In Hollywood movies, someone having a heart attack clutches their chest and suddenly falls to the floor. Everyone in the room knows what’s going on: The person is having a heart attack.

In reality, heart attack symptoms can be much less dramatic. Most start slowly with mild pain or discomfort. The symptoms can be so subtle that you might even put off getting help.

A heart attack is often the end result of coronary artery disease, which develops slowly and is the most common form of heart disease. With time, cholesterol and other material, called plaque, build up in the arteries that feed blood to the heart. The plaque can narrow and eventually block the artery or arteries. If not enough oxygen-rich blood reaches your heart, you might feel chest pain (angina) or suffer a heart attack. Most heart attacks occur when a blood clot suddenly disrupts the heart’s blood supply, leaving you with permanent damage to the heart muscle.

Symptoms of Heart Attack 

Discomfort or pain in the center of the chest is the classic sign of a heart attack. It can last for more than a few minutes or go away, only to return later on. It can feel like an uncomfortable squeezing, pressure, pain, or fullness. Be aware of these other red flags, too: 

  • Shortness of breath
  • Tingling down the arm (usually the left one) 
  • Profuse sweating
  • Dizziness and weakness

Sometimes, heart disease and heart attack symptoms can be more subtle and mild, though no less dangerous: 

  • Heartburn, nausea, vomiting, or upper abdominal pain 
  • Back, shoulder, neck, or jaw pain 
  • Anxiety
  • Extreme fatigue 
  • Pounding heartbeat or feeling extra beats or a fluttering in the chest
  • Insomnia
  • Erectile dysfunction (being unable to get or keep an erection)

Symptoms of Heart Disease and Heart Attack in Women 

Though you might think of heart disease as a men’s health issue, it’s also the leading killer of women in the United States. There are some notable differences in symptoms between men and women: 

  • Many women who have a heart attack do not experience chest pain. 
  • More than 70% of women experience early warning signs, such as extreme weakness that can seem like the flu.
  • Women often confuse signs of a heart attack with those of a panic attack, like anxiety, shortness of breath, and indigestion.  
  • In men, plaque often collects in clumps, but in women, it may spread out evenly throughout artery walls. This can make heart disease harder to detect in women.
  • The hormone estrogen is thought to protect women against heart disease. So, if you’re past menopause (in general older than 50), you’re more at risk for a heart attack than a younger woman. 
  • 42% of women who have heart attacks die within a year, while only 24% of men do. 

When Coronary Artery Disease Leads to Heart Failure 

Coronary artery disease can weaken your heart muscle and contribute to heart failure. That’s when your heart can’t pump blood efficiently throughout your body. Heart failure symptoms include: 

  • Fatigue and shortness of breath due to blood and fluid backing up from the heart and building up in the lungs. 
  • Fluid buildup in the feet, ankles and legs. This swelling is known as edema.

You can learn more about heart failure, coronary artery disease, and heart attack through the American Heart Association or Better Medicine For more information on heart disease and women, go to the Women's Heart Foundation.

Key Takeaways

Women and men don’t always experience the same symptoms of a heart attack. Many women who have a serious heart attack do not experience classic chest pain symptoms. 

Especially in women, symptoms of a heart attack can be subtle, such as heartburn, nausea, fatigue, and shoulder, neck or jaw pain.

Don’t hesitate to call 911 if there’s even a slight chance you could be having a heart attack. If you or someone you are with is having a heart attack, more heart muscle is damaged with each passing minute.

The buildup of plaque in your arteries can lead to coronary heart disease. If unchecked, this can progress to heart failure. Signs include severe swelling and worsening shortness of breath.

This article is part of a series of heart health articles produced for the Healthgrades Pledge for Heart Health campaign. The Pledge for Heart Health campaign is a Facebook application that asks people to virtually pledge that they’ll talk to their doctor about heart health. For each pledge received in the month of February 2013, Healthgrades will donate $1 to the American Heart Association (up to $10,000).