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Coronary artery disease

Signs of a heart attack

Photo of a woman calling an ambulance

The most common signs of a are severe chest tightness 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.).

Sometimes, people have a that is caused by coronary artery disease (CAD) that they already knew about. But heart attacks can happen without any previous symptoms, too.

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

Possible signs of a heart attack

The typical signs of a are:

  • A strong feeling of tightness or pressure in the chest
  • A stabbing, burning or heavy pain behind the breastbone
  • Pain that spreads to the left or right arm, the back, neck or upper abdomen (belly) as well
  • Pain or numbness in the upper body that may spread to the shoulder blades, the front or back of the neck, and the jaw

The symptoms often start suddenly, but can also be more gradual. The pain lasts for more than five minutes and doesn’t get better when the person rests.

Other possible symptoms include:

  • Shortness of breath
  • Nausea, vomiting
  • Sweating or cold sweats
  • Paleness
  • Weakness, dizziness, loss of consciousness
  • Intense anxiety or fear of death

The symptoms of a vary from person to person. Heart attacks don't always cause tightness and pain in the chest. For example, chest tightness is less common in women, older people, and people with diabetes or heart failure. They are more likely to have other symptoms such as shortness of breath, nausea or vomiting.

Illustration: Possible areas of pain during a heart attack

Suspected 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 damage. It is 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 . If signs of a occur at night, do NOT wait until the next morning to do something about it.

How can other people help?

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 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. If several people are there and there's an "external defibrillator (AED)," it should be used.

Known CAD: Temporary symptoms or emergency?

It can be difficult for people who have CAD to tell the difference between temporary symptoms, a short-term worsening and an emergency. It is likely to be an emergency if the symptoms

  • also occur at rest,
  • don't go away when you rest after physical strain such as climbing the stairs,
  • don't go away even after taking emergency medication (such as nitrate sprays),
  • last for longer than a couple of minutes, or
  • there are also other signs of a .

Even if you aren't sure: Do NOT wait. Call the emergency services straight away!

Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale Versorgungsleitlinie Chronische KHK. Langfassung. AWMF-Registernr.: nvl-004. 2019.

Canto JG, Shlipak MG, Rogers WJ et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA 2000; 283(24): 3223-3229.

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. informedhealth.org 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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Signs of a heart attack

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Updated on February 18, 2022

Next planned update: 2025

Publisher:

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

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