Recognizing a Heart Attack or Angina

If you have risk factors for heart problems, it's important to watch for signs of a heart attack such as chest pain.

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If you have risk factors for heart problems, you should always watch for signs of angina or a heart attack. If you have a sudden heart problem, getting treatment right away could save your life.

Risk factors for a heart attack include:

  • Being older.

  • High cholesterol.

  • High blood pressure.

  • Having a brother, sister, or parent who had a heart attack before age 50.

  • Diabetes.

  • Smoking.

  • Being overweight.

  • Smoking or using stimulants such as cocaine or amphetamine.

  • High stress.

There are other risk factors. They include eating a high-fat diet and not getting much exercise.

Understanding angina and heart attack

  • Angina is an uncomfortable burning feeling, tightness, or pressure in the chest, back, neck, throat, or jaw. It can be painful. It means that not enough blood is getting to the heart muscle. This is most often from a blocked artery in the heart. Angina is a sign that you may be having, or are about to have, a heart attack. You need to call 911 right away.

  • A heart attack is also known as acute myocardial infarction (AMI). It's what happens when blood and oxygen can't get to part of the heart muscle. That part of the heart muscle is damaged. It starts to die. If enough of the heart is affected, it won't be able to beat correctly. This can keep it from sending enough blood to the brain and the rest of the body. It may cause death. Get help as soon as you can for a heart attack.

Stable angina versus unstable angina

Stable angina is also known as chronic angina. It has a typical pattern. It happens when you exert yourself or feel a strong emotion. Nitroglycerin, rest, or both will easily ease stable angina symptoms. The symptoms will most likely feel the same each time you have them. Make sure to discuss these symptoms with your doctor. They can be a warning sign of a future heart attack.

Unstable angina causes symptoms that you don't expect or can't predict. They often happen when you're at rest. Unstable angina is a medical emergency. Angina is also unstable if resting and nitroglycerin don't ease symptoms. Symptoms that get worse, happen more often, or last longer are also a sign of unstable angina. They may mean that you have a severe blockage or a spasm of a heart artery. Unstable angina is often a sign of an active heart attack. Keep these tips in mind:

  • Stable angina symptoms should go away with rest or medicine. If they don’t go away, call 911!

  • Stable angina symptoms last for only a few minutes. If they last longer than that, or if they go away and come back, you may be having a heart attack. Call 911!

  • If you have shortness of breath, cold sweat, an upset stomach (nausea), or lightheadedness, call 911!

For angina that shows up for the first time, there is only one response: Call 911! You should never diagnose angina by yourself. If these symptoms are new or are worse than normal, call 911!

Warning signs of a heart attack

Man grabbing chest in pain.

If you have symptoms that you can’t explain, call 911 right away. Don't drive yourself to the emergency room (ER). These are warning signs of a possible heart attack:

  • Chest discomfort. Most heart attacks cause discomfort in the center of the chest that lasts more than a few minutes or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.

  • Discomfort in other parts 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 may happen with or without chest discomfort.

  • Other signs may include breaking out in a cold sweat, nausea, or lightheadedness.

If you think someone is having a heart attack, call 911 instead of driving the person to the ER. After you call 911, you'll be told what to do. The 911 dispatcher may tell you to give the person aspirin while you wait for help to arrive. If you aren't told to do this, don’t give the person aspirin. Aspirin can be dangerous in certain cases.

  • Note for women. Like men, women often have chest pain or discomfort as a heart attack symptom. But women are somewhat more likely than men to have less common symptoms. These include shortness of breath, abnormal tiredness, lightheadedness, heartburn, nausea and vomiting, back pain, and jaw pain.

  • Note for older adults. Older people may also not have typical symptoms of a heart attack. They may have symptoms that include fainting, weakness, or confusion. Don't ignore these symptoms. They can be serious and deadly. Get them checked out right away.

  • If you've had a heart attack. People who have had one heart attack are at risk of having another. Your doctor may prescribe medicine such as nitroglycerin to take when chest pain starts. Or you may need medicines to lower your heart rate and blood pressure. This is to prevent angina and another heart attack. Make sure to take any medicines your doctor has given. Don't stop taking them without speaking with your doctor first.

If you have diabetes: Silent heart problems

Over time, high blood sugar can damage nerves in your body. This may keep you from feeling pain caused by a heart problem. This is called a “silent” heart problem. If you don’t feel symptoms, you're less able to know that you may be having a heart attack and get treatment right away. Talk with your doctor about how to control your blood sugar levels and lower your risk for silent heart problems.