While many Americans can recognize several early warning signs of a heart attack, millions are unable to name even a single symptom, like chest pain, according to a national study by Yale School of Medicine’s Center for Outcomes Research & Evaluation (CORE) researchers. 

Participants were also given a choice of the best response to a suspected heart attack: call for emergency services or “other.” About 4.5% of the more than 25,000 U.S. adults surveyed chose “other.”  

Heart attack symptoms can range from a subtle twinge to extreme pain in different areas of the body, including the chest; arm or shoulder; or jaw, neck, or back. This pain is often accompanied by shortness of breath and feeling lightheaded and weak. No matter which combination of symptoms occurs, it’s important to get to a doctor as quickly as possible. Time makes a significant difference in whether or not a person survives a heart attack, and their health going forward.

“The quicker we can get a person having a heart attack into the cardiac catheterization lab the better,” says Erica Spatz, MD, MHS, a cardiologist at Yale Medicine. “Yale has been a leader in establishing that time matters in treating heart attacks.”

The heart pumps oxygen-rich blood to the rest of the body through an intricate network of arteries. However, the arteries around your heart can get blocked, usually by a blood clot and less often because of severe spasms and dissection. When this happens, blood flow is slowed or blocked. 

Over time, the oxygen-starved heart tissue dies. Blood clots can form when plaque that has built up in the artery ruptures. Spasms can be caused by certain drugs, like cocaine, emotional stress or pain, exposure to extreme cold, or smoking. Dissections can occur spontaneously; sometimes they occur with pregnancy.

The classic image of a person having a heart attack is one of a person clutching their chest, complaining of crushing chest pain or an elephant sitting on their chest. However, in real life, the symptoms can be more subtle. That’s why you should go to the hospital as quickly as possible if you suspect you are having a heart attack, even if you’re not experiencing the stereotypical symptoms.

The most common symptoms of a heart attack include:

• Chest pain: Most heart attacks involve some sort of pain in the center or left side of the chest. This pain can either be severe or mild. Some people, especially women, experience discomfort rather than pain during a heart attack. This discomfort can feel like pressure, squeezing or even indigestion.
• Upper body discomfort: Chest pain can sometimes radiate to the left arm or to the jaw. These symptoms can also occur in isolation, without chest pain.
• Shortness of breath: This symptom may accompany chest pain or discomfort, or it may be the only symptom of the heart attack.

Here are some other symptoms that might accompany the ones above:

• Nausea
• Lightheadedness
• Breaking out in cold sweat

You have a higher risk of having a heart attack if:

• You are a man over 45 years old or if you are a woman over 55 years old
• You have a family history of heart disease

In addition, these lifestyle conditions can increase your risk for heart attack:

• Smoking
• High blood pressure
• High cholesterol
• Diabetes
• Overweight and obesity
• A diet high in unhealthy fats, cholesterol and sodium
• Lack of physical activity

Time is the most important factor in treating heart attack. If you suspect you or someone near you is having a heart attack, call 911 immediately. A dispatcher will send an ambulance within a couple of minutes. Once the ambulance arrives, paramedics will administer an electrocardiogram (EKG) and send the results straight to the emergency department, where the diagnosis is confirmed by an emergency medicine physician. 

If you are having a certain type of heart attack that requires immediate opening of a heart artery, a medical team including nurses, doctors and other professionals assembles immediately; they will already be there by the time the ambulance arrives. This way, they can get you to the catheterization immediately to open a potentially blocked artery.

To treat the blockage causing the heart attack, a doctor threads a  catheter (a long thin tube) with a balloon at the tip through an artery in either the arm or the groin. The catheter is then glided up to the blocked artery with the help of an x-ray. 

Once in place, a balloon is inflated, which will unblock the artery by pushing the plaque against the artery wall. Doctors may also use a stent, which is a small, mesh-like device usually made of metal. It acts like a support or scaffold that keeps the artery open and allows blood to flow through.

Yale Medicine doctors have set the standard in treating heart attacks both in academic research and in hospitals around the world. In 2006, Yale researchers published a widely-cited study in the New England Journal of Medicine establishing the importance of time when treating heart attacks. That research encouraged cardiology programs around the country to cut down on the time it takes for a patient to get to a cardiac catheterization lab. Since then, the death rate from coronary heart disease has dropped 38 percent. 

In addition, Yale Medicine doctors are committed to helping patients recover fully after the heart attack. Patients are referred to the Yale New Haven Hospital Cardiac Rehabilitation Center at one of two locations—in New Haven or Branford. 

Since moderate exercise is important in restoring and maintaining heart health, our staff helps patients regain their confidence when exercising.  The centers are outfitted like gyms, with state-of-the-art equipment, including treadmills, rowing machines, exercise bikes and weights. Each patient is monitored with frequent EKG and blood pressure tests, and more. Those results are sent to the primary referring cardiologist.