When the heart sends a warning: How to recognise early heart attack symptoms

For most of us, the image of a heart attack comes straight from television: a man clutches his chest, staggers, and collapses. It's dramatic, unmistakable, and, most of the time, wrong. In reality, a heart attack often arrives quietly, wearing the disguise of indigestion, tiredness, or a nagging ache that seems too ordinary to worry about. That gap between expectation and reality is exactly why so many people delay seeking help — and why understanding the subtler signs matters more than ever.

What's actually happening

A heart attack occurs when blood flow to part of the heart muscle is suddenly cut off, usually because a clot has formed over a fatty deposit inside a coronary artery. Starved of oxygen, heart tissue begins to suffer damage within minutes. This is the reason doctors so often repeat the phrase "time is muscle" — the longer treatment is delayed, the more lasting the harm.

Beyond the textbook chest pain

The chest discomfort most people associate with heart attacks is real, but it rarely feels like sharp, stabbing pain. Instead, people describe pressure, tightness, squeezing or heaviness — sometimes mistaken for trapped wind or acid reflux. It usually sits in the centre or left side of the chest and can ease off before returning minutes later, which can lull people into a false sense of reassurance.

What catches many people out, though, is discomfort that has nothing to do with the chest at all. Pain can radiate into one or both arms, the shoulders, back, neck, jaw, or even the upper abdomen. The old idea that only the left arm is affected is a myth worth retiring.

Other signs are easy to dismiss individually: breathlessness that appears with or without chest discomfort, a sudden cold sweat, nausea or vomiting, light-headedness, a racing or irregular heartbeat, and an unusual, unexplained exhaustion. Women, in particular, are more likely to experience these less "typical" symptoms — fatigue, breathlessness, nausea, or a vague sense that something isn't right — without the classic crushing chest pain. This is part of why women's heart attacks are diagnosed later so often; the presentation simply doesn't match what many of us have been taught to look for.

You can't diagnose yourself — And you shouldn't try

It's tempting to run through a mental checklist and decide whether symptoms "count." But chest discomfort can stem from many causes — anxiety, muscle strain, acid reflux, lung problems — and there's no reliable way to distinguish a heart attack from something harmless just by how it feels. Doctors themselves rely on an ECG and blood tests to confirm the diagnosis. The safest approach isn't to ask, "Is this definitely a heart attack?" but rather, "Could this possibly be one?" If the answer is yes, it deserves emergency treatment until proven otherwise.

What to do in the moment

If you or someone nearby develops these symptoms, the single most important step is to call emergency services immediately rather than waiting to see if things improve, and to avoid driving to hospital independently, since deterioration can happen suddenly en route and paramedics can begin treatment straight away.

Aspirin often comes up in these conversations, and it does have a role — but only as a supporting measure, never a substitute for professional care. Current first-aid guidance suggests that an alert adult with sudden chest pain, and no known allergy or prior medical advice against it, may chew and swallow a dose of aspirin while waiting for help to arrive. What matters is the sequence: symptoms first prompt a call for emergency help, and aspirin comes after that call, never instead of it.

It's also worth knowing that a heart attack and a cardiac arrest aren't the same event. A heart attack is a circulation problem — a blocked artery. Cardiac arrest is an electrical fault that causes the heart to stop pumping altogether, leaving a person unresponsive and not breathing normally. One can lead to the other, but they require different immediate actions, with cardiac arrest calling for CPR.

Reducing the risk long before it happens

Much of cardiovascular risk is modifiable. Avoiding tobacco, staying physically active, eating a diet built around vegetables, whole grains and legumes rather than excess salt and processed fat, and keeping blood pressure, blood sugar and cholesterol under regular review all make a measurable difference — particularly because these risk factors can build silently for years before symptoms appear.

The takeaway is simple, even if it's easy to forget in the moment: the most dangerous symptom is rarely the most painful one. It's the one we talk ourselves out of taking seriously.

Dr Sanjeeva Kumar, Director - Cardiology at the CK Birla Hospital, Delhi.

 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.