Could you be having a heart attack? Sneaky signs you may not recognize

Published: February 09, 2023

Author: Joshua M. Lader, MD

You’re queasy and your insides burn. Is it something you ate? Your heart races and your feel dizzy. Is it atrial fibrillation? Your chest hurts and your heart is pounding. Is it anxiety? Or could you be having a heart attack?

Heart attack, also known as myocardial infarction, has classic symptoms that most people are aware of:

  • Chest pain (angina), which feels like pressure, tightness, pain, squeezing or aching and diminish with rest.
  • Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth or sometimes the upper belly.
  • Sweating.
  • Extreme fatigue.
  • Heartburn or indigestion.
  • Lightheadedness or sudden dizziness.
  • Nausea.
  • Shortness of breath.

But some people, often women, can experience atypical symptoms like brief or sharp pain felt in the neck, arm, or back. Some people have no symptoms at all or think their symptoms are merely indigestion. For others, the first symptom is sudden cardiac arrest, which happens when the heart suddenly and unexpectedly stops beating.

February is American Heart Health Month, and it’s important to take a minute and think about your own heart health. Heart attacks are common. They strike 800,000 people in the United States every year. That’s one person every 40 seconds. Most of these — about 600,000— are first heart attacks. About 1 in 5 are silent. They occur and cause damage without you knowing it.

A heart attack, also known as myocardial infarction, happens when some part of the heart doesn’t get enough blood and therefore oxygen. The culprit behind most heart attacks is heart — or coronary artery — disease, which results when cholesterol deposits, or plaques, accumulate along the walls of the heart arteries and reduce, or block, the flow of oxygen-rich blood to the heart.

Many people walk around with heart disease and don’t find out until they have symptoms or an actual heart attack. The best way to avoid heart disease is to have regular checkups and work with your doctor to reduce or eliminate key risk factors, including high blood pressure and cholesterol, and smoking, and to treat other possible risk factors, like:

  • Diabetes.
  • Overweight and obesity.
  • Unhealthy diet.
  • Physical inactivity.
  • Excessive alcohol use.

Another important way to avoid a heart attack is to distinguish its symptoms from those that mimic it, such as:

  • Atrial fibrillation or AFib, occurs when the heart beats irregularly, either too fast, slowly, or in some other way that feels unfamiliar. This irregular heartbeat is called an arrhythmia. Like a heart attack, AFib can cause chest pain, lightheadedness, extreme fatigue, or shortness of breath. Or it can occur with no symptoms. Unlike a heart attack, however, AFib has nothing to do with blocked arteries or blood flow. It is an electrical rather than a plumbing problem with your heart. It can be episodic or permanently recurring. It can also increase your risk of stroke.
  • Indigestion is commonly mistaken for angina or heart pain. If it happens when you’re eating, or when you change physical position, then it’s probably indigestion. If it worsens when you walk around or it’s cold outside, then it could be a heart attack.
  • Anxiety can also make your chest hurt or your heart flutter. If exercise or some other movement eases it, then it’s probably just anxiety.

An electrocardiogram will help your doctor determine if the symptoms you’re having indicate AFib, indigestion, anxiety, or an actual heart attack. Some doctors may even provide you with a personal, portable EKG machine that you can wear to monitor your own heartbeat.

But don’t substitute self-monitoring for regular checkups with your primary care physician or cardiologist, especially if you’re 65 or older. In addition to lack of diet and exercise, preexisting medical conditions, age and family history affect your risk of heart attack.

Finally, know your body. What does it feel like when you’re well? How does it feel when you’re active? If you feel something that’s not normal for you, then it’s time to see your doctor.

If you think you're having a heart attack:

  • Call 911 or your local emergency number.
  • Have someone drive you to the nearest hospital.
  • Take nitroglycerin, if prescribed to you by a health care provider while awaiting emergency help.
  • Take aspirin, only if a health care provider or emergency medical personnel tells you to do so.

Remember: If something about the way you usually feel changes, then call your doctor.

About the Author

Joshua M. Lader, MD, is a cardiologist and cardiac electrophysiologist at Stamford Health.

Featured Expert/ Author

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Cardiovascular Disease, Clinical Cardiac Electrophysiology

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