Symptoms and getting help for a heart attack

A heart attack (sometimes called myocardial infarction) usually causes severe pain in the centre of the chest. The pain usually feels like a heaviness or tightness, which may also spread to the arms, neck, jaw, back or stomach. The pain may affect only the neck, jaw, arms or stomach. A person having a heart attack may also sweat, feel light-headed, feel sick, or be short of breath or have an overwhelming feeling of anxiety.

Many of the people we interviewed had severe chest pain which spread to their arm, and they called ‘999’ for an ambulance or they called their GP.

He had severe chest pain and a tingling sensation in his right arm.

Age at interview 52

Gender Male

Age at diagnosis 51

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Well what happened there was, it was totally out of the blue, I was sitting down, I’d had breakfast, and I was just thinking about making a cup of coffee, and suddenly this sort of pain hit me. And initially I thought, well it might be indigestion or something but it went on and after, I would guess 10 or 15 seconds, it was so excruciating.

I’d never experienced a pain like this, it was just coming in waves, and it was lucky that my family who were about to leave the house for the day, hadn’t. So they spotted fairly quickly and called an ambulance probably within two or three minutes dialled 999. And this pain I walked, I could still walk around, I tried to lie down and it wouldn’t go away and basically it was so excruciating I was sort of screaming, and I think I probably realised I’d had a heart a heart attack. I had a sort of tingling sense in my right arm.

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One woman said the pain was so severe that she couldn’t speak. Others likened it to having their chest in a vice that was slowly being tightened, or an elephant balancing on their chest. For some people the pain was not severe at first but it kept coming back. It was only when it got more severe that they realised that they had to get help.

He had chest pain that got worse during the day.

Age at interview 66

Gender Male

Age at diagnosis 47

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I was Conservative Party Agent for the [nearby] constituency and I lived in [a different town]. I was 47 at the time. I was driving two of my children to their schools at about eight o’clock in the morning and as I drove, felt an almost finger-shaped sharp pain high in the chest and thought to myself, “That’s funny, I wonder what that is.”

I dropped the two children at their various schools and went on in to my office in [nearby London] I had odd pains in the chest all day and I was preparing for a cheese and wine party. I was buying cheese and things like that around the town and the pains were something I hadn’t experienced before. At the party I drove various elderly ladies to the function and I was standing talking to my Member of Parliament and someone else and jokingly said, “I’ve got pains in the chest. I think I’m having a heart attack.” And that was what it was, jokingly.

The function finished about ten o’clock in the evening and drove home through [town name] where I had a severe pain in the chest and tingling down in to my left little finger and the next one and drove on through it. I got home and said to my wife, “I’ve had pains in the chest,” and she said, “You’ve been drinking and eating pickled onions and things, haven’t you?” “Yes I have been indeed.”

I went out in the car again, about I suppose quarter to eleven, to pick up my daughter from her boyfriends about ten minutes away from the house. Came back in with her and sat down in an armchair and had a glass of red wine which had been left over from the party. With one sip, the pain came back and the family could see how distressed I was. They sent for our GP.

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Sometimes mild pain was accompanied by shortness of breath, sweating, or feeling sick. One woman had mild chest pain, which she thought might be her hiatus hernia but was sufficiently concerned to contact NHS direct. During the call she felt sick and started sweating, and the nurse agreed that it might be a heart attack and called an ambulance.

Her symptoms got worse while she was speaking to NHS Direct and the nurse called an ambulance for…

Age at interview 80

Gender Female

Age at diagnosis 77

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Well it was just Valentines morning in 2001 and woke up, had my breakfast in bed, porridge and afterwards I got this little pain just right in the middle of my chest and I thought, ‘oh my hiatus hernia. And normally I can make myself comfortable, with eating something similar to porridge and I feel better but it didn’t go away, it got more persistent and it wasn’t a burning pain, it wasn’t quite like it but similar.

And, this was about half past eight in the morning and my daughter lives with me so I, I called her and I said to her, I said, ‘I’m having a lot of pain. I wasn’t sure, I thought, ‘no it’s not a heart attack,’ it just didn’t feel, you hear about all these crushing pains and all the rest of it, and it wasn’t that and nothing, my arm was fine. And so I said to her, ‘I’m going to ring the NHS Direct and have a word with them.

So I did that and they were talking to me and so I said to her, ‘I have a feeling it’s my hiatus hernia, yet it’s not quite the same as normally. So while I was talking to her I began to get a bit sweaty and I could feel myself feeling nauseous and I said to her, ‘I think, I think I’m having a heart attack.

So she said, ‘Yes I think you are. So she said ‘Don’t worry, I’ll call an ambulance for you and you just make yourself comfortable, stay there, are you on your own?’ So I said, ‘No, I’ve got my daughter. So she said, ‘I’ll stay and talk to you until the ambulance arrives.

And she did this, and the ambulance came, it came quite quickly, it was no more than about ten minutes, and they were very good, gave me oxygen and so forth because I’m asthmatic as well and got me down to the hospital, the local.

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Several people who had milder chest pain mistook it for indigestion and took antacid medicine, and only when that didn’t work, rang their GP or went to accident and emergency.

He thought he had indigestion so he took indigestion pills but when it didn’t go away he called…

Age at interview 71

Gender Male

Age at diagnosis 65

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I first suspected there was something wrong when I thought I had a bad bout of indigestion. I had decided, having just retired that I would take up golf, and in the morning I had a golf lesson. In the afternoon, I decided it was time to start clearing up the garden, so I literally chopped a tree down and in the evening suffered this bad bout of indigestion. I thought that I’ll sleep it off. My wife gave me some indigestion pills that she said were very effective.

But in the early hours of the morning I realised that it wasn’t getting any better. She phoned the surgery when she could and booked an appointment. I still had this enormous pain that you refuse to accept is anything other than indigestion and had a shower ready to go to the surgery. Going back upstairs after the shower, it really hit me.

So she phoned them and we had absolutely marvellous service, they immediately, they asked her for symptoms and she said, ‘Well hes got this pain in his arm, which meant nothing to us, it meant nothing to me, I thought I’d strained a muscle chopping the tree down and they said, ‘theres an ambulance on it’s way, and I was taken to hospital.

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You can have a heart attack without having chest pain. One 52-year-old woman said she had pains in her arms, she was sick and said she had never felt so unwell.

She had pains in her arms and was sick and had never felt so unwell.

Age at interview 54

Gender Female

Age at diagnosis 53

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But I just got up one morning and I was in the kitchen making breakfast and I suddenly felt funny and it was a kind of funny that I’d never felt before and I didn’t know what it was. I just thought perhaps it was a virus or something because there were lots of funny things going around.

So I came and sat down in the living room and then I couldn’t get comfortable. So I tried to go and lie down and still couldn’t get comfortable and I decided to phone my husband to say that I really didn’t feel very well and could he come and take me to the doctor’s because I just, I didn’t think I could manage it myself and he came round and in the meantime, I had pains that went down my arms and then I was sick and then I thought, ‘I’m going to have a heart attack.

He came and I told him and he said, ‘Well, phone the doctor straight away. So I did and I spoke to the triage nurse and she said, ‘come in at half past eleven. This was about half past eight in the morning because there weren’t any appointments. She did ask me to describe the symptoms and everything but obviously they weren’t bad and I didn’t have the, the crushing pain or anything.

I just thought, ‘oh I’m going to have one. But when she said, ‘Come at half eleven’, I thought, ‘oh I must be alright then. So I went at half eleven and saw the doctor and he said, ‘I think you’d better go down to the hospital. It’ll be quicker if your husband takes you, rather than me calling an ambulance. So I went to the hospital and they admitted me.

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Another said she had sensations in her chest and throat and pain in her left arm, and she thought she was having a panic attack. One 37-year-old woman felt sick, started sweating, felt short of breath and had pins and needles in her arms and legs.

She had crushing sensations in her chest and throat and pain in her left arm.

Age at interview 57

Gender Female

Age at diagnosis 53

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To start with, I thought I was having a panic attack because it goes all in your throat and it was all in my throat and I couldn’t breathe properly and I thought, ‘oh it’s a panic attack’ and that’s what I just thought it was.

But when the pain started going down my arm and the nurse come to me and took my blood pressure, she said ‘no’ she said, ‘you need to get into hospital. But by the time I’d got, the ambulance come and I’d gone in the ambulance it had eased off and I was going, ‘I’m all right now, I’m fine you know, I don’t have to go to hospital.

But it’s a good job they took me in the end. But it’s not a pain, theres a crushing, it’s this horrible sensation. It’s all up in my throat and it’s very difficult to explain what it’s like; it isn’t like a toothache or, it’s not like that, it’s this horrible crushing, stifling pain. And it’s not very nice at all.

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When there is no chest pain, people may not realise they are having a heart attack. But it was very rare for people, even though they might not have typical symptoms, not to realise that there was something serious going on. One man in his early forties kept getting bouts of severe back pain, which he did not relate to his heart, but when it got really bad he decided to go to casualty.

He had bouts of severe back and shoulder pain which he did not relate to his heart.

Age at interview 46

Gender Male

Age at diagnosis 42

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I didn’t actually suspect there was anything wrong with my heart; I thought I had a backache, a back problem. I was going to work normally, I wasn’t, I didn’t have any days off sick or anything but I was moaning about my back at work, and it was sporadic and it felt like once I got moving about a bit, it would go off;

I was still playing football on a Saturday and I used to get some pain during that but it was across my shoulders and up here, and I’d always, you know you see the films and people have heart attacks, clutch their chest, or their breast and fall to the floor. So looking back I don’t really know whether I really did think there might be a problem and that I’ve just chosen to forget it;

Because I do remember at work running up the stairs to see if it got worse because I knew [laughs], I knew that would bring something on and then when it didn’t, I thought, ‘well I must be all right then, it must be my back,’ and this continued, my back was getting a bit worse;

My wife told me that I’d have to sort myself out and get my back looked at but she said, ‘I didn’t look too clever,’ and we had something to eat, went to bed and I don’t think I slept but I just felt worse and worse. So I thought, ‘well I’ll get up,’ and I came downstairs;

My wife came downstairs and found me bent over the ironing board. Not a pretty sight I shouldn’t think, because that was the most comfortable position I could find myself in, and I still thought it was my back because being bent to ninety degrees supported, seemed to help a bit;

But the pain was so bad and my hands were numb, my arms hurt but it felt like somebody was squeezing my top but squeezing my fingers. But I did think there was probably something wrong, but I thought, ‘this is one hell of a backache,’ and so we went to casualty;

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Another man had what he described as five-minute episodes of discomfort in the centre of his stomach, which he found debilitating rather than painful. Two days later he had what he thought was indigestion, becoming nauseous and experiencing an overwhelming feeling of tiredness. It was at this point that he was diagnosed as having had a heart attack.

One 37-year-old woman describes the pains she had in her teeth and arms. Another man, a hospital consultant, explained that he had what felt like severe heartburn but none of the classic symptoms of a heart attack.

She had pain in her teeth, and her arms and started sweating and was sick.

Age at interview 42

Gender Female

Age at diagnosis 37

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I didn’t think there was anything wrong. It was five years ago, shopping in London and I didn’t feel very well. I felt as though I had the flu, all my bones were aching. When we came home later that day I took paracetamol, and sat here on the settee, and my husband rang the doctor, because the flu-like symptoms, all my bones aching just got worse. I didn’t like have pains in my chest though, or not then.

The doctor on the phone said to have a hot bath and go to bed. So they – I think the girls, I think they run me a bath, but I went upstairs to get undressed to have a bath, but I collapsed on the bedroom floor, and my husband said, “That’s it, I’m taking you down to the surgery.” Not to the hospital, down to the surgery.

So we got in the car, but in the car I got really bad, like, earache, and my teeth were – I can’t describe the pain in my teeth, and it was a winter’s evening, so it was cold, but I was really, really hot; I had to have all, like, four windows open as we were driving.

We went to the surgery, and I saw a lady doctor who I didn’t know, and she said I was getting myself in a state, I was having an anxiety attack, and because I’d never had one before, I couldn’t understand why, just before Christmas, I was having an anxiety attack and what was it? She said because I was breathing heavily and getting myself in a state.

And I had this – I couldn’t control my arms, I didn’t know what to do with my arms. My husband kept on saying, “You’re flapping your arms, you’re flapping your arms.” It made me feel better to flap my arms, because they were in that much pain, so I flapped them as I was talking. They were like – and they were uncontrollable, and she said the best thing was to go home and, she listened to my chest, and she said I wasn’t having a heart attack, and I was too young for anything like that.

So we came – we left, and as we left the building I laid on the floor, and I said, “Please,” to my husband, “you’ve got to help me, I’m really bad, I don’t know what to do with myself.” So he said, “That’s it, well go across the road to Accident and Emergency”. Of course you have to wait your turn, and see the triage nurse, and I can’t sit still at this point.

My arms are flapping and I have to keep walking, so I was like, pacing up and down the corridor and people are looking, as if to say, you know, what’s up with her? And then it was my turn and they called me in and I said, “I’m ever so sorry, but I’ve got to lie on your desk.” So she said, “What’s the problem?” I said, “I don’t know, I just don’t feel very well at all. I can’t explain it”.

So they put me into a cubicle, and before I got into this bed I was sick, and then I weed myself. Then they laid me on the bed and said they were going to strap me up to an ECG machine, and then they were all running round then, still not knowing what was the matter, and then they gave me an injection, and said, “What was the pain like from one to ten?” and I said, “Nine – it was bad,” and then it was in my chest then. And as they put me on the machine and they were doing all the readings, they said, “You are actually having a heart attack, now.

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He had none of the classic symptoms of a heart attack.

Age at interview 62

Gender Male

Age at diagnosis 59

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And then I felt the heartburn came back again. So I ask her to just look after the patient and I will go and have a cup of tea and come back so, I left her with the patient on the table and I went, came back again with the heartburn.

I didn’t have any you know, I didn’t feel weak or, just normal apart from this blackout. So I went changed and dressed up and I took my briefcase and I walked down with the briefcase down to the car park which was about five hundred yards away from the theatre. No shortness of breath, no chest pain, no dizziness, no sweating, nothing at all from the things which you know from the [laughs] what’s told in the books or ask the patients about;

So I made a cup of tea and I was sitting there and thinking shall I call the GP, shall I wait, because you know I felt completely normal, nothing. There is nothing at all, still the heartburn is there which I think, ‘Well I will take an anti-acid and see what happens. But that didn’t relieve it, which makes me more suspicious that it might be something else. So I rang the GP and I spoke to him and I said that’s what happened;

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Occasionally, a heart attack is ‘silent’ and produces little discomfort. People may not know they have had one until they have a medical investigation for other symptoms or a routine medical examination (see ‘Initial emotions’).

A few people said they had no symptoms and had felt well before their heart attack. Several described breathlessness, chest pain when walking up a hill or exercising, arm pains, or felt lethargic or more tired than usual in the lead up to having a heart attack. But many did not recognise the significance of these symptoms until after their heart attack. They had thought at the time that they were caused by asthma, indigestion or other gastric conditions.

Diagnosing a heart attack

Most heart attacks are diagnosed from the results of an electrocardiogram [ECG] and a blood test, which can confirm whether or not a heart attack...