Is it indigestion or chest pain? Knowing the symptoms of a heart attack can save your life.

John H., 46, a physician, thought he had indigestion. He felt discomfort in his abdomen on and off for about a month, took antacid tablets, and went about his life. One day, his wife came home to find him lying on the floor, clutching his chest in pain. She called an ambulance and had him rushed to the emergency room. There, he learned he was having a myocardial infarction (MI), a type of heart attack that causes damage to heart cells. If Dr. H. had waited much longer to get to the hospital, it is quite likely he would have died.

Every year, hundreds of thousands of Americans suffer heart attacks. Heart disease is the leading cause of death in the United States.

The Death of Heart Cells

Most heart attacks are a result of atherosclerosis: deposits of lipids or fatty cells, which build up and cause damage to and narrow the arterial walls. The body responds by creating plaque, which forms a scar inside the artery, causing even more damage. If the plaque ruptures, it releases its contents that can block the flow of blood to the heart. Without blood, the heart does not receive the oxygen it needs, and cells of the heart muscle begin to die.

While a heart attack may describe several possible conditions, MI refers strictly to the death of heart cells. The longer the heart muscle goes without blood, the more severe and extensive the damage and the greater the risk of ongoing heart muscle weakness, or even death. MIs can also be caused by drug use, particularly cocaine.

Immediate Treatment Is Essential

A heart attack is a medical emergency and needs immediate care. The first thing you need to do is call for emergency medical services. Your survival chances increase with earlier emergency treatment. Heart damage can often be minimized or averted by immediate treatment.

Why People Delay

There are many reasons why people having heart attacks delay getting medical help. Some are fearful or in denial. Others are put off by complications or costs of the medical system, have trouble reaching their doctors, run into language or cultural barriers, or do not have access to care. But many people simply do not realize that they are having a heart attack. That is because the warning signs vary widely, and the symptoms can be unclear.

The Symptoms

The classic symptom is intense, central chest pressure. However, many people do not experience typical chest pain during a heart attack. Other common symptoms include: pain or heaviness in the left arm, nausea, shortness of breath, increased perspiration, a feeling of impending doom, or pain in the jaw, teeth, arm, or abdomen. It is especially common for women to present with symptoms other than chest pain. Symptoms may come on gradually and may be intermittent or vague. A small percentage of patients—particularly those with diabetes—experience no symptoms at all.

If you have any concerning symptoms, you should let your doctor know. By asking questions about your symptoms and what causes them to happen, your doctor may determine that the problem is minor; it might be indigestion or a pulled muscle. If a heart attack is suspected, you will be sent to the hospital for tests to determine if your heart has been damaged. But, if your symptoms come on suddenly and you think they might be due to a heart attack, call for emergency medical services right away. Time is precious when blood flow to the heart muscle stops, and your life may depend on how quickly help comes.

Are You at Risk?

Because heart attack symptoms can be difficult to recognize, it is important to know if you are at risk. Heart attacks are more common in men, especially men over 45. Women older than 55—or younger if they experienced early menopause—are also at higher risk.

You may be at higher risk if you:

Help From Medical Technology

At the hospital, you will have an electrocardiogram (ECG). This quick test reads your heart rhythm and can detect abnormalities and damage. Blood tests can detect enzymes or markers in the blood which may indicate a heart attack. A more invasive method called cardiac catheterization can quickly determine whether an artery is blocked, where, and to what extent.

Drugs may also be prescribed to break up clots. Doctors may use a catheter device to open blocked arteries. They may even prop open an artery with a stent, so blood can continue to flow freely. In some cases, bypass surgery may be needed.

Life After a Heart Attack

To minimize the risk of a future MI, doctors usually prescribe medicines, such as beta blockers, ACE inhibitors, statins, and aspirin to prevent future coronary blood clots. Doctors may also recommend a low-fat, high-fiber diet, a regular program of aerobic exercise, smoking cessation, diabetes control, blood pressure control, and weight management.