Heart disease is the number one killer of men and women in this country. Of the one million heart attacks that occur each year, statistics from the National Institutes of Health (NIH) predict half of them will end in death.

The term "heart attack" may conjure up images of people suddenly clutching their chests and then collapsing in pain. But the warnings signs of a heart attack vary, and don't always include chest pain, so the more you know about possible symptoms, the better prepared you'll be in the event of a heart emergency.

Chest Pain

Classic heart attack chest pain, also called angina, gets your attention. Craig Narins, MD, associate professor of medicine in the division of cardiology at the University of Rochester Medical Center, describes it as an extremely uncomfortable tightness or squeezing in the center of the chest that typically spreads across the left arm or jaw. "Heart attack chest pain usually doesn't subside with rest and lasts more than 15 minutes," he says. "Conversely, stabbing pain [as opposed to tightness or a squeezing sensation] that hasn't changed for several hours is less likely heart trouble, but still requires immediate attention."

Subtle Signs of Danger

Experts say heart-related chest pain with no other symptoms is unusual, but people often miss these minor changes, which can function as important warning signs. "Symptoms of an emerging heart attack can occur over the course of the day—it may not be a sudden onset of symptoms. Most people will tell you they felt lousy before the chest pain started," says Narins.

Margaret Shanks, MSN, FNP/C, a nurse practitioner in Philadelphia who specializes in cardiac care, recalls countless conversations with heart attack victims who admit they noticed—but dismissed—small changes like shortness of breath or becoming unusually fatigued while performing normal chores weeks before their cardiac event. "If you start needing to rest while carrying groceries or a basket of laundry up two flights of steps—pay attention," she pleads. "It could be your heart telling you it’s working too hard."

Take note of such differences: "Little things like tight shoes or having to prop yourself up at night with extra pillows when sleeping on a flat pillow had been the norm can signal heart trouble, too," says Shanks. "The goal is to identify heart disease before it progresses to a heart attack."

One story Shanks will never forget happened to a man before having his second heart attack: "He called me in the middle of the night complaining about pain in his thumb. I didn’t think it was of any consequence until he told me it was the same location and painful feeling that preceded his first heart attack!"

Calling All Women

According to the American Heart Association, heart disease is the number one killer of women, causing one in three deaths each year. But symptoms of heart disease in women can be different from those in men.

Women have not been studied as extensively, so less is known about how the problem affects their bodies, but "We do know that females are more likely to have shortness of breath, nausea and vomiting, fatigue and pain in the back, shoulders, and jaw then men," explains Narins. "Women should also know that dizziness, lightheadedness, and fainting are more common for them."

The female anatomy and body chemistry affects their experience, according to Dennis Cheek, RN, PhD, Abell-Hanger professor of gerentological nursing at Texas Christian University’s Harris College of Nursing in Fort Worth. "In men, heart blockages tend to happen in the larger arteries of the heart so their symptoms are bigger and more obvious. In women artery clogging happens in the small vessels of the heart so it feels different."

Although the most common heart attack symptom in both men and women is chest pain or discomfort, one-third of heart attack patients report feeling no chest pain; this is more common among older, female, or diabetic patients. (People with diabetes are at higher risk of having a heart attack than the general population, and the disease can affect their nerves, making them unable to feel pain.)

Time is Muscle

Acting quickly is vital. According to NIH, to receive the best care, you have about 90 minutes from the onset of symptoms for a cardiologist to restore the flow of blood to the heart (with surgery or medication) before critical tissue is damaged or dies. "In cardiology we say, 'Time is muscle,'" says Cheek. "In other words, the more quickly an evolving heart attack is treated the more heart muscle is saved."

Don’t be a grim statistic: Call 911 to get immediate medical attention if you experience chest pain that lasts longer than five minutes and is not relieved by rest or prescribed medication.

Craig Narins, MD, Margaret Shanks, MSN, FNP/C, and Dennis Cheek, RN, PhD, reviewed this article.


Craig Narins, MD, associate professor of medicine in the division of cardiology at the University of Rochester Medical Center and is board certified in echocardiography. Phone interview, 15 July 2014.

Margaret Shanks, MSN, FNP/C, nurse practitioner specializing in cardiology. Philadelphia, PA Phone interview, 18 July 2014.

Dennis Cheek, RN, PhD, Abell-Hanger Professor of Gerontological Nursing at Texas Christian University in Fort Worth, TX. Phone interview, 16 July 2014.

"Types of Heart Attacks." The Society for Cardiovascular Angiography and Interventions. Accessed 18 July 2014.  

"Life After a Heart Attack." US Department of Health and Human Services. National Institutes of Health. National Heart, Lung and Blood Institute. Accessed 18 July 2014. 

"Symptoms and Diagnosis of Heart Attack." American Heart Association. Updated 15 July 2014. Accessed 18 July 2014. 

"Heart Disease. Scope and Impact." The Heart Foundation. Accessed 18 July 2014. 

"Heart Attack." MedlinePlus. Page last updated August 19, 2014.