Heart attack

Symptoms

What are the signs and symptoms of a heart attack?

Symptoms of a heart attack include:

• pain or discomfort in your chest that happens suddenly and does not go away
• pain that spreads to either arm, your neck, jaw, back or stomach
• feeling sick, sweaty, light-headed or short of breath.

Other less common symptoms include:

• suddenly feeling anxious, similar to a panic attack
• lots of coughing or wheezing.

Heart attack symptoms are different for different people. You may not have all of these symptoms.

The pain can feel very bad while for others it’s more uncomfortable. It can feel like heaviness or a burning pain similar to indigestion.

I think I'm having a heart attack: what should I do?

You should:

• call 999 for an ambulance
• sit down and stay calm
• take 300mg aspirin if you have it and you’re not allergic
• wait for the ambulance.

If you are deaf and have an emergency, you can call 999 using a free BSL helpline.

It’s important you get medical attention immediately. Do not worry about wasting anyone’s time. A heart attack is a medical emergency.

If you delay, you may suffer serious heart damage and are more likely to need intensive care and to spend longer in hospital.

Heart attack vs cardiac arrest

A heart attack is not the same as a cardiac arrest. A heart attack happens when there’s a sudden loss of blood flow to a part of the heart muscle while a cardiac arrest happens when your heart suddenly stops pumping blood around your body.

• Learn more about cardiac arrest.

What else can cause chest pain?

Discomfort in the chest can be caused by many things from a heart attack to indigestion and muscle strain.

Some people might confuse a heart attack for a panic attack. While the symptoms are similar, there are some signs that can help you tell the difference between them.

The pain caused by a heart attack typically spreads to other areas like the jaw, arm and back, while that of a panic attack usually stays within the chest. Panic attacks also typically last for a few minutes to 1 hour while the symptoms of a heart attack usually stay for a while.

• Learn more about the different causes of chest pain.

Causes

What are the causes of a heart attack?

Most heart attacks are caused by coronary heart disease (CHD).

CHD causes your coronary arteries to become narrowed by a gradual build-up of fatty deposits called atheroma. 

If a piece of atheroma breaks off, a blood clot forms around this to try and repair the damage to the artery wall. This clot can block your coronary artery, causing your heart muscle to be starved of blood and oxygen. 

Other less common causes of a heart attack include:

• spontaneous coronary artery dissection (SCAD) which is when a tear appears in the wall of one of your coronary arteries
• using harmful drugs like cocaine and amphetamines (speed)
• hypoxia (which is a sudden drop in oxygen levels in the body).

Although symptoms can vary from person to person, women and men generally experience the same heart attack symptoms. However, research shows women tend to not recognise the symptoms as a sign of a heart attack as quickly. This is mainly because heart attacks are wrongly believed to be a “man’s problem."

In the UK, on average 3 women die of coronary heart disease every hour, many of them due to a heart attack. You dramatically increase your chance of survival if you call 999 straight away.

• Learn more about women and heart attacks

Diagnosis

How is a heart attack diagnosed?

If you think you’re having a heart attack, you need to call 999 for an ambulance. Do not try and take yourself to hospital, as the ambulance team will give you the best care and do tests on the way.

The paramedics will do an electrocardiogram (or ECG) to measure the electrical activity of your heart. This is an important test to find out if you're having a heart attack. If the ECG shows you’re having a heart attack, you’ll be taken to a specialist centre to get the best treatment.

Whether or not the ECG confirms a heart attack, you’ll need further tests to find out what’s going on. These tests may include:

• an assessment of your symptoms and medical history
• physical examinations, including measuring your blood pressure and monitoring your heart rhythm and heart rate
• blood tests to see if there’s been any damage to your heart muscle
• more ECGs 
• an echocardiogram to take pictures of your heart.

You might hear a heart attack being called acute coronary syndrome, myocardial infarction (MI) or coronary thrombosis while you're at hospital. 

Treatment

How is a heart attack treated?

Quick treatment to get the blood flowing to your heart muscle again is important. This can reduce the amount of permanent damage to your heart and save your life. 

Many people need to have emergency treatment to restore the blood flow. Emergency treatment may include: 

• Coronary angioplasty — putting 1 or more stents (which are like small pieces of scaffolding) into the narrowed or blocked artery to keep it open and improve the blood supply to the heart.
• Thrombolysis — involves giving you "clot-busting" medicine to dissolve the blood clot that's blocking the coronary artery.
• Coronary bypass surgery — helps to bring back normal blood flow by attaching a blood vessel from your leg, arm or chest in your heart to go around the blocked artery.

You’ll discuss with your doctor which of these treatments might be best for you.

Recovery

What happens after a heart attack?

You'll usually stay in hospital for about 2 to 5 days after having a heart attack. This depends on what treatment you've had and how well you're recovering.

• If you’ve had coronary angioplasty or stents, it’s likely you'll stay in hospital for 2 or 3 days.
• If you’ve had coronary bypass surgery, it’s likely you'll stay in hospital for at least 1 week.

During your stay, you’ll be monitored and have tests to see how well your heart is recovering.

When you first arrive in hospital, you’ll likely be admitted to a coronary care unit (CCU) which is for people with serious heart issues who need to be closely watched. During your stay, you might be moved to a cardiac ward.

You will not be sent home (discharged) from hospital until your doctor is certain you’re well enough to go home. To decide this, they’ll talk to you about going home and do assessments such as have you climb stairs to see if you’re fit enough.

What happens when I go home?

When you get home, it’s a good idea to gradually build up how much you do. Even if you do not feel like it, many people find getting up, washing and dressing a positive first step.

Over time, you can do some light household activities like making a hot drink or get back into the habit of doing the usual things like the washing up. Walking around the house or standing up from the chair and marching on the spot for a minute is another way of keeping active.

You might find it helpful to have someone stay with you for the first few days or weeks once you return home. If it’s not safe for you to be discharged from the hospital on your own, you may be able to stay longer.

You can speak to your team about going home as soon as possible and they can help you get support like a small, temporary package of care or special equipment at home if you need it. Learn more about care after being discharged from hospital.

A heart attack can be a frightening experience and it can take time to come to terms with what's happened. It’s natural to be worried about your recovery, feel scared, frustrated and isolated. For more support, visit our emotional support page.

• Hear from Allison who had a sudden heart attack caused by SCAD.

What is cardiac rehabilitation?

After a heart attack, you’ll be offered cardiac rehabilitation (“cardiac rehab” for short). Cardiac rehab gives you the best chance of recovery by offering:

• talks and information from experts 
• exercise sessions 
• regular assessments 
• the chance to meet people going through a similar experience.

Cardiac rehab is an important step that guides and supports you on your journey to recovery. Talk to your healthcare team about how you can start a cardiac rehab programme.

• Learn more about cardiac rehab

Medicines

Will I need to take medicine after a heart attack?

It’s essential that you take any medicine that’s been prescribed even if you feel well. Medicines may include:

• Antiplatelets like clopidogrel or ticagrelor are commonly prescribed for 1 year to reduce the chance of you having another heart attack. Most people are also prescribed lifelong aspirin.
• ACE inhibitors or ARBs such as ramipril or losartan are prescribed to treat heart failure and high blood pressure.
• Beta blockers like bisoprolol help control your heart rate and can also help lower blood pressure. This helps to reduce the workload of the heart so that it can recover.
• Statins like atorvastatin reduce the level of cholesterol in your blood and protect the insides of your arteries.
• Glyceryl trinitrate (GTN) spray helps reduce chest pain which can happen after a heart attack.

If you have any questions, concerns or are worried about side effects from your medicine, do not stop taking it and talk to your doctor. If your symptoms are serious, speak to your GP or pharmacist straight away.

If you notice some side effects but they’re not too bad, it can help to keep a diary of your symptoms before you talk to your doctor so they can help you manage. Another option is to use the New Medicine Service (NMS) through the NHS to get extra help if you’re prescribed medicine to treat a long-term condition.

Reduce your risk

How do I reduce my risk of having a heart attack?

Get support

• Speak to our cardiac nurses by phone, callback, email or online chat on Heart Helpline (Monday to Friday, 9am to 5pm).
• Sign up to our Heart Matters magazine for online tips, support and recipes to look after your heart health.
• Join our online HealthUnlocked community to speak to other people going through the same experience.

Listen to this information or read it in another language

 We also have heart attack information available in Arabic, Bengali, Gujarati, Polish, Punjabi, Romanian, Urdu and Welsh.