Signs of a heart attack

Photo of woman calling an ambulance
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The most common signs of a are chest pain and shortness of breath. But there may be other symptoms as well. A is a medical emergency. If you think someone might be having a , it is very important to call the emergency services right away (112 in Germany and many other countries, 911 in the U.S.).

People who have heart attacks often have already had coronary artery disease for years. This causes recurring chest pain (angina) or shortness of breath during exercise. Others hardly have any symptoms beforehand – they only find out about their heart problem when they have a .

Some women think that heart attacks are a lot more common in men. That isn’t true, though. Women tend to be older when they have heart attacks, though. More women die of a than of breast cancer.

The main symptoms: Chest pain, shortness of breath and nausea

Heart attacks often start with sudden stinging, burning chest pain or pressure in the chest area. But sometimes the symptoms only develop gradually. The pain goes on for more than five minutes and it doesn’t get better when the person rests. It can spread from the chest down the left or right arm, and it may affect your back, neck or upper abdomen as well. The pain can be very mild or very strong.

Some people know they have coronary artery disease, and have often effectively relieved the symptoms using nitrate medication in the past. If they are having a , this medication will no longer help.

People who are having a often have a sense of impending doom, look pale and sickly, and break out in sweats. Many have difficulties breathing, feel nauseous or vomit. These symptoms may be much more noticeable than the chest pain. Breathing difficulties, nausea and vomiting are sometimes the main signs of a , particularly in women. For this reason, heart attacks in women are more likely to be overlooked than heart attacks in men.

The symptoms aren’t always clear

Not only do the signs of a vary widely from person to person, they may also be very different from the signs of a previous . Heart attacks that don’t cause any symptoms are known as “silent” heart attacks.

Apart from chest pain, breathing difficulties and nausea, the symptoms of a may include:

  • A feeling of tightness and pressure in the chest area
  • Pain or numbness in the upper body that spreads to the shoulder blades, the back of the neck and the jaw
  • Lightheadedness or fainting
  • Dizziness
  • Sweating
  • Paleness and cold sweats

Illustration: Possible areas of pain during a heart attack – as described in the information

Possible areas of pain during a heart attack

If you think someone is having a heart attack, call an ambulance!

Heart attacks are a medical emergency! Every minute counts – life-saving measures should be started as soon as possible in order to limit possible damage. So it’s important to call the emergency services immediately (112 in Germany and many other countries, 911 in the U.S.) if you suspect someone might be having a – even if you aren’t sure. If signs of a occur at night, do NOT wait until the next morning to do something about it.

While waiting for the ambulance to arrive, people who are with the patient can

  • try to calm them,
  • put them in a comfortable lying position, with their upper body slightly raised,
  • loosen tight clothing,
  • open a window to let in fresh air and,
  • if they have prescription medication for stable angina, such as nitrates, give them that.

If the person passes out, they stop breathing and their heartbeat stops, they will need CPR (resuscitation) as a first aid measure.

Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Patientenleitlinie zur Nationalen Versorgungsleitlinie KHK. January 2017.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on July 27, 2017
Next planned update: 2022


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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