Heart Attack Recognition & Response

Heart disease kills more people globally than any other cause — approximately 17.9 million deaths annually. In many of those cases, the person experiencing the heart attack, or a bystander, failed to recognise the symptoms quickly enough. Early treatment dramatically improves outcomes: a heart artery reopened within 90 minutes of symptom onset preserves substantially more heart muscle than one reopened after several hours.

This guide covers how to recognise a heart attack, what distinguishes it from cardiac arrest, and exactly what to do in the critical first minutes.

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Heart Attack vs Cardiac Arrest — A Critical Distinction

These terms are often used interchangeably but describe very different medical events. The distinction matters because the immediate response is different.

Feature	Heart Attack	Cardiac Arrest
What is happening	Blockage in a coronary artery — heart muscle is starved of oxygen	Heart stops pumping — no organised electrical activity
Consciousness	Patient is usually conscious and responsive	Patient is unresponsive
Breathing	Usually breathing normally	Not breathing or only gasping (agonal breaths)
Pulse	Present	Absent
Pain	Typically severe chest pain or pressure	May be preceded by chest pain if heart attack caused it
Immediate action	Call 999/911; aspirin; reassure; wait for ambulance	Call 999/911, CPR, AED
Can talk and describe symptoms	Yes	No

A heart attack can progress to cardiac arrest if the arrhythmia that results from the blocked artery causes ventricular fibrillation. This is why a heart attack patient must never be left alone and why you should always have CPR and AED capability ready.

⚠️ If a heart attack patient loses consciousness and stops breathing normally — they have likely gone into cardiac arrest. Start CPR immediately and call for an AED.

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Classic Heart Attack Symptoms

The most widely recognised symptom is crushing chest pain or pressure, but heart attacks present in many ways:

Chest symptoms:

• Central chest pain, pressure, tightness, squeezing, or heaviness — often described as "an elephant sitting on my chest"
• Pain that lasts more than 20 minutes and does not resolve with rest or antacids
• Pain that may come and go in waves

Radiating pain:

• Left arm (most classic) — aching or tingling down the inner aspect of the left arm
• Right arm (less common but documented)
• Jaw, throat, or teeth
• Upper back, between the shoulder blades
• Upper abdomen — can be mistaken for indigestion or a stomach complaint

Accompanying symptoms:

• Shortness of breath — even without chest pain
• Cold sweats — sudden onset, clammy skin
• Nausea or vomiting
• Lightheadedness or dizziness
• Sense of impending doom or unusual anxiety

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Atypical Presentation — Especially in Women

Women are significantly more likely to experience heart attacks without classic chest pain. This has historically led to women's heart attacks being misdiagnosed — by both patients and clinicians — as anxiety, indigestion, or other conditions.

Women are more likely to report:

• Shortness of breath as the primary or sole symptom
• Extreme fatigue — unusual tiredness that may develop days before the event
• Nausea, vomiting, or abdominal discomfort
• Jaw or neck pain rather than chest pain
• Sleep disturbance in the days preceding the event

This does not mean women do not get classic chest pain — many do. But in the absence of it, the other symptoms listed above should still prompt an emergency call. When in doubt, call emergency services. A false alarm costs nothing. A missed heart attack can be fatal.

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Immediate Actions — What to Do

Step 1 — Call Emergency Services Immediately

Call 999 (UK), 911 (USA), 112 (EU), or your local emergency number. Do not drive the patient to hospital yourself if an ambulance can reach you faster — paramedics can begin treatment en route, including clot-busting drugs and 12-lead ECG transmission to the hospital.

Tell the dispatcher:

• "I think someone is having a heart attack"
• Location (address and any landmarks)
• The patient's age and the symptoms they are experiencing
• Whether the patient is conscious and breathing

Step 2 — Help the Patient into a Comfortable Position

Sit the patient down — ideally on the floor with their back against a wall, or on a chair. A semi-reclined position reduces strain on the heart. Do not allow them to walk around or exert themselves.

Step 3 — Aspirin 300 mg (If Appropriate)

Aspirin inhibits platelet aggregation and can limit the size of the clot blocking the coronary artery. The AHA, BHF, and NHS all recommend 300 mg of aspirin to be chewed (not swallowed whole — chewing achieves faster absorption) as soon as possible if:

• The patient is conscious and able to swallow
• They are NOT allergic to aspirin
• They are NOT already taking a blood thinner that contraindicates aspirin
• There are no signs of active bleeding or peptic ulcer

Use adult aspirin 300 mg. Regular-strength aspirin (325 mg in the USA) is equivalent. Enteric-coated aspirin is less suitable — if only coated is available, it should still be chewed.

Do not give aspirin if the patient is unconscious, has a known allergy, has been told specifically by a doctor not to take aspirin, or if you are unsure.

Step 4 — Monitor and Reassure

Stay with the patient. Talk calmly. Keep them warm and still. Monitor their level of consciousness and breathing every minute.

Step 5 — Be Ready to Start CPR

If the patient loses consciousness and stops breathing normally, begin CPR immediately. Cardiac arrest during a heart attack is survivable with prompt defibrillation — AEDs have the highest impact in these situations.

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Should You Drive to Hospital?

This is one of the most important questions in cardiac emergency response.

Call an ambulance rather than driving when:

• Symptoms have been present for more than 5 minutes
• The trip to hospital is more than a few minutes in light traffic
• You are the only person available — driving a heart attack patient alone means no one monitors them

Driving may be acceptable only if:

• Hospital is very close (1–2 minutes) and ambulance response time is significantly longer
• A second person can monitor the patient while you drive
• No ambulance is available (remote areas)

Ambulances are almost always preferable. UK ambulances carry 12-lead ECG equipment and can alert the cardiac catheterisation lab before arrival, so the team is ready when the patient arrives — dramatically reducing time to treatment.

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Warning Signs in the Days Before

Research shows that many heart attack patients experienced warning symptoms in the 24–72 hours beforehand — symptoms that, if acted on, could have led to earlier intervention:

• Unusual chest discomfort that came and went
• Unexplained breathlessness during normal activity
• Unusual fatigue or feeling "off"
• Occasional palpitations
• Mild nausea or indigestion that did not resolve

These are symptoms of unstable angina — a pre-heart attack state that requires urgent medical evaluation. If you or someone you know experiences these, seek medical assessment the same day.

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Quick Reference

Symptom / Situation	Action
Central chest pain > 20 min	Call 999/911 immediately
Chest pain with arm, jaw, or back pain	Call 999/911
Shortness of breath + sweating + nausea	Call 999/911 — possible atypical heart attack
Patient wants to drive themselves	Do not allow it — call ambulance
Aspirin available, patient conscious, no allergy	Give 300 mg, chewed
Patient loses consciousness	Check for breathing, start CPR, call for AED
Patient appears to recover but symptoms returning	Do not cancel ambulance — symptoms can return suddenly
Women with fatigue/nausea/back pain	Treat as potential heart attack — call 999/911

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Risk Factors — Who Is Most Vulnerable

Understanding risk factors helps identify when atypical symptoms deserve extra urgency:

• Age (men over 45, women over 55)
• Smoking — present or past
• High blood pressure
• High cholesterol
• Diabetes
• Family history of heart disease
• Obesity and physical inactivity
• Chronic stress and depression

Any person with multiple risk factors presenting with the symptoms above should be treated as a potential heart attack until proven otherwise. When in doubt — call.