The most common heart attack warning sign is pressure, tightness or pain in the centre of the chest that lasts more than a few minutes or keeps coming back. It may spread to the arms, jaw, neck or back, and often comes with breathlessness, sweating or nausea. If you suspect a heart attack, call 108 or 112 immediately, because every minute of delay means more heart muscle is lost.
Key takeaways
- Chest discomfort is the classic symptom, but women, older adults and people with diabetes often have vaguer signs such as breathlessness, nausea, back or jaw pain, or sudden tiredness.
- Call 108 or 112 straight away rather than driving yourself to hospital or waiting to see if it passes.
- Indians tend to develop coronary artery disease 5 to 10 years earlier than many other populations, so screening should not wait until old age.
- If someone collapses and is not breathing normally, start hands-only CPR: push hard and fast in the centre of the chest.
- Most heart disease is linked to risks you can change: tobacco, blood pressure, blood sugar, cholesterol, inactivity and diet.
What happens during a heart attack
A heart attack (myocardial infarction) happens when blood flow to part of the heart muscle is blocked, usually by a clot forming on a fatty plaque inside a coronary artery. Without oxygen, the affected muscle starts to die. Fast treatment to reopen the artery can save both the heart and the person.
A heart attack is not the same as cardiac arrest. In a heart attack the person is usually awake and in discomfort. In cardiac arrest the heart's rhythm fails, the person collapses, stops breathing normally and needs CPR at once. A heart attack can trigger cardiac arrest, which is why speed matters so much.
Classic heart attack symptoms
Symptoms can build slowly over minutes or start suddenly. They may also come and go. Common signs include:
- Chest discomfort: pressure, squeezing, heaviness, fullness or pain in the centre of the chest, lasting more than a few minutes or returning.
- Spreading pain: discomfort in one or both arms, the left shoulder, neck, jaw, back or upper stomach.
- Shortness of breath: with or without chest pain.
- Other signs: cold sweat, nausea or vomiting, light-headedness, a racing or irregular heartbeat, or a pale, grey look to the skin.
If "acidity" comes with sweating or breathlessness, treat it as a possible heart attack.
Atypical symptoms: women, diabetics and older adults
Women
Chest pain is still the most common symptom in women. However, women are more likely than men to report breathlessness, nausea, vomiting, and pain in the back or jaw. Unusual fatigue or weakness lasting days can also be a warning. Because these signs feel less dramatic, women often delay seeking help.
People with diabetes
Long-standing diabetes can damage the nerves that carry pain signals, so a heart attack may cause little or no chest pain. Breathlessness, sudden tiredness, sweating, nausea or unexplained high blood sugar readings may be the only clues. Some heart attacks are "silent" and are only discovered later on an ECG.
Older adults
Confusion, fainting or weakness can be the main sign.
Warning signs before an attack
Many people notice symptoms hours, days or weeks beforehand. Chest pressure that comes on with effort (such as climbing stairs) and settles with rest, or that keeps returning, needs a prompt medical review.
What to do in the first few minutes
| Step | What to do |
|---|---|
| 1. Call for help | Dial 108 or 112 at once. Say "possible heart attack" and give a clear address and landmark. |
| 2. Stop and rest | Sit the person down in a comfortable position. Loosen tight clothing. |
| 3. Ask about aspirin | Ask the emergency operator or a doctor whether aspirin should be chewed. Only take it if they advise it and the person is not allergic or told by their doctor to avoid it. |
| 4. Use prescribed medicine | If the person has been prescribed medicine for chest pain, help them take it as their doctor instructed. |
| 5. Unlock and prepare | Unlock the door, keep the phone line free, and gather any medicine list and reports. |
| 6. Watch closely | If they collapse and stop breathing normally, start CPR immediately. |
Avoid driving yourself. Ambulance teams can start treatment on the way. If no ambulance is available, have someone else drive you to the nearest hospital with cardiac emergency care.
Hands-only CPR basics
If an adult collapses and is unresponsive and not breathing normally, call 108 or 112 (or ask someone else to) and start chest compressions:
- Kneel beside the person on a firm surface.
- Place the heel of one hand in the centre of the chest, with the other hand on top.
- Keep your arms straight and push down hard and fast, about 5 to 6 cm deep, at 100 to 120 compressions per minute.
- Let the chest rise fully between pushes, and keep going until help arrives or the person starts breathing normally.
- If an automated external defibrillator (AED) is available, switch it on and follow its voice prompts.
A short certified CPR course builds real confidence.
Why Indians face higher risk at younger ages
Research reviews report that coronary artery disease appears about 5 to 10 years earlier in Indians and other South Asians than in many other ethnic groups.
Contributing factors include high rates of diabetes, a tendency to store fat around the waist even at a "normal" weight, unfavourable cholesterol patterns, tobacco use, and diets heavy in refined carbohydrates and fried foods. A parent or sibling with early heart disease also raises your risk.
Risk factors you can and cannot change
| Can change | Cannot change |
|---|---|
| Smoking, bidi, gutkha and other tobacco | Age |
| High blood pressure | Male sex (women's risk rises after menopause) |
| High blood sugar and diabetes | Family history of early heart disease |
| Unhealthy cholesterol levels | Ethnic background |
| Physical inactivity | |
| Excess weight, especially around the waist | |
| Diet high in salt, sugar and fried food | |
| Heavy alcohol use, chronic stress, poor sleep |
Air pollution is also recognised as a heart risk, which is relevant in many Indian cities.
Heart-healthy habits that make a difference
- Quit tobacco in every form. Your risk starts falling soon after stopping. Ask your doctor about support and quitlines.
- Know your numbers. Ask your doctor how often to check blood pressure, blood sugar and cholesterol. Many adults with a family history start screening earlier.
- Move most days. Aim for at least 150 minutes of moderate activity, such as brisk walking, each week.
- Eat more plants. Fill half your plate with vegetables, choose whole grains and pulses, and cut back on salt, sugar, deep-fried snacks and packaged foods.
- Sleep and stress. Aim for seven or more hours of sleep and find daily ways to unwind.
- Take prescribed medicines regularly. If you have been prescribed treatment for blood pressure, diabetes or cholesterol, do not stop it without talking to your doctor.
When to see a doctor
Call 108 or 112 immediately for:
- Chest pain, pressure or tightness lasting more than a few minutes or coming back
- Chest discomfort with sweating, breathlessness, nausea or fainting
- Sudden severe breathlessness, or collapse
- Signs of stroke: face drooping, arm weakness, or slurred speech
Book a prompt appointment if you get chest discomfort or breathlessness on exertion that eases with rest, unusual tiredness when walking, palpitations, or if you have diabetes, high blood pressure or a family history of early heart disease and have not been checked recently.
Frequently asked questions
Can a heart attack feel like acidity or gas?
Yes. Burning, fullness or discomfort in the upper stomach or chest can be a heart attack, especially when it comes with sweating, breathlessness or weakness. If you are unsure, it is safer to call for help and be checked than to wait at home.
Should I chew aspirin during a heart attack?
Aspirin can help in some heart attacks, but it is not safe for everyone, for example people with an allergy or certain bleeding problems. Call 108 or 112 first and follow the advice of the emergency operator or a doctor about whether to take it.
Can young people have heart attacks?
Yes. In India, heart attacks under 45 are increasingly seen, particularly with smoking, diabetes, high cholesterol or a strong family history. Age alone should never be a reason to dismiss chest pain.
What is a silent heart attack?
A silent heart attack causes few or no obvious symptoms and is often found later on an ECG or scan. It is more common in people with diabetes and older adults. It still damages the heart, so regular check-ups matter.
Sources
- World Health Organization: Cardiovascular diseases (CVDs) fact sheet
- American Heart Association: Warning signs of a heart attack
- American Heart Association: Understand your risks to prevent a heart attack
- American Heart Association: What is CPR?
- NHS: Heart attack
- Mayo Clinic: Heart attack symptoms and causes
- National Lipid Association: Atherosclerosis in the Indian population