and feel better. Let me know!
It’s very important for people who think they might be having a heart attack, to call 911. They should not drive themselves to an ED or have a neighbor or spouse drive them. Passing out while driving or while being driven by somebody else could result in a car accident or your death, because you didn’t get medical help right away. Please call 911.