The most common symptom of a heart attack is severe chest pain, although this sensation is not always present. In one study of people treated for a heart attack, almost half of them came to the emergency room because they had symptoms other than chest pain. These symptoms included shortness of breath, dizziness, weakness or fainting, and abdominal pain.¹Women, older adults, and people with diabetes are less likely to have chest pain during a heart attack and more likely to have other symptoms.

It is possible to have a "silent heart attack" without any symptoms, but this is rare. Most people have chest pain and at least one other symptom, such as:

• A feeling of choking or a "tight throat," a lump in the throat, or a need to keep swallowing.
• A cold sweat.
• Nausea.
• A sense of impending doom.
• Difficulty breathing or breathlessness.
• Palpitations, or feeling your heart beat rapidly or irregularly. (Palpitations are very common and are usually harmless in a healthy heart, but they may signal coronary artery disease if brought on by exertion.)
• Numbness or discomfort in either arm or hand.
• Weakness.

People who are having a heart attack often describe their chest pain in various ways. The pain:

• May feel like pressure, heaviness, weight, tightness, squeezing, discomfort, burning, a sharp ache (less common), or a dull ache. People often put their fist to their chest when describing the pain.
• May radiate from the chest down the left shoulder and arm (the most common site) and also to other areas, including the left shoulder, middle of the back, upper portion of the abdomen, right arm, neck, and jaw. See a picture of the areas where you might have pain during a heart attack.
• May be diffuse-the exact location of the pain is usually difficult to point out.
• Is not made worse by taking a deep breath or pressing on the chest.
• Usually begins at a low level, then gradually increases over several minutes to a peak. The discomfort may come and go. Chest pain that reaches its maximum intensity within seconds may represent another serious problem, such as an aortic aneurysm.

Women are more likely to have symptoms such as shortness of breath, heartburn, nausea, jaw pain, back pain, or fatigue.

Call911or your local emergency services if:

• Your chest pain gets worse or lasts more than 5 minutes, especially if you are short of breath or feel weak, nauseated, or lightheaded.
• Your chest pain doesn't improve or gets worse within 5 minutes after taking 1 dose of nitroglycerin.

It may not always be possible to tell the difference between unstable angina and a heart attack. Often the symptoms are similar. Both conditions require immediate emergency care.

People who have unstable angina often describe their pain as:

• Starting within the past 2 months and becoming more severe.
• Limiting their physical activity.
• Suddenly becoming more frequent, severe, or longer-lasting or being brought on by less exertion than before.
• Occurring at rest with no obvious exertion or stress-it may wake the person up.
• Not responding to rest or nitroglycerin.

The symptoms of stable angina are different from those of unstable angina. Stable angina occurs at predictable times with a specific amount of exertion or activity and may continue without much change for years. It is relieved by rest or nitrates (nitroglycerin) and usually lasts less than 5 minutes.