What are the signs of a heart attack, and what do I do?
What a heart attack actually feels like, why it is often not the dramatic version people expect, the position that helps, and the NHS advice on aspirin while waiting.
- Difficulty
- beginner
- Time
- 7 min
- Read
- 5 min
- Safety
- warning
Short answer
Chest pain that feels like crushing, squeezing or tightness, which may spread to the arm, neck or jaw. Also shortness of breath, feeling sick, something that feels like indigestion, sweating, and pale or discoloured skin. Ring 999. Sit them on the floor with their back supported and knees bent. NHS advice is to give 300mg of aspirin to chew if it is available and they are not allergic, and to use their own GTN spray if they have one.
The version in films — clutching the chest and collapsing — is one presentation among several, and expecting it is why people talk themselves out of ringing. Discomfort that will not settle, breathlessness, sweating and a feeling of indigestion are all on the list, and any of them with chest tightness is a 999 call.
Safety
Step by step
- Recognise the chest symptom.Pain or discomfort that feels like crushing, squeezing or heavy tightness rather than a sharp stab. It may spread to one or both arms, the neck, the jaw or the back. It does not always come on suddenly and it does not always feel severe.
- Recognise the other symptoms.Shortness of breath, nausea, a sensation like indigestion, sweating, light-headedness, and skin that looks pale or discoloured. These can occur with only mild chest discomfort, or occasionally with none.
- Ring 999 without deliberating.Say there is chest pain and describe it. Ambulance control treats chest pain as a priority and will stay on the line. It is far better to be assessed and sent home than to wait and be wrong.
- Get the position right.NHS advice is to sit and rest on the floor, in a comfortable position, with the knees bent and the back supported — against a wall or a piece of furniture. Sitting on the floor means there is nowhere to fall if they lose consciousness.
- Give aspirin, if the conditions are met.NHS advice is 300mg of aspirin, chewed slowly, if it is available and the person is not allergic to it and has not been told not to take it. Do not go out looking for aspirin and do not delay anything else to find it.
- Use their own angina medication if they have it.If the person has been prescribed a GTN spray or tablets for angina, they should use it as they have been told to. Never give someone else's prescribed medication to anyone.
- Stay with them and keep checking.Monitor whether they are responding and whether they are still breathing normally. Keep them calm and still — physical effort makes the heart's job harder at exactly the wrong moment.
- Be ready for cardiac arrest.If they stop responding and are not breathing normally, ring 999 again if you have hung up, start chest compressions immediately, and send someone for a defibrillator.
Tips
- Unlock the front door and, if you can, put someone outside to flag the ambulance down. Minutes get lost at the door more often than anyone expects.
- Have a list of the person's medication and conditions ready if you can find it quickly. It is the second thing the crew will ask for.
- Anyone with existing angina who finds their usual spray is not working, or whose pain is different from usual, should treat that as a 999 situation rather than a bad episode.
Common mistakes
- Waiting to see whether it is indigestion — A heart attack can feel exactly like indigestion, and the two cannot be told apart at home. That overlap is precisely why so many people delay.
- Driving to hospital — The ambulance service begins treatment on the way and can manage a cardiac arrest if one happens. A car cannot, and a driver who becomes a patient is a road traffic collision as well.
- Letting them walk to the ambulance — Exertion increases the demand on a heart that is already struggling. The crew will bring what they need to the person.
- Giving aspirin to someone who should not have it — The advice is conditional: available, not allergic, and not told to avoid it. It is a helpful step within those conditions and is not worth any delay to the 999 call.
If it doesn't work
Chest discomfort that eases when resting and returns with effort
Cause: This is the pattern of angina rather than a heart attack, but it still needs medical assessment — Fix: New chest pain on exertion should be assessed urgently — contact NHS 111 or a GP the same day. Pain that comes on at rest, or does not settle, is a 999 call.
They insist it is nothing and refuse an ambulance
Cause: Denial is extremely common in heart attacks — Fix: Ring 999 and describe it to the handler. You can ask their advice with the person listening; a professional voice often changes the answer.
The pain has gone but they feel unwell and sweaty
Cause: Symptoms can fluctuate during a heart attack — Fix: Still 999. Improvement is not evidence that the event has finished, and the cardiac muscle is still at risk.
Questions people ask
Is a heart attack the same as a cardiac arrest?
No. A heart attack is a blockage in a blood vessel supplying the heart, and the person is usually conscious. A cardiac arrest is the heart stopping, and the person is unresponsive and not breathing normally. A heart attack can cause a cardiac arrest, which is why you stay with them.
Do symptoms differ between men and women?
Chest discomfort is the commonest symptom in everyone. Breathlessness, nausea, back or jaw discomfort and fatigue are reported more often as the leading symptom in women, and are a recognised reason heart attacks in women are diagnosed later. Treat any of them seriously.
Why 300mg of aspirin?
That is the dose NHS guidance gives for this situation, chewed so it is absorbed quickly. It is not the same as the low dose some people take daily, and it is only appropriate where the conditions above are met.
What if it turns out to be nothing?
That is a good outcome and it happens often. Ambulance crews would far rather assess someone who turns out to be well than arrive too late to someone who was not.