Heart Attack Symptoms: Warning Signs You Should Not Ignore

What happens in a heart attack

A heart attack happens when blood flow through one of the arteries supplying the heart muscle is suddenly blocked, usually by a clot forming on top of a fatty deposit that has built up over years. The muscle beyond the blockage is starved of oxygen, and starts to die.

That last point is the whole reason urgency matters. Heart muscle does not grow back. How much you lose depends almost entirely on how quickly the artery is reopened.

The common warning signs

Most heart attacks involve some combination of these:

• Chest pain or pressure — often described as heaviness, tightness, squeezing or a band around the chest rather than a sharp pain
• Pain spreading to the left arm, both arms, jaw, neck, back or upper abdomen
• Breathlessness, with or without chest discomfort
• Cold sweating, often described afterwards as a sense that something was badly wrong
• Nausea or vomiting
• Light-headedness, or feeling as though you might faint
• Unusual, overwhelming fatigue

Pain that lasts more than a few minutes, or comes on at rest, is more concerning than brief discomfort that settles quickly on stopping.

Symptoms that are easy to miss

This is the part worth reading carefully, because it is where heart attacks get missed at home.

In women, chest pain is still the commonest symptom, but breathlessness, nausea, back or jaw pain and profound fatigue are more likely to dominate than in men — and are more likely to be attributed to something else.

In people with diabetes, nerve damage can blunt pain signals, so a heart attack may present with breathlessness, sudden weakness, confusion or sweating and very little chest pain at all. This is sometimes called a silent heart attack, and it is not rare.

In older people, the presentation is frequently vague: sudden confusion, a fall, unexplained breathlessness or simply "not being right".

Anyone may mistake it for acidity or gas. Upper abdominal burning with sweating and breathlessness deserves an ECG, not an antacid.

What to do if you suspect a heart attack

1. Call for an ambulance immediately — 108 is the national number and it is free. An ambulance can begin treatment on the way and alert the hospital before you arrive.
2. Stop all activity and sit or lie down. Loosen tight clothing.
3. Chew one aspirin if it is available and you are not allergic to it and have not been told to avoid it.
4. Do not drive yourself. If you lose consciousness at the wheel the outcome is far worse for you and for others.
5. Stay with the person. If they become unresponsive and are not breathing normally, start chest compressions if you know how.

Why minutes matter

Treatment for a heart attack — usually angioplasty to reopen the blocked artery — works dramatically better the sooner it happens. The phrase clinicians use is "time is muscle": every period of delay costs heart muscle that cannot be recovered, and that lost muscle is what determines whether someone lives with heart failure afterwards.

Most delay in India is not hospital delay. It is the hours between symptoms starting and someone deciding to leave the house. That is the part within your control.

Who is most at risk

• Existing heart disease, or a previous heart attack
• Diabetes — which raises risk substantially and can mask symptoms
• High blood pressure and high cholesterol
• Smoking or any tobacco use
• A family history of heart disease before 55 in men or 65 in women
• Being significantly overweight, and physical inactivity

South Asians tend to develop coronary artery disease earlier and at lower body weights than many other populations, which means the age thresholds used elsewhere can give false reassurance here.

If several of these apply to you and you have never had your blood pressure, cholesterol and blood sugar checked, that is worth doing while you feel well — a preventive health checkup covers all three.