Reviewed by Dr. A M Thirugnanam, MD, MSICP, FSCAI, Ph.D. — Senior Interventional Cardiologist
If you think you or someone near you is having a heart attack right now, stop reading. Call 108 or go to the nearest hospital with an emergency department immediately. Heart muscle dies minute by minute. The single greatest determinant of how much heart you keep is how quickly you arrive.
What a heart attack actually feels like
Films have taught everyone the wrong thing. A person clutching their chest and collapsing is the exception. Far more often it begins as something that feels almost reasonable — a heaviness, a tightness, a pressure, a squeezing sensation in the centre of the chest. Many patients describe it as though someone were sitting on them, or as severe indigestion.
The features that should worry you:
- Central chest discomfort — pressure, tightness, heaviness or burning — lasting more than a few minutes, or coming and going
- Discomfort spreading to the left arm, both arms, the jaw, the neck, the upper back or the region between the shoulder blades
- Breathlessness, with or without chest discomfort
- Cold sweating, often described as breaking out in a clammy sweat for no reason
- Nausea or vomiting
- Sudden overwhelming fatigue or a feeling of impending doom
- Light-headedness or fainting
The character of the discomfort matters more than its severity. A moderate pressure in the centre of the chest with sweating is far more concerning than a sharp, stabbing pain that lasts two seconds.
What is usually not a heart attack
Pain that is sharp and momentary. Pain reproduced exactly by pressing a spot on the chest wall. Pain that changes clearly with the position of your body or with breathing in. Pain lasting many hours entirely unchanged, in someone otherwise completely well.
These patterns are reassuring, not guarantees. If you have diabetes, are over sixty, or have known heart disease, the usual rules are less reliable and the threshold for seeking help should be lower.
Why women are misdiagnosed
Women more often present without dramatic chest pain. Instead there may be unusual fatigue for days beforehand, breathlessness, nausea, discomfort in the jaw or upper back, or disturbed sleep. Because this does not match the expected picture, women are more likely to be sent home from an emergency department and more likely to delay coming in at all.
If you are a woman with new, unexplained breathlessness or profound fatigue and you have risk factors, ask explicitly: “Could this be my heart?” Asking the question directly changes what gets tested.
Why people with diabetes must be more cautious
Long-standing diabetes damages the nerves carrying pain from the heart. A meaningful proportion of heart attacks in people with diabetes are silent — no chest pain at all. The presentation may be breathlessness, sudden weakness, confusion in an older person, or unexplained collapse. If you have had diabetes for more than a decade, treat new breathlessness on exertion as cardiac until a doctor says otherwise.
What to do in the first ten minutes
- Call 108, or arrange immediate transport to hospital. Do not drive yourself.
- Sit or lie down and stop all exertion. Loosen tight clothing.
- Chew — do not swallow whole — 300 mg of aspirin (usually four 75 mg tablets or one 325 mg tablet), unless you are allergic to it or have been told not to take it. Chewing gets it into the bloodstream faster. This one step measurably reduces deaths.
- Do not wait to see if it passes. The commonest cause of death from heart attack in India is delay in reaching hospital, not inadequate treatment once there.
- Go to a hospital with a catheterisation laboratory if one is reachable within a reasonable time. Opening the blocked artery with an angioplasty is the definitive treatment.
- If the person becomes unresponsive and is not breathing normally, begin chest compressions — hard and fast in the centre of the chest, about two per second — and send someone for an automated defibrillator if one is available.
Do not take someone else’s sorbitrate or nitroglycerine tablet. If blood pressure is low, it can be dangerous.
The warning that comes weeks earlier
Many heart attacks are preceded by stable angina — a reproducible chest tightness or breathlessness that appears at a predictable level of exertion and settles within a few minutes of rest. Climbing the same two flights of stairs that were effortless last year now produces a heaviness that eases when you stop.
This is the body giving notice, and it is the most valuable warning you will ever receive. It means an artery is significantly narrowed but not yet blocked. Investigated at this stage, the outcome is usually excellent. Ignored, it may progress to a heart attack.
Seek an urgent cardiology assessment, not an emergency one, if you notice exertional chest discomfort or breathlessness that is new for you, or angina that is occurring at lower levels of activity than before, or waking you at night.
What to ask your doctor
- Given my risk factors, what symptoms should make me go straight to hospital?
- Should I keep aspirin at home, and what dose should I chew in an emergency?
- Which nearby hospital has a 24-hour catheterisation laboratory?
- Are my symptoms consistent with angina, and do they warrant a stress test or angiogram?
Emergency: call 108 or go to the nearest hospital. Do not use this website.
This guide is educational and does not replace a consultation with your own doctor. It cannot be used to diagnose or rule out a heart attack.
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