Typical signs of a heart attack include a feeling of pressure, tightness, or pain in the chest area. The pain often radiates into the left arm, though in some cases the right arm or both arms may be affected. Discomfort in the neck, jaw, or upper abdomen can also occur. Other possible symptoms include anxiety, sweating, nausea, vomiting, shortness of breath, abdominal or back pain, and irregular heartbeat. In some people, none of these symptoms appear because they experience what is known as a “silent heart attack.” This type is more common in women, people with diabetes, patients over the age of 75, and those with kidney disease or dementia.^[1]

The heart is supplied with all the substances it needs to function through the so-called coronary arteries. During a heart attack, one or more of these arteries suddenly become completely blocked. As a result, the heart muscle is abruptly deprived of oxygen, and part of the tissue dies. The longer the blood flow remains blocked, the greater the damage. Often, the heart can no longer pump effectively. A heart attack is always life-threatening.^[2] There are several possible causes for this blockage. In medicine, two main types of heart attacks^[1] are distinguished:

Myocardial infarction type 1: Certain components of the blood accumulate in the coronary arteries, forming so-called plaques that grow over time and eventually cause a complete blockage. The affected part of the heart can no longer receive oxygen and nutrients. If the blocked artery is not reopened quickly, the tissue in that area dies.

Myocardial infarction type 2: Even without plaque formation, parts of the heart can die off. The causes are usually conditions such as arrhythmias, high or low blood pressure, infections, or major surgeries.

Many people today survive a heart attack. What is most important is that those affected are brought to a hospital as quickly as possible. Every minute counts, because a heart attack is always life-threatening. ^[3]

Experts attribute three-quarters of all deaths to the fact that those affected underestimated their chest pain and did not call emergency services in time.^[2] Therefore, do not hesitate to see a doctor even if your symptoms seem minor. Only a doctor can determine whether it is an emergency or not.

If a blockage of a blood vessel is detected in the hospital, it must be reopened as quickly as possible. This should be done within the first 1½ hours. Then the muscle tissue can largely recover. But time is critical. With every passing minute, the risk increases that the affected person will suffer permanent damage or, in the worst case, die.^[2]

After examining the patient, doctors calculate an initial prognosis using various clinical data and so-called risk scores, such as the GRACE score.^[1] This assessment includes, among other factors, the results of blood tests and measurements of heart rate.^[4]

This means that the question of whether a heart attack can be survived can only be answered individually. People with a good prognosis have a better chance of surviving a heart attack than those with a poor prognosis.

There is also no single answer to this question, as it depends on the severity of the heart attack. In general, chest or upper body pain should never be ignored. You should seek medical attention or go to a hospital as quickly as possible.^[5]

Do not delay your visit with the following or similar excuses:^[5]

The following table provides an overview of typical and atypical signs of a heart attack:^[5]

The treatment of a heart attack is always individual and can be very complex. Therefore, it is important to stay in close contact with your doctor. The following information can help you gain an overview of the most common therapies, making it easier to discuss and exchange information with doctors or other healthcare professionals. The type of heart attack (also called myocardial infarction or MI) determines the treatments that a medical team will recommend.

A complete blockage of a coronary artery indicates a “STEMI” heart attack, or ST-elevation myocardial infarction. A partial blockage is referred to as an “NSTEMI” heart attack, or non-ST-elevation myocardial infarction. The treatment methods are similar in some aspects but can also differ significantly. The main goal of therapy is to restore normal blood flow.

Here you will find a list of many common surgical treatments for heart attacks:

• Angioplasty: A special medical tube with a deflated balloon attached to its tip is inserted into the narrowed area of the coronary arteries. By inflating the balloon, the blockage is opened and the plaque is pressed against the vessel wall.
• Atherectomy: A procedure similar to angioplasty, except that the catheter has a rotating shaver at its tip to remove plaque from the artery.
• Bypass surgery: Blocked vessels are re-supplied with blood by inserting a new vessel to bypass the blocked area. Veins or arteries are often taken from other parts of the body, such as the arms or legs.
• Heart transplant: A diseased heart is replaced with a donated, healthy human heart.
• Cardiomyoplasty: An experimental procedure in which skeletal muscles from the patient’s back or abdomen are used to support the function of the heart.
• Artificial heart valve surgery: Replaces a damaged or diseased heart valve with a functioning one.
• Laser angioplasty: Similar to angioplasty, but the catheter has a laser tip that opens the blocked artery.
• Minimally invasive heart surgery: Specialized centers can perform bypass or valve replacement operations in a very gentle way through the smallest possible incisions. The goal is to avoid fully opening the chest and, if possible, to operate without using a heart-lung machine.
• Radiofrequency ablation (RFA): A catheter with an electrode at its tip is guided through the veins to the heart muscle to destroy carefully selected heart muscle cells in a very small area.
• Stent procedure: A stent is a small mesh tube inserted during angioplasty to help keep an artery open.
• Transmyocardial revascularization (TMR): A laser is used to create small holes in specific areas of the heart to help restore blood flow.

The treatment of a heart attack includes a variety of medications. The following list provides a quick overview of commonly used drugs. Your doctor will recommend the best combination of heart attack medications for your specific situation.

• Angiotensin-converting enzyme (ACE) inhibitors: Dilate blood vessels and reduce resistance by lowering the level of angiotensin II. This allows blood to flow more easily and makes the heart’s work easier and more efficient.
• Angiotensin II receptor blockers (ARBs): Lower blood pressure and protect blood vessels.
• Angiotensin receptor–neprilysin inhibitors (ARNIs): A combination of active ingredients that dilates blood vessels, prevents an increase in blood pressure, and reduces the strain on the heart. Often used when ACE inhibitors and beta blockers do not achieve the desired effect.
• Anticoagulants: Reduce blood clotting.
• Beta blockers: Also called beta receptor blockers, they lower resting heart rate and blood pressure.
• Cholesterol-lowering medications: Cholesterol is a type of fat that occurs naturally in the body. When levels are too high, it can build up in the arteries. Treatment may therefore include lowering cholesterol levels.
• Digitalis preparations: Help increase the strength of the heart’s contractions and reduce heart rate to relieve the overall workload on the heart.
• Diuretics: Promote urination (diuresis) and help remove excess water from the body to relieve strain on the heart.
• Dual antiplatelet therapy (DAPT): Some patients are treated with two types of antiplatelet agents simultaneously to reduce blood clotting, for example after stent placement or coronary artery bypass surgery.
• Calcium channel blockers: Lower blood pressure by blocking calcium from entering muscle cells.
• Combined alpha and beta blockers: Also used to lower blood pressure, typically prescribed when other medications have not sufficiently reduced the strain on the blood vessels.
• Antiplatelet agents: Prevent the formation of blood clots by stopping blood platelets from sticking together. One common antiplatelet drug is aspirin (ASA). Almost all patients with coronary artery disease, including those who have had a heart attack, are treated with aspirin for the rest of their lives. A second type of antiplatelet agent, called a P2Y12 inhibitor, is usually prescribed in addition to aspirin for several months or even years.
• Vasodilators: Work by dilating the blood vessels.

You will be prescribed the medications that are best suited for you based on your individual risk of blood clots and bleeding. The choice of medication type and the duration of treatment will be determined in consultation with your healthcare provider.

Heart attack patients are often asked to undergo a series of diagnostic tests and procedures. These tests are important because they help your doctor determine whether a heart attack has occurred, how much damage your heart has sustained, and whether you have coronary artery disease (CAD) and to what extent. CAD is often the underlying cause of a heart attack. These tests also help your doctor decide which treatments and lifestyle changes can keep your heart healthy and prevent serious future medical events.

There are “non-invasive” and “invasive” diagnostic tests. Invasive procedures may involve inserting a tube, device, or endoscope into the body. Non-invasive diagnostic tests are imaging procedures that do not require any instruments to be inserted into the body.^[7]

Standard

Electrocardiogram (ECG): This is usually the first test performed to diagnose a heart attack. The ECG records the electrical signals of the heart. Adhesive patches (electrodes) are placed on the patient’s chest and limbs. The signals are recorded as waves that are displayed on a monitor or printed on paper. Because an injured heart muscle does not conduct electrical impulses normally, the ECG can show whether a heart attack has occurred or is currently happening.

Blood tests: Certain substances slowly enter the bloodstream after the heart has been damaged by a heart attack. Emergency room doctors will take blood samples to look for these proteins or enzymes.

Optional

Chest X-ray: An X-ray image of your chest allows your doctor to check the size of your heart and blood vessels and to look for fluid in your lungs.

Echocardiogram: Sound waves (ultrasound) create images of the heart in motion. This test allows your doctor to see how the chambers and valves of your heart pump blood through it. An echocardiogram can help identify whether an area of your heart has been damaged.

Coronary catheterization (angiogram): A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter). The catheter is inserted through an artery, usually in your leg or groin, and guided to the arteries of your heart. The dye makes the arteries visible on an X-ray image and reveals areas of blockage.

Computed tomography (CT) or magnetic resonance imaging (MRI) of the heart: These tests create images of your heart and chest. Cardiac CT scans use X-rays, while cardiac MRI uses a magnetic field and radio waves to produce detailed images of your heart. In both tests, you lie on a table that slides into a long, tube-shaped machine. Both can be used to diagnose heart problems, including the extent of damage caused by heart attacks.^[8]

Will I recover from my heart attack?
The answer is most likely yes. The heart muscle begins to heal soon after a heart attack, and the healing process usually takes about eight weeks. However, scar tissue may remain in the damaged area, which cannot contract and pump as effectively as healthy muscle tissue. The degree to which the heart’s pumping ability is affected depends on the size and location of the scar tissue. Most heart attack survivors have coronary artery disease (CAD). They should make lifestyle changes and may need to take medication to help prevent another heart attack.^[7]

Why is there often no warning?
Patients with early or progressive atherosclerosis (hardening of the arteries) often have few or no symptoms. When a coronary artery narrows and restricts blood flow, nearby blood vessels that supply the heart may sometimes widen to compensate. This may explain why there are no warning signs. Such a network of enlarged nearby blood vessels is called collateral circulation, and it helps the body delay a heart attack. Collateral circulation can also develop after a heart attack to help the heart muscle recover.

Is my heart permanently damaged?
The extent of heart muscle damage depends on the size of the area supplied by the blocked artery and the time between the blockage and treatment. The heart muscle damaged by a heart attack heals by forming scar tissue, which can take several weeks. The duration of healing also depends on how large the affected area is and how well the body can repair itself. In general, the heart is a very resilient organ. Even if part of it is severely injured, the rest continues to function. However, due to the damage, your heart may become weaker and unable to pump as much blood as before. With proper treatment and lifestyle changes after a heart attack, further damage can be limited or even prevented.^[7]

What treatments will I need?
Treatments for heart attack patients include medications, lifestyle changes, and, in some cases, surgical procedures. Your doctor may also perform diagnostic tests to determine how much damage your heart has sustained and to assess the extent of any coronary artery disease.

How long should I rest after my heart attack?
Rest is important after a heart attack. But it is just as important to take part in leisure activities and social events, and to start making physical activity a regular part of daily life. In many cases, doctors even recommend being more physically active than before the heart attack. Good sleep is especially important for heart attack patients, and if you feel tired during the day, take a nap or a short break. Heart patients should rest before they become overly fatigued.

When can I return to work?
Most heart attack patients can return to work within two weeks to three months, depending on the severity of the heart attack. Your doctor will determine when you can resume work and whether your current occupation is suitable for someone who has had a heart attack.

Is it normal to feel this depressed?
Heart attack patients experience a wide range of emotions, typically lasting about two to six months after the event. Depression is completely normal, as are fear and anger. For example, many people feel anxious every time they experience a small pain, worrying that it might happen again or that they might die. This is normal and will fade over time. Some people feel angry that it happened to them and become irritable or short-tempered. Feelings of resentment are common after a heart attack. Try to remember that your family and friends are just as worried as you are. Although depression after a heart attack is normal, you should talk to your doctor and loved ones about how you feel, especially if your sleep or self-esteem is affected, or if you have thoughts of suicide. Do not hesitate to ask for help. With a supportive team of healthcare professionals, family, and friends, recovery can happen much faster.

How will my family feel?
Your heart attack has probably had a major emotional impact on your family. Your loved ones may feel frightened, angry, resentful, or even guilty. Teenagers are especially sensitive and might think that something they did caused your heart attack. It’s best for everyone to express their feelings openly. Don’t let emotions fester, this can be destructive. If you think counseling could help your family cope better with your heart attack, ask your doctor for assistance. They can refer you to appropriate support services.

Are chest pains normal after a heart attack?
Once you have had a heart attack, your risk of experiencing another one is higher. A relatively common type of pain associated with coronary artery disease (CAD), which is often the cause of a heart attack, is a mild pain or pressure in the chest that disappears quickly. It typically occurs during or right after physical exertion, intense emotions, or a heavy meal. Any other kind of chest pain should be checked by your doctor. There are exercises and medications that can help relieve or prevent this pain. If you are unsure whether your chest pain is a symptom of CAD or another heart attack, call emergency services immediately.

Why is cardiac rehabilitation important?
One of the best things you can do for yourself is to take part in a cardiac rehabilitation program. There, you will learn everything you need to recover and stay healthy. Rehabilitation programs are medically supervised and designed to help you improve your health through exercise training, education, and stress management counseling. These programs often take place in a hospital setting with a rehabilitation team or with the support of your doctor, a nurse, a nutritionist, or other healthcare professionals.

Why are lifestyle changes important?
Changing your lifestyle is one of the most important things you can do to prevent another heart attack, heart disease, or stroke. Stop smoking, engage in appropriate physical activity, and maintain a healthy diet.

What about sex after a heart attack?
Most people can return to their normal sexual activity within a few weeks after recovering from a heart attack. Talk to your doctor to determine what is safe for you.^[9]

In 2019, more women died from ischemic heart disease than from breast cancer (52,550 vs. 18,519), and an additional 18,361 women died from acute or recurrent myocardial infarction.^[10]

According to one study, the most common symptoms reported by women one month before a heart attack were: 1. fatigue, 2. sleep disturbances, and 3. shortness of breath. Only about 30% reported upper body discomfort.^[11]

Typical early symptoms of heart disease in women include^[12]:

• Shortness of breath
• Fatigue
• Physical weakness
• Sleep disturbances
• Upper abdominal discomfort

Unlike men, women often report other symptoms only when specifically asked, such as pressure or tightness in the chest after physical exertion, during stressful situations, in cold weather, or after heavy meals. Moreover, these symptoms occur in only about 40–60% of women before a heart attack.^[12]

These eight key factors can help you reduce your risk of heart attack and stroke if you’ve never had one. They can also help you work with your healthcare team (doctors, nurses, pharmacists, nutritionists, and other professionals) to create an effective prevention plan.

1. Know your risk
If you are between 40 and 75 years old and have never had a heart attack or stroke, you can use online tools to estimate your risk of a cardiovascular event within the next 10 years. These risk calculators are available for free on various websites. Certain factors can increase your risk, such as smoking, kidney disease, or a family history of heart disease. Knowing your risk factors can help you and your healthcare team choose the best treatment plan for you. Many risk factors can be improved through lifestyle changes.

2. Eat a healthy diet
Focus your diet on vegetables, fruits, whole grains, legumes, nuts, plant-based proteins, lean animal proteins, and fish. Avoid highly processed foods, sugary drinks, excessive sodium, and saturated or trans fats. Pay attention to the nutrition labels on packaged foods.

3. Be physically active
Move more. It’s one of the best ways to stay healthy, fit, and prevent disease. Adults should engage in at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous-intensity activity per week. If you’re already active, you can increase the intensity to gain even more benefits. If you’re not active yet, start by sitting less and moving more.

4. Maintain a healthy weight
Stay within a healthy weight range for you. You can check this using your Body Mass Index (BMI), with many calculators available online. Try to lose weight if you are overweight by eating fewer calories and increasing your physical activity. If you need help, talk to your healthcare team about creating a personalized weight loss plan.

5. Live as smoke-free as possible
If you don’t smoke, vape, or use tobacco products, never start. There is no such thing as a safe tobacco product. If quitting smoking or tobacco use is challenging for you, ask your healthcare team for help to break the habit using proven methods. Don’t simply switch from one form of tobacco to another, and try to avoid exposure to secondhand smoke as well.

6. Manage existing health conditions
If you have medical conditions that increase your risk, it’s very important to work closely with your healthcare team and make lifestyle changes. These conditions include high blood pressure (hypertension), high cholesterol, high blood sugar, or diabetes. Many of these can be prevented or controlled through better nutrition, increased physical activity, weight loss, and quitting tobacco use.

7. Take your medication
f you have a medical condition, your doctor may prescribe statins or other medications to help control cholesterol, blood sugar, and blood pressure. Take all medications exactly as prescribed. However, do not take aspirin for prevention unless your doctor advises you to do so. If you have never had a heart attack or stroke, taking daily aspirin may not help you at all and could cause problems, including an increased risk of bleeding. If you have already had a heart attack or stroke, your doctor may recommend a low-dose aspirin to help reduce the risk of another event.

8. Be a team player
Your healthcare team can help you lower your risk of heart disease or stroke so you can live a longer, healthier life. Work together on your prevention plan. Ask questions and talk openly about any challenges you face when trying to make healthy changes. Factors such as stress, sleep, mental health, family circumstances, tobacco use, food access, social support, and other issues can all affect your health and well-being.

9. Live well today for a healthier tomorrow
A healthy lifestyle is the best way to delay or prevent many heart and brain diseases. This means staying active and fit, eating a balanced diet, avoiding tobacco, and managing conditions that can increase your risk. Take charge of your health. Find tips, tools, and inspiration to make changes and build healthy habits you can maintain for life.

This is a difficult question that many people — and their doctors — ask themselves every year. Chest pain can have many causes besides a heart attack. For example, it can also result from problems with the pancreas, the lungs, or from panic attacks.^[5]

Panic attacks occur when stress hormones trigger the body’s “fight-or-flight” response, often causing a racing heart, chest pain, and shortness of breath. In most heart attacks, a blockage in a coronary artery leads to similar symptoms.

One of the main differences between the two is that a heart attack often occurs during physical exertion, while a panic attack tends to happen during periods of rest. When the heart’s workload increases — for example, while shoveling snow or climbing stairs, especially in people who are not regularly active — a heart attack is more likely.

Another difference is the duration: panic attacks usually subside gradually and often pass within 20 minutes, whereas a heart attack typically lasts much longer and may worsen over time.

If in doubt, always seek medical attention immediately. It’s important not to downplay the symptoms, as the situation can quickly become critical. Never hesitate to call emergency number 112.

If it turns out that the symptoms are due to a panic attack, several treatment options are available. These include integrative therapies focused on stress management and relaxation techniques such as meditation, acupuncture, yoga, and tai chi.

A Cardisiography can also provide reassurance by helping you take preventive care of your heart. This method is described in detail here.

The following table compares the different symptoms of heart attacks and panic attacks.^[14] The table below also provides an overview of typical and atypical signs of a heart attack.^[5]