Heart Attack: Know the Signs
In 12 minutes you'll know the classic heart attack signs, the different signs women and people with diabetes often get instead, and exactly what to do.
Print this course — or save it as a PDF from the print dialog. Good for a fridge, a glovebox, or a waiting room.
Why this matters
During a heart attack, part of the heart muscle loses its blood supply, and muscle that goes without oxygen too long does not come back. Heart disease is the leading cause of death for both men and women in the United States (Centers for Disease Control and Prevention), and treatment works best within the first hour or two. The signs are not always the ones you expect, and closing that gap is what this course is built to do.
Know the signs
The classic signs
The classic signs: pressure, squeezing, fullness, or pain in the center of the chest lasting more than a few minutes, or that fades and returns. Pain spreading to an arm, the jaw, neck, or back. Shortness of breath, with or without chest discomfort. A cold sweat, nausea, or sudden lightheadedness.
Not every heart attack causes crushing pain. Some feel more like pressure sitting on the chest than an injury.
When it does not look like a heart attack at all
Women, older adults, and people with diabetes often have a heart attack without any chest pain at all. This is not rare, and it is the single most dangerous gap in what most people think they know.
Instead of chest pain, watch for: unusual fatigue that feels heavier than normal tiredness, sometimes for days beforehand. Nausea or vomiting. Pain in the jaw, neck, or upper back that seems to come from nowhere. Shortness of breath without exertion. Lightheadedness or a cold sweat with no clear cause.
These signs get dismissed constantly — as stress, a bad night's sleep, or getting older — because they do not match the heart attack shown in movies. A person having one may seem calm, hold a conversation, and still be in real danger. If something feels seriously wrong with no obvious explanation, treat it as seriously as chest pain, and call 911.
Time is heart muscle
Heart muscle that loses its blood supply starts to die and does not grow back. The sooner blood flow is restored — often by opening the blocked artery with a thin tube threaded through a blood vessel — the more muscle survives, and the better someone's long-term heart function is likely to be.
That is why this course exists: to shave minutes off between the first sign and the first call.
Never drive yourself
If you think you might be having a heart attack, call 911. Do not drive yourself, and do not have a family member drive you, even if the hospital is close.
Paramedics can start treatment the moment they arrive, and can radio an EKG (a heart tracing) ahead so the cardiac team is ready before you arrive. If your heart stops in the car, nobody is there to help.
About aspirin
You may have heard that aspirin helps during a heart attack. Call 911 first, and if the dispatcher tells you to chew one, follow their instruction — they will ask about allergies and bleeding risk before they say so.
Do not take aspirin on your own beforehand, or give it to someone else without a dispatcher's direction.
Heart attack vs. cardiac arrest
These two are often confused. A heart attack is a plumbing problem — a blocked artery cutting off blood flow — and the person is usually conscious, talking, and breathing, at least at first.
Cardiac arrest is electrical: the heart's rhythm turns chaotic and stops pumping. The person collapses, unresponsive, not breathing normally. A heart attack can lead to cardiac arrest, which is why the response differs — hands-only CPR and an AED (a device that can shock the heart back into rhythm), covered in its own course.
How it really looks
Mowing the lawn on a Saturday afternoon
Deon is 58 and halfway through mowing his lawn when a tight pressure settles across his chest. He stops, blames the burrito from lunch, and sits on the porch step to let it pass. Ten minutes later it hasn't, and now his left arm feels heavy too. His neighbor walks over to say hello and sees him gray-faced and sweating. She calls 911 immediately while Deon insists it's just indigestion. Paramedics arrive within minutes, run an EKG on the porch, and confirm a blocked artery on the way to the hospital. Deon is home within a week, and back to mowing his own lawn a month later.
A week of feeling wrong
Marguerite is 64 and has felt off for a week — deep tiredness that sleep doesn't fix, a dull ache along her jaw, and breathlessness on stairs she's climbed for thirty years. She has no chest pain, so a heart attack never crosses her mind; she assumes it's her age, or a bad week. Her daughter, who took this course, hears the symptoms over the phone and doesn't like how they add up. She drives over and calls 911 instead of waiting for an appointment. At the hospital, tests confirm Marguerite is in the middle of a heart attack with no chest pain at all. Because her daughter recognized the pattern, Marguerite gets treated in time.
What to do until help arrives
- Call 911 immediately. Do not drive yourself or wait to see if it passes.
- Stop what you're doing and sit or lie down in a comfortable position.
- Chew an aspirin only if the 911 dispatcher tells you to — follow their instruction exactly.
- Loosen tight clothing and stay as calm as you can while you wait.
- If there's a history of heart problems, tell the dispatcher and have the medication list ready.
- Unlock the door and turn on the lights so paramedics can get in fast.
- If the person becomes unresponsive and stops breathing normally, start hands-only CPR.
Myths & mistakes
People often think a heart attack always causes crushing chest pain.Actually many heart attacks, especially in women, older adults, and people with diabetes, show up as fatigue, nausea, jaw or back pain, or breathlessness, with little or no chest pain at all.
People often think it's faster to drive yourself or have someone drive you to the hospital.Actually calling 911 is faster and safer. Paramedics start treatment the moment they arrive and can radio ahead so the hospital team is ready before you get there.
People often think you should take an aspirin right away, on your own, just in case.Actually call 911 first and let the dispatcher decide. They will ask about allergies and other risks before telling you whether to chew one.
What you learned
- Classic signs are chest pressure or squeezing, pain spreading to the arm or jaw, breathlessness, cold sweat, and nausea.
- Women, older adults, and people with diabetes often have no chest pain at all — watch for fatigue, nausea, and jaw or back pain instead.
- Time is heart muscle. The faster you call, the more muscle survives.
- Never drive yourself or anyone else. Call 911 and let paramedics start treatment on the way.
- Chew an aspirin only if the dispatcher tells you to.
Sources
- American Heart Association — Heart attack warning signs in men and women
- Centers for Disease Control and Prevention — Heart disease facts and heart attack symptoms
- National Heart, Lung, and Blood Institute — Heart attack signs, risk, and treatment
Spot an error? Tell us — accuracy matters more to us than being fast.
Common questions
Can you have a heart attack without any chest pain?
Yes, and it's common, especially in women, older adults, and people with diabetes. Instead of chest pain, watch for unusual fatigue, nausea, breathlessness, or pain in the jaw or back. If something feels seriously wrong and you can't explain it, call 911 rather than waiting for chest pain to appear.
Is it ever okay to drive myself to the ER during a possible heart attack?
No. Call 911 instead. Paramedics can begin treatment immediately, monitor you the whole way, and alert the hospital's cardiac team before you arrive. If your heart stops in the car, there is no one there to help you.
Should I take an aspirin if I think I'm having a heart attack?
Call 911 first. If the dispatcher tells you to chew an aspirin, follow their instruction — they will ask about allergies and bleeding risk before advising you. Do not take one on your own beforehand, and never give aspirin to someone else without that guidance.
Check what you know
Five questions. Four correct to pass. Retake as many times as you like — this is practice, not a test.
Keep going
This course belongs to Everyday Emergencies · Caring for Aging Parents. Courses that pair well with it:
From other readers
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