In the movies, you never doubt when a man's having a heart attack. He clutches his chest, screams, or moans, and falls to the ground. If he's lucky, help is on its way.
In real life, the signs aren't always so clear. Some people do experience Hollywood-type symptoms, says Mohamud Daya, MD, an associate professor of emergency medicine at Oregon Health and Science University in Portland. But others don’t. “Some people say they just feel uneasy discomfort or vague discomfort, not pain that really hurts. Sometimes it feels more like heaviness or pressure,” Daya explains.
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Doctors say, in general, the three most commonly reported symptoms when men have a heart attack are:
No Two Heart Attacks the Same
“Some chest symptoms almost invariably accompany a heart attack, but everyone experiences it a little bit differently,” says Kristin Newby, MD, a cardiologist at the Duke Heart Center in Durham, NC. “Describing it as pain or pressure or tightness or burning or any of those symptoms are probably all reflecting each individual’s perception of the same thing.”
Chest pain or discomfort can come on fast or slow. Symptoms can come and go or last for more than a few minutes. In a study published in the American Journal of Critical Care in 2008, men reported more severe chest pain than women. They were also more likely to say their symptoms were brought on by exertion.
However, that same study found that 10 percent of men experienced no chest pain at all. And diabetics can have heart attacks without feeling pain. It’s also possible to experience a cluster of other symptoms. While less common than chest pain, these can include:
Discomfort or pain in other areas, such as one or both arms, the neck, jaw, back, or stomach
Shortness of breath, lightheadedness, nausea, or sweating
“You have a spectrum of presentations. We tend to make medicine black and white,” Daya says. "It really isn’t. People can have minor symptoms or very major symptoms. That’s the challenge.”
Every Second Matters
About half of sudden cardiac deaths happen outside a hospital, meaning that people don't act on early warning signs, the CDC says.
A 2010 study published in the Journal of Cardiovascular Nursing found that most men wait 6 hours before calling 911 when having heart attack symptoms.
“The really bad news is that is too late,” says Holli A. DeVon, PhD, RN, who led the study. “We say you should call 911 within 5 minutes. That is the goal. And we are missing that goal by hours, not minutes.”
DeVon, an associate professor in the College of Nursing at the University of Illinois at Chicago, says the faster you get to the hospital, the better the outcome.
Once you're there, doctors can begin treatments like clot-dissolving drugs or angioplasty to restore blood flow to the heart muscle and limit damage. “If you get to the hospital in a few minutes rather than a few hours, you are more likely to have a better outcome with less complications, and you are less likely to die,” she says.