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What is a heart attack? Causes and symptoms

Not all chest pain is caused by a heart attack, but it’s best to be safe. Here's what to know about heart attacks before they happen.

Published: July 25, 2024 |18 minutes to read

Written by: Jessica Sebor

A person sits on their bed grimacing with one hand on their chest, as if in pain.

Note: If you have questions about your heart health, it’s best to talk with a trained health professional. If your health might be in immediate danger, call 911 immediately in order to get to the nearest emergency room.

In the United States alone, heart disease is the leading cause of death, and about 805,000 heart attacks happen every year.1 But silver linings do exist. Between 1999 and 2020, the fatality rate from heart attacks dropped by more than half.2 This is partly because heart problems can now be diagnosed more quickly, and more hospitals have the tools and medications they need to treat these patients fast, according to a report from the American College of Cardiology.3

When someone is experiencing a heart attack, it’s important to seek help immediately. In a hospital setting, “a heart attack can be stopped,” says Ernst von Schwarz MD, PhD, Professor of Medicine and Clinical Academic Cardiologist in Los Angeles.4 Call 911 if you notice symptoms of a heart attack. “Every second counts,” he adds.5

A lot can be done to help prevent heart attacks before they occur. Small lifestyle changes can make a difference.6 Read on to understand how heart attacks happen and what can be done to reduce the chances of having one.

In this article:

What causes a heart attack?

A heart attack, also called a myocardial infarction, happens when blood can’t flow to the tissues in the heart, which keeps it from being able to function.7

“The heart is a pump made of muscle,” explains Annapoorna Kini, MD, Professor of Cardiology and Interventional Director of Structural Heart Program at Mount Sinai School of Medicine in New York City. “That muscle requires nutrition, and its nutrition is oxygen, which comes through pipes called blood vessels on the surface of the heart.”8 When the heart isn’t getting the nutrition it needs to keep pumping, that’s when a heart attack happens.9

A heart attack can happen for many reasons. The most common cause is coronary artery disease (CAD).10 As the name implies, this disease affects the blood vessels in and around the heart, called the coronary arteries.11 CAD is typically caused by atherosclerosis, a buildup of plaque inside the artery walls.12

That layer of plaque in atherosclerosis is developed over time by cholesterol, fat and blood cells.13 The more plaque that builds up within the arteries, the more difficult it is for blood to pass through them.14 This can lead to a blockage that keeps blood and oxygen from reaching the heart. Plaque poses an additional risk because pieces can break away from the artery wall and become stuck in other places in the bloodstream, leading to obstructions.15

Coronary artery disease and atherosclerosis are linked to lifestyle. That includes a diet high in saturated fat, smoking and sedentary living, as well as conditions like high cholesterol, diabetes and obesity.16

While most heart attacks are caused by coronary artery disease, a heart attack can also be brought on by less common conditions:

  • Lack of oxygen (hypoxia): If the lungs can’t function properly, oxygen in the blood decreases, which can damage heart muscles and cause a heart attack.17 Severe pneumonia, asthma, cystic fibrosis and carbon monoxide poisoning can all lead to hypoxia.18
  • Coronary artery spasm: When muscles around the arteries tighten unexpectedly, a blockage can occur. Spasms can be triggered by alcohol withdrawal and stimulant drugs like cocaine.19
  • Spontaneous coronary artery dissection (SCAD): In rare cases, an artery wall can tear, leading to a restriction in blood flow.20 The cause of SCAD is not known, but it may be linked to hormonal changes (SCAD is more common in women), genetics and extreme physical or emotional distress.21
  • Infection. Certain infections, including COVID-19, can cause inflammation in the arteries and increase the risk of heart attack.22

What does a heart attack feel like?

Heart attacks can be extremely painful with excruciating pressure located in the middle of the chest around the heart. “A lot of people say it feels like an elephant is sitting on their chest,” says Dr. von Schwarz. However, he adds, not everyone will experience this sensation.23 In fact, a heart attack can feel very different for different people.24

“A common misconception about heart attacks is that they always cause the classic symptoms of chest pressure or pain,” says Justin Parizo, MD, an Advanced Heart Failure and Transplant Cardiologist and Director of Heart Failure at Sharp Memorial Hospital in San Diego.25 “Some populations including patients with diabetes and women may present differently, often with more subtle symptoms.”26

Symptoms of a heart attack may include:

  • Severe chest pain or heaviness in the chest
  • Inability to breathe or shortness of breath
  • Profuse sweating
  • Pain in the neck, throat, arm, jaw, back or shoulders
  • Nausea and vomiting
  • Feeling light-headed or dizzy
  • Extreme fatigue
  • Irregular heartbeat or heart palpitations

Allison R. Zielinski, MD, Assistant Professor of Cardiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine Cardiologist in Chicago, notes that symptoms may not present all at once.27 “Often the symptoms are more subtle or can be ‘stuttering,’” she says.28 If there are persistent symptoms, such as shortness of breath that gets worse with activity, they should still be investigated, since they might be related to the heart.29

Where in the arm is heart attack pain felt?

A telltale symptom for some heart attacks is pain that radiates from the chest down the left arm.30 However, a patient can experience no arm pain or pain anywhere in the left arm, right arm or both arms at the same time.31

Dr. von Schwarz explains that one common misconception is that the left arm hurts because of the position of the heart.32 “A lot of people come to our office and say, ‘Oh, it hurts on the left side of the chest where the heart is,’” he says. “The heart is not on the left side of the chest. The heart is located in the middle of the chest, and usually a patient with a heart attack will have pressure in the middle of the chest, not on the left side.”33

Pain outside of the chest, including the arms, jaw, neck and shoulders, may occur thanks to a peculiarity of the nervous system.34 The nerves in our body are part of a large, interconnected network, and sometimes our brain can signal pain in places different from (although usually close to) where the pain actually originates.35 In this case, the cause of the pain is occurring in the heart but can feel like it’s in other places close by, like the arm.

How many beats per minute is a heart attack?

When a heart attack occurs, the heart rate may speed up, slow down or act erratically.36

In fact, 90 percent of people who experience a heart attack will have abnormal heart rhythms (called arrhythmias).37

However, there is no typical beats per-minute range during a heart attack. It can vary from person to person.38 So measuring heart rate is not a good indicator of whether or not someone is experiencing a heart attack, explains Dr. Kini.

Neither the Centers for Disease Control and Prevention (CDC) nor the American Heart Association recognize heart rate as an indicator of a heart attack.39 “Heart rate can go up or down for other reasons,” Dr. Kini says.40 She notes that a heart attack is a “plumbing problem,” but people can have, for instance, “electrical problems” — symptoms of the nervous system — that also cause heart rate issues. “We cannot connect a heart rate up or down with having a heart attack,”41 she says.

For information about normal heart rates and a normal resting heart rate, explore our other articles.

Action plan when a heart attack strikes

At the first signs of a heart attack, it’s critical to seek medical care as soon as possible.42 “If you think you are having a heart attack, you have to call 911 immediately,” says Dr. von Schwarz. “Do not get in your car and think you can drive to your doctor’s office, urgent care or the emergency room, because you might not make that.”43

The sooner a person gets treatment, the more effective the treatment will be.44 Studies show that every 30 minutes someone waits to receive care can take one year off of their life.45

If someone may be experiencing a heart attack, these steps are most commonly recommended:

  1. Call 911. “Heart attacks can vary in severity,” says Dr. Zielinski. That variation can depend on the location of the blockage, whether or not an artery is 100 percent blocked and how long the heart muscle has been deprived of oxygen.46 “The most important thing for patients is to not delay seeking treatment, because the longer the heart muscle is deprived of oxygen, the more damage can occur,”47 she says.
  2. Get into a comfortable position. Stop moving and sit or lie down immediately.48
  3. Consider medication. While waiting for first responders to arrive, the 911 operator may recommend chewing an aspirin — a blood thinner — to help encourage blood flow.49 The operator may ask if the person has any known allergies or conditions that might make aspirin too risky.50 They may also suggest taking nitroglycerin if a doctor has prescribed this medication and it’s readily available.51 Once on the scene, the emergency medical help might also offer these medications if they haven’t been taken yet.52
  4. Convey symptoms clearly to emergency responders. The U.S. Department of Health and Human Services recommends explaining pain in a direct manner to ensure the condition is taken with the utmost seriousness.53

There may be situations where a person collapses or is unresponsive and unable to call for help. This may be due to cardiac arrest.54 Most heart attacks do not cause cardiac arrest, but in cardiac arrest, death can occur quickly if the patient does not receive life-saving treatment.55

When you are near someone who is unresponsive who may have had a heart attack, call 911 immediately and before starting cardiopulmonary resuscitation (CPR). If a bystander is trained in CPR, they should start performing CPR immediately after.56 If there are two people on the scene, one should call 911 while the other starts CPR. If there is an Automated External Defibrillator (AED) available, it should be used as soon as possible.57

If CPR is performed immediately, it can double or even triple a person’s chance of surviving the heart attack.58 CPR training should be renewed every two years.59 If you are interested in being CPR certified, you can find a class through the American Heart Association or the American Red Cross.60

How long does a heart attack last?

Symptoms of a heart attack — the pain, pressure and discomfort — often last 20 minutes or longer.61 As a reminder, this isn’t a health condition that anyone should try to wait out. “If people are concerned that they are having a heart attack, they should seek care immediately,” says Dr. Parizo. “If untreated, a heart attack can progress over hours to days depending on exactly what is happening within the heart arteries.”62

What is a widow-maker heart attack?

A widow maker is one type of heart attack.63 All heart attacks occur when blood flow to the heart is partially or fully obstructed.64 Without blood flow, oxygen can’t reach the heart and the muscle begins to die.65 In a heart attack, blood flow can be obstructed in any of the three arteries leading to the heart. A widow-maker heart attack occurs when the largest artery leading to the heart (the left anterior descending artery or LAD) becomes fully blocked.66 The LAD artery is responsible for half of the heart muscle’s blood supply.67

While the name suggests that this sort of heart attack affects only men, all sexes can suffer from widow makers.68 Widow-maker heart attacks typically share the same causes and symptoms as other types of heart attacks. They are commonly brought on by coronary artery disease (CAD), which leads to plaque buildup in the LAD artery.69 Symptoms of a widow-maker heart attack may include pain in the chest and the surrounding area, lightheadedness, shortness of breath, fatigue and upset stomach.70

The action plan for when a widow maker strikes should be the same as for any type of heart attack. Immediately call 911 and perform life-saving procedures as instructed by the 911 dispatcher or if you are trained in CPR.71 Time is of the essence, particularly for this sort of attack, because the blockage is in a critical area.72

Can someone have a heart attack and not know it?

According to the American Heart Association, roughly 20 percent of heart attacks occur with no or minimal symptoms — an occurrence called a silent heart attack.73 Of the 805,000 heart attacks experienced in the United States every year, 170,000 of them will be silent.74 Dr. Kini explains that patients who have a silent heart attack will only learn that they had an attack after they go to the doctor and have an electrocardiogram (EKG) test.75 “At that time, we can know that you probably had a heart attack,” she says.76

Certain groups of patients may be at higher risk for silent heart attacks.77 Women and those assigned female at birth experience silent heart attacks more often than men and those assigned male at birth.78 They are also more likely to have a heart attack with symptoms that don’t involve crushing chest pain.79

Patients with diabetes are also more prone to silent heart attacks.80 Diabetes can cause nerve damage around the heart, which may dull the pain during an attack.81 “Another group of patients who can have a heart attack but might not feel it are those who have had a heart transplant, because the nerves in the chest are cut,” says Dr. von Schwarz.82

Can a heart attack be stopped?

A heart attack can be stopped, explains Dr. von Schwarz.83 However, he adds, that no one can stop a heart attack at home.84 While some false resources may promise to “stop a heart attack in 30 seconds,” successful treatment can only be carried out by medical professionals.85 “This needs to be done in a hospital setting,” he says.86 Measures like chewing an aspirin at the direction of a health care provider or 911 operator or performing CPR (when appropriate) may help minimize damage and prevent death — but they will not stop an attack.87

Because a heart attack occurs due to a blockage of blood and oxygen, it can only be stopped by treating the occlusion.88 “The goal is to reestablish blood flow as quickly as possible in order to avoid death of parts or portions of the heart,” says Dr. von Schwarz.89

What other conditions resemble a heart attack?

Not all chest pain is caused by heart attacks.90 There are a number of other conditions that have similar symptoms: pain in and around the heart, difficulty breathing, fatigue, heart palpitations and dizziness.91 Conditions that may be mistaken for a heart attack include:

  • Panic attacks, which can happen suddenly, causing shortness of breath and the feeling of a racing heart rate.92 However, they are brought on by extreme stress and, unlike a heart attack, will typically go away within 20 minutes or so.93
  • Acid indigestion, sometimes referred to as “heartburn” as it can cause pain or discomfort in the chest.94 Caused by stomach acid that flows upward and irritates the esophagus, heartburn doesn’t actually involve the heart at all.95
  • A blood clot in the lungs (pulmonary embolism), a condition that can “give the same shortness of breath, rise to chest pain and feeling of lightheadedness,” Dr. Kini says.96,97 A blood clot in the lungs also requires immediate medical treatment.98
  • Chronic obstructive pulmonary disease (COPD), which includes shortness of breath and chest tightness and can also indicate lung disease.99 Patients with COPD are also more likely to have cardiovascular disease.100
  • A chest injury or an injury to the heart, which can lead to pain in the same area where heart attack pain occurs.101 Myocardial contusion or bruising of the heart muscle can happen due to blunt force trauma (think sports injuries or car accidents) and can feel like a heart attack.102
  • Anemia, a condition that occurs when a person doesn’t have enough healthy red blood cells. It can also lead to fatigue, dizziness and feeling out of breath.103

If you’re not sure whether or not you’re experiencing a heart attack, it’s always best to play it safe. “Generally, I recommend calling 911. If people are not sure if they should be worried about the symptoms they are experiencing,” advises Dr. Parizo, “go to the emergency department to be evaluated.”104

Are heart attacks different between sexes?

The immediate reason for a heart attack — sudden obstructed blood flow to the heart — is the same for all sexes.105 However, the risk factors, symptoms and outcomes can differ between the sexes.106

When it comes to heart attacks, advanced age plays a bigger factor for women and those assigned female at birth than it does for men and those assigned male at birth.107 On average, women and those assigned female at birth who suffer their first heart attack are 6.5 years older.108 Dr. Kini explains that this may be due to the protective effects of the reproductive hormone estrogen.109 During menopause, women and people with ovaries stop producing estrogen at the same rate they used to, and their risk of heart disease increases.110 Women and people assigned female at birth who suffer heart attacks are also more likely to have preexisting conditions, including diabetes and high blood pressure.111

Dr. von Schwarz explains that heart attack symptoms can be different as well. “In women, we often see what we call ‘atypical symptoms,’” he says.112 “That’s the reason why in women, much more often than in men, the diagnosis is delayed.”113 Symptoms that deviate from the typical crushing chest pain, like shortness of breath and nausea, are more common.114

Women and people assigned female at birth also face a greater risk of death following a heart attack.115 According to a study from the American Heart Association, women are 20 percent more likely to go into cardiac arrest or die within five years of experiencing their first heart attack.116 Learn more about heart attacks in men and heart attacks in women.

What are heart attack risk factors?

Nearly half of all adults in the United States (47 percent) have at least one of the three primary risk factors for heart disease: high blood pressure, high cholesterol and smoking.117 Heart attack risk factors include the following:

  • Family history. Heart disease has a genetic link.118 Risk increases if there’s a family member who was diagnosed with early heart disease (younger than age 55 for men and people assigned male at birth and younger than 65 for women and people assigned female at birth).119
  • Age. While heart attacks can occur at any time in life for all sexes, the risk goes up as we get older.120 Men and those assigned male at birth over age 45 and women and those assigned female at birth over age 55 are considered to have an increased risk.121
  • High blood pressure. This condition can damage arteries, which can lead to a heart attack.122
  • High cholesterol. Genetic predisposition or a diet high in saturated fats can increase cholesterol numbers. Higher levels of bad cholesterol can lead to a buildup of plaque in blood vessels and arteries.123
  • Weight. A body mass index (BMI) that qualifies as overweight or obese is linked to heart disease.124,125
  • Sedentary lifestyle. Physical inactivity is connected to an increased risk of heart attack.126
  • Smoking. Over time, smoking can damage blood vessels, which can lead to a heart attack.127
  • Unhealthy eating. A diet high in saturated fat, trans fat, cholesterol and sodium can contribute to heart disease.128
  • History of preeclampsia. Women and people with ovaries who are diagnosed with preeclampsia (high blood pressure during pregnancy) are twice as likely to have heart disease and stroke later in life.129

The more risk factors, the greater the overall risk of heart disease. While some factors, like genetics, can’t be changed, there are a number of lifestyle modifications that can be made to lower the risk.

“Your primary care physician or cardiologist can formally estimate your risk with a risk calculator, which can help you decide on which preventative efforts are best for you,” says Grant Reed, Program Director for the Interventional Cardiology Fellowship at Cleveland Clinic.

What complications can a heart attack lead to?

Experiencing a heart attack can lead to a number of complications — and they range in severity.130 The sooner someone is able to seek treatment for a heart attack, the less likely they are to experience complications.131 “Once the artery is open, the likelihood of any complication is low,” says Dr. Kini.132

One of the most common complications of a heart attack is arrhythmia, when the heart beats irregularly, too quickly or too slowly.133 Arrhythmia can occur if the heart muscle is damaged during an attack.134

Damaged muscle in the heart can also lead to heart failure (the heart is not able to pump blood effectively) and heart rupture (an uncommon condition when the heart muscles or valves split apart).135 All of these complications are potentially life-threatening but may be treated with surgery or controlled with medication, depending on the severity and specific complication.136

What are some treatment options for heart attack?

Immediate medical treatment for a heart attack will often include a combination of medications, as well as a procedure to reestablish blood flow.137 “Heart attacks are first treated with medications to thin the blood and decrease the stress on the heart,” says Dr. Parizo.138

Drugs to treat heart attacks may include:

  • Aspirin, which can help prevent blood from clotting.139 Other blood thinning medications like heparin may be used as well.140
  • Nitroglycerin, which helps widen blood vessels to improve blood flow, while treating chest pain as well.141
  • Thrombolytic medication is sometimes called a “clot buster” because it helps break up blood clots and get much-needed blood and oxygen to the heart muscle.142

“Then patients often undergo a coronary angiogram,” Dr. Parizo explains.143 During this test, often performed in a hospital’s cardiac catheterization laboratory (cath lab), a catheter is inserted from the wrist or groin to just above the heart.144 A substance is inserted into the catheter that can be viewed on an X-ray to identify the blockage.145

If a blockage is identified, a procedure called a cardiac angioplasty will be performed to open the artery.146 A doctor will put in another catheter and inflate a balloon at the site of the occlusion.147 They will then insert a stent (mesh tubing) to keep the artery open and ensure blood flows to the heart.148

In the long term, a patient may be prescribed blood thinners or cholesterol medication.149 “They’ll need to see a cardiologist regularly,” says Dr. Kini. She explains that cardiac rehab is often recommended to help establish an exercise program in a safe way.150

Heart attack prevention

“Start paying attention to your cardiovascular health early,” advises Dr. Parizo. “While we cannot avoid aging and we cannot change our family history, we can avoid or mitigate the other main risk factors for cardiovascular disease.”151

The following steps are recommended to help prevent a future heart attack:152

  • Assess the risk. At an annual physical, a doctor will likely perform tests, including blood pressure and cholesterol tests, to ensure a person is in the normal range.153 After age 40, a person can have their 10-year risk of cardiovascular disease evaluated.154 This assessment will measure factors including age, race, sex, diabetes status, family history and more.155
  • Aim for a healthy diet. Eat plants, grains and lean protein. Limit trans fat, saturated fat, added sugar and sodium.156
  • Stay active. Try to get a minimum of 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity every week.157
  • Keep weight in a “normal” range.158 Those who are overweight or obese should aim to manage portion sizes, increase exercise and consider a food diary or tracking app to help reach their goals.159
  • Don’t use tobacco.160 Avoiding tobacco alone may reduce the risk of heart attack by 36 percent.161 That means quitting cigarettes and vaping. If you are having trouble quitting, speak with a health care provider about one of the many proven options to help you quit.
  • Manage existing conditions. “Diabetes and high blood pressure require strictest control,” says Dr. von Schwarz. “In particular, for high blood pressure, patients don’t take it seriously enough because it doesn’t hurt. That’s the biggest risk, because uncontrolled high blood pressure can lead to heart attacks.”162
  • Stay on top of medication. Take over-the-counter and prescription medication according to the label instructions or as prescribed by a health care provider.
  • Work with a health care team. A health care provider can work on a heart-healthy plan that matches a person’s lifestyle. 163

Heart attacks are serious, but no matter age or health status, lifestyle changes can make a big difference in lowering the risk.164

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.