Early Signs of a Heart Attack

Many of us have experienced that moment. Perhaps we’re driving in traffic or working out at the gym when we feel a twinge in our chest, or an aggressive pulse. Or maybe we just don’t feel right. We might pause at these moments and wonder if it’s time to hightail it the doctor or if this is normal.

The reality is people can notice subtle heart attack symptoms months before an actual event occurs, says Sutter Zi-Jian Xu, M.D., a cardiologist in the Sutter Health network.

Dr. Xu frequently discusses heart attack symptoms and prevention with his patients. Here’s what you need to know.

How far in advance can people experience heart attack symptoms?

For some people, symptoms can occur months or even longer before a heart attack occurs, Dr. Xu says. For others, they might not experience anything before a heart attack happens.

What do these early symptoms typically look like?

Dr. Xu says the majority of patients experience somewhat typical symptoms, such as radiating chest pain, heaviness or discomfort, heart palpitations, cold sweats, and shortness of breath. Others -- women more so than men -- will experience some atypical symptoms as well, which may include fatigue, a general sense of unease, vague discomfort, back or abdominal pain and declining stamina. Both types of symptoms can be experienced months before an actual heart attack occurs.

Is there anything that distinguishes these symptoms? How do you know when those subtle, atypical symptoms are concerning?

It’s important to know your risk for heart disease in order to assess early symptoms. Dr. Xu says when he works with a patient, they discuss his or her family and personal history, blood pressure, cholesterol levels, age and disease history to determine a risk level for heart attacks.

Within this context of risk, they talk about symptoms. Are they typical or not? How are they experienced? At rest or during exertion? Are they associated with emotional stress or cold weather? Are they happening in conjunction with other symptoms such as shortness of breath, rapid heartbeat or cold sweats? This is the starting point for a treatment plan.

Early symptoms don't really sound like the “Hollywood heart attack” experience. Is that typical?

There are two main ways that people present with heart attacks, Dr. Xu says:

• Sudden — A person may or may not have any symptoms previously, but all at once a plaque deposit ruptures, triggering a chain of events and a sudden heart attack.

• Gradual — The other presentation happens slowly as coronary disease progresses. In this situation, an artery is getting narrower over time. When the artery is narrowed down to more than 70 percent, a person will start to have warning symptoms ahead of time, especially with physical exertion.

When should I see a doctor?

It’s important not to ignore symptoms and wait until they become severe. If you have a concern, talk to your doctor. If heart disease is caught early, there are many lifestyle changes you can make to reduce your risk of further problems: eat a healthy diet with plenty of fruits and vegetables, get regular exercise (for most people, about 150 minutes per week), maintain a healthy weight, drink alcohol in moderation (if at all), and don’t smoke.

What if your doctor assures you it's just stress or fatigue?

If a young, healthy patient doesn’t have other risk factors, the likelihood of having significant coronary artery disease is low. It may not be appropriate to jump into testing. But the important thing is to always keep coronary risks in mind. Anyone who is experiencing symptoms that don’t go away or get worse should go back to a doctor for further evaluation.