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What Are the Initial Heart Attack Symptoms?

By Stephen Christensen ; Updated September 26, 2017

Heart disease is the leading cause of death in the United States. In 2009, more than 386,000 people died of coronary heart disease, the most common form of heart disease. One-third of these deaths were due to heart attacks. Nearly half of all deaths due to heart attacks occur before victims arrive at a hospital, suggesting that many people with heart disease either do not recognize or fail to act on the early signs and symptoms of a heart attack.

Chest Pain

The classic presentation of a heart attack is deep, crushing pain centered beneath your breastbone and radiating to your left shoulder and arm. However, the pain due to a heart attack may radiate to your back, upper abdomen, neck, jaw, right arm or even your teeth. This pain, called angina, occurs when your heart muscle is starved for oxygen.

In people with angina, the harbinger of a heart attack, the chest pain usually worsens with exertion and improves with rest. Once a heart attack begins in earnest, though, your pain may be present even at rest. Occasionally, people having heart attacks do not experience significant pain. This is particularly common among people with long-standing diabetes.

Abnormal Rhythms

Your heart is an electromechanical pump whose rhythmic contraction is regulated by an internal pacemaker that generates an electrical impulse about 70 times each minute. During a heart attack, the electrical activity of your pacemaker may be disrupted, so your heart rate may be faster or slower than normal. A heart attack may trigger irritability in other areas of your heart, as well, so your pulse may become irregular or erratic. Arrhythmias, or abnormal heart rhythms, are a principal cause of death in people who have heart attacks.

Decreased Pumping Capacity

If your heart is not receiving enough blood flow due to a heart attack, it may lose its ability to pump blood to your brain and other vital organs. Thus, sudden lightheadedness, weakness or confusion could accompany chest pain during a heart attack. However, such symptoms might occur without chest pain and could be the only indication your heart is in trouble. Shortness of breath or wheezing may also occur, as the blood returning to your heart from your lungs cannot be pumped forward and is consequently backed up into your lungs.

Systemic Symptoms

During a heart attack, your heart struggles to perform its functions in the face of a diminished blood supply. It releases hormones into your bloodstream and sends signals to your brain that can trigger a variety of systemic signs and symptoms. Nausea, vomiting, sweating, cool skin and an urge to empty your bowel or bladder are common during a heart attack. In some people, sudden loss of consciousness due to interruption of blood flow to the brain is the only sign of a heart attack.


Anyone with persistent or recurrent chest pain should see their doctor right away. Due to their increased risk for heart attack, smokers, men over the age of 45, women over the age of 55, diabetics, people who are obese or sedentary, individuals with a family history of heart disease and people with high cholesterol, high blood pressure or known heart disease should seek immediate medical care in the event of chest pain, sudden shortness of breath, irregular pulse or other worrisome symptoms.

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