Chest Discomfort. Pain in the chest is the No. 1 symptom doctors look for. But not all heart attacks cause chest pain, and chest pain can stem from ailments that have nothing to do with the heart. Heart-related chest pain is often centered under the breastbone, perhaps a little to the left of center.
The pain has been likened to “an elephant sitting on the chest,” but it can also be an uncomfortable sensation of pressure, squeezing, or fullness. Sometimes people make the mistake that the pain comes from a stomach problem. Chest pain during exercise or other physical exertion, called angina, is a common symptom of chronic coronary artery disease (CAD).
- Shortness of Breath. People who feel winded at rest or with minimal exertion might have a pulmonary condition like asthma or chronic obstructive pulmonary disease (COPD). But breathlessness could also indicate a heart attack or heart failure.
- Dizziness. Heart attacks can cause lightheadedness and loss of consciousness. So can potentially dangerous heart rhythm abnormalities known as arrhythmias.
- Fatigue. Unusual fatigue can occur during a heart attack as well as in the days and weeks leading up to one. The heart can’t pump enough blood to meet the needs of body tissues so the body diverts blood away from less vital organs, particularly muscles in the limbs, and sends it to the heart and brain. Feeling tired all the time may be a symptom of heart failure. But many other things can cause fatigue.
- Sudden Sweating. Suddenly breaking out in a cold sweat is a common symptom of heart attack.
- Rapid or irregular pulse. To “make up for” the loss in pumping capacity, the heart beats faster. Doctors say that there’s usually nothing worrisome about an occasional skipped heartbeat. But a rapid or irregular pulse — especially when accompanied by weakness, dizziness, or shortness of breath — can be evidence of a heart attack, heart failure, or an arrhythmia. Left untreated, some arrhythmias can lead to stroke, heart failure, or sudden death.
- Pain in other parts of the body. In many heart attacks, pain begins in the chest and spreads to the shoulders, arms, elbows, back, neck, jaw, or abdomen. But sometimes there is no chest pain — just pain in these other body areas like one or both arms, or between the shoulders. The pain might come and go.
- Indigestion, Nausea or Lack of Appetite. It’s not uncommon for people to feel sick to their stomach or throw up during a heart attack. The digestive system receives less blood, causing problems with digestion. And abdominal swelling associated with heart failure can interfere with appetite.
- Swelling. Heart failure can cause a buildup of excess fluid in body tissues. This can cause swelling — often in the feet, ankles, legs, or abdomen — as well as sudden weight gain and sometimes a loss of appetite.
- Weakness. In the days leading up to a heart attack, as well as during one, some people experience severe, unexplained weakness. “One woman told me it felt like she couldn’t hold a piece of paper between her fingers,” McSweeney says.
- Persistent coughing or wheezing. A symptom of heart failure can result in fluid accumulation in the lungs.
- Confusion and Impaired Thinking. Changing levels of certain substances in the blood, such as sodium, can cause confusion, memory loss and feelings of disorientation. A caregiver or relative may notice this first.
- Sexual Dysfunction. Trouble performing may be a concern for heart health as well as sexual health. When blood vessels don’t work well, sexual problems can occur. “If you have dysfunction in one circulatory area you have it in others,” says Dr. Rene Alvarez, associate professor of medicine at the University of Pittsburgh Medical Center Cardiovascular Institute.
- Snoring and Sleep Apnea. A study from Emory University in Atlanta found that the obstructed airways in people who have sleep apnea or snore were linked to higher risk of cardiovascular disease. Disturbed sleep may be a predisposition of high blood pressure and diabetes, both contributing to heart disease.
- Intense Anxiety. To complicate matters further, a racing heart and shortness of breath can also be a sign of an anxiety attack, and a feeling of anxiety is also an indicator of a heart attack. Heart attack can cause intense anxiety or a fear of death. Heart attack survivors often talk about having experienced a sense of “impending doom.”