Heart attack feels like

Catch the signs early

Don’t wait to get help if you experience any of these heart attack warning signs. Some heart attacks are sudden and intense. But most start slowly, with mild pain or discomfort. Pay attention to your body and call 911 if you experience:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes – or it may go away and then return. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath. This can occur with or without chest discomfort.
  • Other signs. Other possible signs include breaking out in a cold sweat, nausea or lightheadedness.

View or download a full-size Jpeg of the common heart attack warning signs infographic.

Download the heart attack warning signs infographic (PDF).

Symptoms vary between men and women

As with men, women’s most common heart attack symptom is chest pain (angina) or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Learn about the warning signs of heart attack in women.

Watch video: “Just A Little Heart Attack” – a short film directed by and starring Elizabeth Banks

Don’t hesitate to call 911

Learn the signs for heart attack, and remember: Even if you’re not sure it’s a heart attack, have it checked out.

Minutes matter. Fast action can save lives – maybe your own.

Call 911 if you experience heart attack warning signs. Calling 911 is almost always the fastest way to get lifesaving treatment.

An emergency medical services (EMS) team can begin treatment when they arrive – up to an hour sooner than if someone gets to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

For many reasons, it’s best to call 911 so that an experienced EMS team can begin treatment and arrange rapid transport to the emergency room.

Watch an animation of a heart attack.

Learn more:

Heart Attack Symptoms

When you’re having a heart attack, every second counts. Learn to recognize the signs and symptoms of a heart attack and seek treatment quickly.

Chest pain is a common symptom of heart attack. iStock

Heart attack symptoms vary in both type and severity.

Your symptoms may be mild and come on slowly over the course of several hours, or they may be sudden and intense.

Chest pain or pressure, in particular, can develop gradually and come and go, often getting worse with exertion and better with rest. (1)

While chest pain may be the most common heart attack symptom, not all people experience chest pain during a heart attack.

According to the National Heart, Lung, and Blood Institute, there’s evidence that about one-third of people with heart attacks experience no chest pain.

People with diabetes and older adults are more likely to experience a heart attack without chest pain. (2)

Heart attack symptoms in men and women are often different.

While the range of symptoms varies, the more symptoms you have, the more likely it is that you’re having a heart attack.

If you think you may be having a heart attack, it’s important to take action immediately. This means, above all, calling for emergency help.

Depending on your doctor’s instructions, you may also benefit from taking aspirin or other drugs that your doctor has prescribed. (1)

Most Common Symptoms

The most common warning signs of a heart attack include the following:

Chest Pain

Most heart attacks involve pain or discomfort in the center or left-center of your chest. This pain can range from mild to severe.

The pain may feel like tightness, fullness, heavy pressure, crushing, or squeezing. It can also feel like heartburn or indigestion.

Chest pain usually lasts more than a few minutes. Sometimes it goes away and comes back, with exertion making it worse and rest making it better.

Upper Body Discomfort

You may also feel pain or discomfort in your arms, jaw, neck, back (especially between your shoulders), or upper part of your stomach (above your belly button).

Sometimes, pain begins in your chest and then spreads to these other areas of your upper body.

Shortness of Breath

You may experience trouble breathing or the sensation of being winded when you’re at rest or doing very slight activity that wouldn’t normally cause breathlessness. Outside of chest pain, shortness of breath is one of the most common warning signs of a heart attack.

This may be the only symptom you experience, or it can happen before or along with chest or upper body pain. (1,2)

Other Common Symptoms

Other common warning signs that may signal a heart attack include:

  • Light-headedness or sudden dizziness
  • Cold sweat or clammy skin
  • Nausea and vomiting
  • Heart flutter or palpitations (especially in women)
  • Cough (especially in women)
  • Heartburn (especially in women)
  • Sleep disturbances (especially in women)
  • Anxiety (especially in women)
  • Extreme fatigue or exhaustion (may occur for days or even weeks leading up to a heart attack, especially in women) (1,2,3,4)

Silent Heart Attack Symptoms

Sometimes a heart attack doesn’t cause obvious symptoms. This is known as a silent heart attack.

Still, a silent heart attack may offer some warning signs, even if they’re brief and mild. These typically include variations on classic heart attack symptoms, such as:

  • Chest discomfort that lasts a few minutes, or comes and goes
  • Discomfort in your neck, jaw, arms, back, or stomach
  • Shortness of breath
  • Cold sweat
  • Nausea
  • Light-headedness (5)

Silent heart attacks are more common in women than in men. (4)

What to Do During a Heart Attack

A heart attack is a medical emergency.

The faster you get to a hospital, the better your chances of surviving the heart attack and minimizing damage to your heart muscle.

Even if you’re not sure your symptoms indicate a heart attack, you should seek emergency medical care. Never worry about a false alarm or causing anyone embarrassment.

Follow these steps if you or someone around you is having heart attack symptoms:

Call 911 Immediately

Don’t wait more than five minutes before calling for help.

If you take nitroglycerin for chest pain that comes on with exertion and goes away with rest, take it immediately.

If your chest pain doesn’t go away within five minutes, call 911.

An ambulance is the best way to get to the hospital, since you can be monitored and start treatments while on your way.

If you cannot call 911 for some reason, have someone drive you to the hospital.

Never drive yourself unless there is absolutely no other choice. (1,2)

Chew One Aspirin if Recommended

After you call 911, the operator may tell you to take an aspirin.

Aspirin may help to slow or reduce clotting and blockage around the site of a ruptured plaque deposit in your artery. This can limit damage to your heart and help save your life.

But aspirin won’t cure a heart attack or make your symptoms go away, so never delay calling 911 to take an aspirin.

You may be told not to take aspirin if you take a medication that can interact with it. (1,2)

Sit Down and Stay Calm

Try to relax and remain calm while you wait for help to arrive.

If you’re at home alone, open the front door and sit on the floor near the entrance.

This will help the paramedics easily find you in case you lose consciousness before the ambulance arrives, and give them a flat surface on which to begin CPR if necessary.

Note the Time

If you’re able to do so, record the time your heart attack symptoms began and what you were doing when they started.

This information may help the doctors treating you when you reach the hospital.

Additional reporting by Quinn Phillips.

Am I having a panic attack or a heart attack?

Panic attacks and heart attacks can feel frighteningly similar: shortness of breath, palpitations, chest pain, dizziness, vertigo, feelings of unreality, numbness of hands and feet, sweating, fainting, and trembling. Some people describe this experience as feeling as if they’re losing control or going to die.
A panic attack occurs spontaneously or a stressful event can trigger it, but it poses no immediate danger. A heart attack is dangerous, and it requires prompt medical attention. In women, though, heart disease symptoms are sometimes mistaken for a panic attack.
Panic disorder is diagnosed in people who experience panic attacks and are preoccupied with the fear of a recurring attack. Like all anxiety disorders, this one is treatable.
Reid Wilson, PhD (at right), offers this advice:

For someone who has had a heart attack and also has panic attacks, together we identify, along with their physician, the symptoms that should trigger an immediate trip to the emergency room. Whether it turns out to be another panic attack or not, this person should treat those symptoms as a possible heart attack. He or she is to treat all other symptoms as signs of anxiety or a panic attack, even though they may feel like a heart attack.
Those who have never had a heart attack—but have been diagnosed with panic disorder and are fearful of a heart attack—should get a thorough physical evaluation to determine their heart health. If they are not at risk of a heart attack, then we begin the psychological work: They must be willing to be uncertain whether they are having a panic attack or a heart attack.
Their first goal is to respond to their typical anxiety or panic symptoms as anxiety or panic. Their position should be to say, ‘I want to recover from panic disorder strongly enough that I am willing to have a heart attack and miss it.’ That is how they will confront their need to be 100 percent certain.
Recent research suggests that people who have received a diagnosis of panic attacks or panic disorder under age 50 have an increased risk of developing heart disease or suffering a heart attack. The conclusions in this study are not definitive, and reasons for the increase in heart disease and heart attack were not established. More studies must be conducted to find out whether panic disorder is a risk factor for developing heart disease.
Mark Pollack, MD (at left), says the findings of this research offer some value. He adds, “The study does suggest the possibility that, like other modifiable cardiac risk factors such as poor diet, sedentary lifestyle, or hypertension, treatment of panic and anxiety may have a beneficial effect on reducing the likelihood of developing heart disease.”
Whenever you’re in doubt about your symptoms, seek care without delay. Only medical tests can rule out the possibility of a heart attack. Once a heart attack is ruled out, seek effective treatment such as talk therapy and medication.
Find a therapist with experience treating panic disorder to learn how to manage panic attacks in the future.
Learn seven steps to break the cycle of panic in Facing Panic, Self-Help for People with Panic Attacks.
Reid Wilson, PhD, is the Director of the Anxiety Disorders Treatment Center, Chapel Hill, North Carolina, and the Associate Clinical Professor of Psychiatry at the University of North Carolina School of Medicine .
Mark H. Pollack, MD, is the Chairman of the Psychiatry Department at Rush University Medical Center in Chicago, Illinois. He is a member of the ADAA Board of Directors.

We’ve all seen the movie scenes where a man gasps, clutches his chest and falls to the ground. In reality, a heart attack victim could easily be a woman, and the scene may not be that dramatic.

“Although men and women can experience chest pressure that feels like an elephant sitting across the chest, women can experience a heart attack without chest pressure, ” said Nieca Goldberg, M.D., medical director for the Joan H. Tisch Center for Women’s Health at NYU’s Langone Medical Center and an American Heart Association volunteer. “Instead they may experience shortness of breath, pressure or pain in the lower chest or upper abdomen, dizziness, lightheadedness or fainting, upper back pressure or extreme fatigue.”

Even when the signs are subtle, the consequences can be deadly, especially if the victim doesn’t get help right away.

‘I thought I had the flu’

Even though heart disease is the No. 1 killer of women in the United States, women often chalk up the symptoms to less life-threatening conditions like acid reflux, the flu or normal aging.

“They do this because they are scared and because they put their families first,” Goldberg said. “There are still many women who are shocked that they could be having a heart attack.”

A heart attack strikes someone about every 43 seconds. It occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely. This happens because the arteries that supply the heart with blood can slowly narrow from a buildup of fat, cholesterol and other substances (plaque).

Watch an animation of a heart attack.

Many women think the signs of a heart attack are unmistakable — the image of the elephant comes to mind — but in fact they can be subtler and sometimes confusing.

You could feel so short of breath, “as though you ran a marathon, but you haven’t made a move,” Goldberg said.

Some women experiencing a heart attack describe upper back pressure that feels like squeezing or a rope being tied around them, Goldberg said. Dizziness, lightheadedness or actually fainting are other symptoms to look for.

“Many women I see take an aspirin if they think they are having a heart attack and never call 911,” Goldberg said. “But if they think about taking an aspirin for their heart attack, they should also call 911.”

Take care of yourself

Heart disease is preventable. Here are Goldberg’s top tips:

  • Schedule an appointment with your healthcare provider to learn your personal risk for heart disease.
  • Quit smoking. Did you know that just one year after you quit, you’ll cut your risk of coronary heart disease by 50 percent?
  • Start an exercise program. Just walking 30 minutes a day can lower your risk for heart attack and stroke.
  • Modify your family’s diet if needed. Check out these healthy cooking tips. You’ll learn smart substitutions, healthy snacking ideas and better prep methods. For example, with poultry, use the leaner light meat (breasts) instead of the fattier dark meat (legs and thighs), and be sure to remove the skin.

Learn more:

  • Angina in Women
  • Go Red for Women
  • Menopause and Heart Disease

Sweating. Pressure. Nausea. Jaw pain. Believe it or not, these are all symptoms of a heart attack in women. They are also symptoms that women often brush off as the flu, stress or simply feeling under the weather—which could put their lives in jeopardy.

“I really couldn’t believe this happened to me,” says survivor Amy Heinl. “I thought of myself as a healthy person, and was exercising when happened.”

Whether it’s disbelief, lack of awareness or misdiagnosis, dismissing the symptoms of a heart attack can delay critical, life-saving actions. Being able to recognize the warning signs and act quickly, however, can save a life.

Causes of a heart attack in women

Heart attacks occur when the flow of blood to the heart is blocked by a buildup of plaque in coronary arteries. While the initial causation can often be pinned on the usual suspects—heavy smokers, people with high-stress lifestyles, or those who are excessively overweight—the not-so-usual suspects can also be at high risk for heart attack.

Heart disease is the No. 1 killer of women, which is why it is imperative that women learn the warning signs and symptoms, see a doctor regularly, and learn their family history.

Symptoms of a heart attack:

  • Uncomfortable pressure, squeezing, fullness or pain in the center of your chest that lasts more than a few minutes, or goes away and comes back.
  • Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath, with or without chest discomfort.
  • Other signs such as breaking out in a cold sweat, nausea or lightheadedness.

As with men, the most common heart attack symptom in women is chest pain or discomfort. But it’s important to note that women are more likely to experience the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

What to do during a heart attack

If you experience any of these signs or symptoms:

  • Do not wait to call for help. Dial 9-1-1, make sure to follow the operator’s instructions and get to a hospital right away.
  • Do not drive yourself or have someone drive you to the hospital unless you have no other choice.
  • Try to stay as calm as possible and take deep, slow breaths while you wait for the emergency responders.

Why it’s important to know the symptoms of a heart attack

Women who consider themselves healthy often misdiagnose the symptoms of a heart attack because they don’t think it could happen to them. That is why it’s crucial to learn about heart disease and stroke, know your numbers, live a heart-healthy lifestyle and be aware of the risk factors of heart disease.

Does Chest Pain Mean a Heart Attack? 6 Facts to Know

Most of us wisely think “heart attack” when someone has chest pain. More than 1 million people have a heart attack each year. That number equals the populations of Milwaukee and Minneapolis combined.

If you think you may be having a heart attack, call 9-1-1. Don’t wait. Call even if you don’t know if it’s a heart attack. The call can save your life.

And don’t drive yourself to the hospital even if you feel OK for a little while. Your condition can change quickly, and you will put others on the road in danger if you lose consciousness.

Here’s some additional information you should know about heart attacks:

Heart attacks can be tricky. Although it’s uncommon, not everyone who’s having a heart attack has chest pain.
Women may experience shortness of breath, fatigue, sudden weakness that feels like the flu.
Diabetics and the elderly may feel unwell, dizzy or weak. They may be short of breath.

Heart disease is the No. 1 killer of men and women. Know the four signs of a heart attack.

We do have some reassuring news: Chest pain may not be a heart attack. Let’s explore:

  1. Your health care professional may refer to “angina” or “angina pectoris.” That’s the medical term for chest pain. The terms encompass pressure or tightness in the chest.
    Angina is not the same as a heart attack. Here are some key differences:

Heart Attack


2. Heart attacks usually come on suddenly. Symptoms last longer – Usually more than 15 minutes.

Angina typically results from stress or exertion. Symptoms usually go away with rest in about 5 to 10 minutes.

3. The pain from a heart attack may be described as extreme pressure, squeezing or fullness. Some victims have no chest pain.

Angina is usually described as discomfort, rather than pain.

4. A heart attack can cause permanent damage to the heart muscle.

Angina doesn’t result in permanent damage to the heart.

5. Other than a heart attack, chest pain can be caused by heart conditions such as:

  • Mitral valve prolapse — your heart’s mitral valve doesn’t close correctly.
  • Myocarditis — a heart muscle inflammation. Along with chest pain, you may have a fever, fatigue and trouble breathing.
  • Pericarditis — an infection or inflammation of the sac around your heart. Pain from pericarditis tends to be sharp and steady. You’ll feel it along your upper neck and shoulder muscles. The pain may get worse when you breathe, swallow food or lie on your back.
  • Aortic dissection — a life-threatening tear develops in your aorta — your largest artery. This uncommon tear causes sudden severe, ripping pain in your neck, back or abdomen.

6. Chest pain can come from one of the other organs in your chest. In fact, for about 25 percent of people with chest pain, the source is not the heart. The source could be your lungs, esophagus, diaphragm (the muscle that draws air into your lungs) or your liver. You also have other muscles, tendons, ribs and lots of nerves in your chest that can be a source of chest pain. Chest pain can be caused by:

  • Heart burn (gastroesophageal reflux disease – GERD), stomach ulcers, an inflammation of your stomach lining (gastritis) or gallstones.
  • Lung problems such as blood clots, an infection (can result in pneumonia) or a collapsed lung.
  • A chest muscle or tendon strain.
  • Asthma.
  • Panic attack. This type of attack can happen without warning.

Now that we’ve reviewed some basic reasons other than a heart attack for chest pain, we want to reiterate a key point:

If you think you may be having a heart attack, call 9-1-1. You won’t know how serious it is until you see your health care professional. If you wait to “see what happens,” you may not see tomorrow.

If you have a chest pain that concerns you, see your health care provider.

You can schedule an appointment online or find a doctor to help guide you.

Once the cause of your discomfort is diagnosed, a course of treatment can be planned to get you back on your road to wellness.

Chest pain: A heart attack or something else?

What makes you worry that chest pain is serious, like a heart attack

Updated: February 6, 2019Published: May, 2010

When is chest pain serious? That dull burning feeling in your chest doesn’t seem to be going away, and even feels like it is getting worse. Is it a heart attack, or something else?

It’s a vexing question, one that millions of people — and their doctors — face each year. What’s the problem? Chest pain can stem from dozens of conditions besides heart attack, from pancreatitis to pneumonia or panic attack.

Millions of Americans with chest pain are seen in hospital emergency departments every year. Only 20% of them are diagnosed with a heart attack or an episode of unstable angina, a warning sign that a heart attack may happen soon. A few have another potentially life-threatening problem, such as pulmonary embolism (a blood clot in the lungs) or aortic dissection (a tear in the inner layer of the aorta). Some are experiencing “regular” angina, which occurs when part of the heart isn’t getting as much oxygen-rich blood as it needs during periods of physical exertion or emotional stress. Most of them, though, had a condition unrelated to the heart or arteries.

The other tricky problem with heart attacks is that different people experience them in different ways. Some have classic chest pain. Others have jaw pain or back pain. Still others become breathless, or extremely fatigued, or nauseated.

Chest pain and heart attack symptoms

Chest pain is only one of the possible signs of an impending heart attack. If you notice one or more of the signs below in yourself or someone else, call 911 or your local emergency number right away.

  • Uncomfortable pressure, squeezing, fullness, burning, tightness, or pain in the center of the chest

  • Pain, numbness, pinching, prickling, or other uncomfortable sensations in one or both arms, the back, neck, jaw, or stomach

  • Shortness of breath

  • Sudden nausea or vomiting

  • Lightheadedness or dizziness

  • Unusual fatigue

  • Heat/flushing or a cold sweat

  • Sudden heaviness, weakness, or aching in one or both arms

Describe chest pain to your doctor

Doctors use several pieces of information to determine who is, and who isn’t, having a heart attack. In addition to the description of your symptoms and your heart risk profile, doctors use the results of an electrocardiogram (ECG) and a blood test called cardiac troponin. But sometimes these don’t immediately show abnormalities. So, what you describe to the doctor and your medical history are extremely important in determining the initial steps in your treatment.

Here are some things your doctors will want to know about what you are experiencing:

  • What is it that you are feeling (pain, pressure, tightness, etc.)?

  • Where is the discomfort?

  • When did it start?

  • Has it gotten worse or stayed the same?

  • Is the feeling constant, or does it come and go?

  • Have you felt it before?

  • What were you doing before these feelings started?

Clear answers to these questions go a long way toward nailing down a diagnosis. A few seconds of recurrent stabbing pain is less likely to be a heart attack (see box), while pain centered in the chest that spreads out to the left arm or jaw is more likely to be one.

Chest pain symptoms and what they mean

More likely to be a heart attack

Less likely to be a heart attack

Sensation of pain, or of pressure, tightness, squeezing, or burning

Sharp or knifelike pain brought on by breathing or coughing

Gradual onset of pain over the course of a few minutes

Sudden stabbing pain that lasts only a few seconds

Pain in diffuse area, including a constant pain in middle of chest

Pain clearly on one side of the body or the other

Pain that extends to the left arm, neck, jaw, or back (see figure below)

Pain that is localized to one small spot

Pain or pressure accompanied by other signs, such as difficulty breathing, a cold sweat, or sudden nausea

Pain that lasts for many hours or days without any other symptoms

Pain or pressure that appears during or after physical exertion or emotional stress (heart attack) or while you are at rest (unstable angina)

Pain reproduced by pressing on the chest or with body motion

When chest pains are serious

Unlike an achy knee or crabby lower back, chest pain isn’t something to shrug off until tomorrow. It also isn’t something to diagnose at home. Don’t play doctor — go see one, fast, if you are worried about pain or discomfort in your chest, upper back, left arm, or jaw; or suddenly faint or develop a cold sweat, nausea, or vomiting. Call 911 or your local emergency number to summon an emergency medical crew. It will whisk you to the hospital in a vehicle full of equipment that can start the diagnosis and keep you stable if your heart really is in trouble.

There are oh-so-many reasons to delay calling for help.

  • I’m too young (you aren’t — even 20-somethings can have heart attacks).
  • I’m in great shape (a heart attack is sometimes the first sign of heart disease).
  • I have a family to take care of (all the more reason to get to the hospital fast).
  • I don’t want to bother anyone (you’d be a bigger bother with advanced heart failure, or dead).

Heart attack pain

Pain from a heart attack isn’t confined to the area around the heart. The most typical locations are marked in dark red; light red shows other possible areas.

What if it isn’t a heart attack? You will be evaluated as if you are having one and, when it is ruled out as the cause of your symptoms, your doctors will look for the actual cause. They won’t be mad at you for crying wolf. Instead, they should congratulate you for taking action (if they don’t, we will) and work with you to get at the root of your chest pain and ease it. If the cause was indigestion, a panic attack, or another possibly recurring condition, the emergency department doctors and your primary care physician can help you interpret what your body is telling you.

Chest pain is serious business. If you think yours might be due to a heart attack, take action right away. The sooner you are checked out, the sooner you can get the kind of artery-opening therapy that can protect your heart from permanent damage.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Chest pain severity not a heart attack indicator

NEW YORK (Reuters Health) – A high degree of pain does not make it any more likely that someone coming into the emergency room with chest pains is having a heart attack, researchers found in a study of more than 3,000 patients.

The most severe chest pain was not a good predictor of which patients were actually having a myocardial infarction, or heart attack, nor of which patients were most prone to having one within the next month.

Conversely, “If chest pain isn’t severe, that doesn’t mean it’s not a heart attack,” said Dr. Anna Marie Chang, an author of the study and an emergency physician at the Hospital of the University of Pennsylvania.

Using a scale of zero to 10, with zero representing no pain and 10 being the worst imaginable, researchers gauged the pain levels of about 3,300 patients who arrived at the UPenn hospital emergency department complaining of chest pain. They then followed the patients for 30 days to see who had further heart-related events.

Patients with the most severe chest pain were no more likely to be having a heart attack, or to have one within the next month, than patients with lesser pain. Pain that lasted more than an hour was also not a useful sign of a heart attack versus other conditions.

Chest pain of any severity should be cause for concern, experts caution. Pain is a red flag for other serious health problems, too, such as stomach ulcers or a tear in the aorta, the heart’s main artery, like the one that killed actor John Ritter in 2003.

“The cause of chest pain may or may not be a heart attack, but it could definitely be something serious,” said Dr. James Feldman, an emergency physician at Boston Medical Center who was not involved in the study.

Classic heart attack symptoms do include chest pain or pressure, but other hallmarks are shortness of breath, nausea, vomiting and faintness.

Moreover, the pain of a heart attack doesn’t always settle in the chest area.

“Pain may occur in the chest, arm, jaw, back or abdomen and may be described differently by different people,” said Dr. Rajiv Gulati, a cardiologist at the Mayo Clinic in Rochester, Minnesota, who was not involved in the study.

Although in the study pain severity wasn’t a good indicator of who was having a heart attack at the hospital, having arrived at the emergency department in an ambulance was.

That may be because people tend to dismiss chest pain until they are having symptoms they deem serious enough to warrant calling emergency services, Feldman explained.

“If you are only waiting for crushing chest pain, you may wait to delay care, and that would be a problem,” he said. “Any chest pain is a serious complaint and means you need to seek medical care right away.”

“Unexplained chest discomfort should be taken seriously, regardless of the intensity of pain,” Gulati agreed. “Early evaluation can save lives.”

The current findings, published in the Annals of Emergency Medicine, could also help save doctors money by helping them judge who is and is not having a heart attack.

Failures to diagnose acute myocardial infarction account for 20 percent of malpractice claims paid out, the authors note, and some two to five percent of patients who are having heart attacks are inappropriately discharged from emergency departments.

SOURCE: bit.ly/rsYHcU Annals of Emergency Medicine, online August 1, 2011.

Our Standards:The Thomson Reuters Trust Principles.

You know what a heart attack is supposed to feel like. It’s that sudden, intense, squeezing chest pain, like an elephant sitting on your chest. Right?

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That’s certainly the classic presentation, says cardiologist Venu Menon, MD. But that’s not what most heart attack patients actually experience, he says.

“A minority of patients have those classical symptoms,” says Dr. Menon. “Many others have symptoms that are more subtle and can be confused with other conditions.”

Symptoms you never suspected

So, what does a heart attack really feel like? According to Dr. Menon, patients most often report:

  • Heartburn-like chest pain. It’s quite common for heart attacks to feel like acid reflux.
  • Shortness of breath. Some heart attacks don’t cause pain at all. These “silent heart attacks” are most common in people with diabetes, older adults and those who have had bypass surgery.
  • Profound fatigue. This symptom is most common in elderly patients and can be misdiagnosed as a flu-like illness.
  • Nausea and sweating. While these symptoms can come with heavy chest pain, they also can occur by themselves, especially in women. These symptoms commonly accompany heart attacks to the inferior wall (bottom) of the heart.

When to call 911

Heartburn, breathlessness and other subtle symptoms aren’t always heart attacks. How can you tell a minor ailment from a heart attack?

“It’s challenging,” admits Dr. Menon. “And that’s a big reason why people don’t get to the doctor sooner when they’re having a heart attack.”

In general, call 911 if:

  • Symptoms occur suddenly and persist for more than five to 10 minutes.
  • Shortness of breath and chest discomfort occur while you’re at rest.
  • You develop symptoms and are a middle-aged or older adult and have a history of smoking, are diabetic or have a strong family history of heart disease. Although premenopausal women are usually protected from heart attacks, younger women who smoke, have diabetes or have ovarian dysfunction also are vulnerable.

It will take a clinical evaluation along with blood tests and an electrocardiogram (EKG) to definitively diagnose a heart attack, says Dr. Menon.

Don’t drive to the ER

If you might be having heart attack symptoms, call 911 for an ambulance to take you to be evaluated. Don’t drive yourself or have a friend drive you to the emergency room.

“About one in 300 people having heart attack symptoms end up developing a life-threatening arrhythmia on the way to the hospital,” says Dr. Menon. “If you’re in an ambulance, the emergency medical team will have you connected to an EKG and will be able to begin treatment right away. If you’re in a car….”

What a heart attack doesn’t feel like

Not all chest pain is a heart attack symptom. Pain is unlikely to be heart-related when it:

  • Is momentary, lasting only for a few seconds.
  • Feels like a pricking sensation.
  • Is in a small, well-localized area of your chest.
  • Can be reproduced when you press on your chest or move your arm.
  • Radiates below your abdomen and into your legs.

The best way to guard yourself from a heart attack is to eat a healthy diet, do regular aerobic activity, avoid smoking, manage diabetes if you have it, have regular checkups with your primary care provider, and know and control your cholesterol levels, says Dr. Menon.

If you notice a sudden change in your ability to perform physical activity, get to a doctor right away.

Is Your Chest Pain a Sign of a Heart Attack, or Something Else?

Chest pain is frightening and must be taken seriously. So know this: If you are having severe discomfort in the chest—especially if the chest pain is radiating to your neck, jaw or arms—and it’s accompanied by shortness of breath, dizziness and sweating, call 911 immediately. Some people (especially women, diabetics and older adults) may not have chest pain at all during a heart attack, but they may have the other symptoms listed. In that case, it’s still best to call 911.

But sometimes chest pain isn’t a heart attack. It might have a different cardiac cause or be totally unrelated to your heart. Here are three clues that it’s not a heart attack:

  1. Pinpointed chest pain. If a sharp pain seems to be coming from a very specific location, it’s probably not heart pain. The pain associated with a heart attack is generally dull and diffusely located in the chest.
  2. Chest pain that shows up in different areas. For example: One day your chest pain is on the right side of your chest, and the next day it’s on the left side of your chest. Heart pain can radiate into the arms, jaw and between the shoulder blades, but it rarely moves from place to place on different days.
  3. Chest pain that gets worse when you take a breath. This could be anything from pericarditis (a swelling of the membrane surrounding the heart) to a cracked rib.

If you are experiencing chest pain like this, call your doctor to make an appointment.

Chest pain that isn’t a heart attack can be heart-related (cardiac) or not (noncardiac).

The Three Most Common Causes of Noncardiac Chest Pain

  1. Gastrointestinal pain. This is the most common type of noncardiac chest pain. It can include acid reflux, esophageal spasm and acidity.
  2. Muscular/skeletal pain. This pain is caused when you pull a muscle or injure a bone. It often occurs after patients have done physical activities such as working in the yard.
  3. Lung pain. A condition like pneumonia or pleurisy, which is inflammation of the tissues around the lungs, can cause pain in the chest that is sometimes mistaken for a heart attack.

Cardiac Pain That Isn’t a Heart Attack

Cardiac pain, or angina, refers to discomfort in the chest because of something going on with the heart. The first thing a cardiologist will try to determine in a patient with cardiac pain is whether the pain is caused by clogged arteries.

Several conditions of the heart can cause cardiac pain but aren’t related to clogged arteries, including:

  • Pericarditis: inflammation of the two thin layers of tissue that surround the heart
  • Dissection: when the aorta splits and causes severe chest and back pain
  • Myocarditis: inflammation of the heart muscle
  • Cardiomyopathy: diseases of the heart muscle

Know What Is a Heart Attack

A heart attack requires immediate emergency care. Symptoms include:

  • Discomfort in the form of tight, heavy pressure or a dull, burning sensation in the chest
  • Pain that radiates to the shoulders, arms, neck, jaw or back
  • Pain that is hard to precisely locate with a single finger
  • Sweating
  • Nausea
  • Dizziness or faint feeling
  • Shortness of breath

If you have any of these symptoms, call 911.

Want to know more if you’re at risk for a heart attack? Take a free HeartAware online risk assessment. Learn more about our cardiac care at UNC REX Healthcare and UNC Medical Center or find a cardiologist near you.

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