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Calculated Shard: 124 (from laksa181)

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curl -X POST \
  'http://laksa124.int.ahrefs:8124/' \
  -H 'Content-Type: text/plain' \
  -H 'X-ClickHouse-Database: crawler3' \
  -H 'Authorization: Basic YXBpOg==' \
  -d 'SELECT getAhrefsURLFromUnparsed(src_unparsed) AS found_url, ifNull(toUnixTimestamp(download_stamp), 0) AS crawl_time, ifNull(toUnixTimestamp(props_url_first_seen), 0) AS first_indexed_time, download_http_code AS http_code, src_unparsed AS src_unparsed, src_root_hash AS src_root_hash, history_drop_reason AS history_drop_reason, meta_title AS meta_title, meta_descriptions AS meta_descriptions, attrs_boilerpipe_text AS attrs_boilerpipe_text, attrs_markdown AS attrs_markdown, attrs_readable_markdown AS attrs_readable_markdown, meta_canonical AS meta_canonical FROM crawler3.page_info_local FINAL PREWHERE (src_root_hash, src_unparsed) IN ((getAhrefsRootHashFromUnparsed(getAhrefsUnparsedNoserviceFromURL(\'https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126\')), getAhrefsUnparsedNoserviceFromURL(\'https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126\'))) FORMAT JSONEachRow'

Response:

{"found_url":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126","crawl_time":1768763010,"first_indexed_time":1611233421,"http_code":200,"src_unparsed":"org,ahajournals!www,\/doi\/10.1161\/CIRCULATIONAHA.113.006126 s443","src_root_hash":"9229693194530778724","history_drop_reason":null,"meta_title":"Warning Signs of a Heart Attack | Circulation","meta_descriptions":[],"attrs_boilerpipe_text":"Introduction\nEach year, approximately 715 000 Americans experience a heart attack, approximately 162 000 of which are fatal (\nTable 1\n).\n1\nOf those who die, almost half die suddenly before they can get to a hospital. Although a heart attack is a frightening event, if you learn the signs of a heart attack and what steps to take, you can save a life, perhaps even your own. During a heart attack, a clot in one of the arteries of the heart suddenly blocks the flow of blood to the heart, and within minutes, heart muscle begins to die. This is technically called a myocardial infarction, meaning death of heart muscle. The more time that passes without treatment, the greater the damage. The part of the heart that dies during a heart attack cannot grow back or be repaired.\nTable 1\n. Who Is at Risk\nMany people think that heart attacks are a “man’s problem,” yet heart disease is actually the No.1 killer of both men and women in the United States. In men, the risk for heart attack increases significantly after the age of 45. In women, heart attacks are more likely to occur in the years after menopause (usually after the age of 50). However, younger men and women can also have heart attacks.\nBesides age, factors that increase the risk for heart attack are the following:\n A previous heart attack or procedure to open up the coronary arteries\n Family history of early heart disease:\n  Father or brother diagnosed before age 55\n  Mother or sister diagnosed before age 65\n Diabetes mellitus\n High blood cholesterol\n High blood pressure\n Cigarette smoking\n Overweight\n Physical inactivity\nIf you have 1 or more of these factors, see your healthcare provider to find out how to reduce your risk of having a heart attack\nFortunately, clot-dissolving drugs and other artery-opening treatments such as angioplasty (often followed by insertion of a stent, which helps to keep the artery open after the procedure) can stop a heart attack in its tracks. Given soon after symptoms begin, these treatments can prevent or limit damage to the heart. The quicker they are started, the more good they will do and the greater the chances are of a full recovery. These treatments are most effective if they are started in the first hour after the onset of heart attack symptoms. The benefit of opening the blocked artery decreases with each passing hour from symptom onset until treatment.\nLearn the Signs\nMany people think that a heart attack is sudden and intense, like the ‘“Hollywood” heart attack depicted in the movies where a person clutches his or her chest and falls over. The truth is that many heart attacks start as a mild discomfort in the center of the chest. Someone who feels such a “non-Hollywood” warning may not be sure what is wrong. The discomfort (and other symptoms) may even come and go. Even people who have had a heart attack may not recognize the signs because the next one can have entirely different symptoms. The warning signs of a heart attack are shown in\nTable 2\n. Learn them, but also remember the following: Even if you are not sure it is a heart attack, you should still check it out promptly. This includes any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, your symptoms become stronger, become more frequent, or last longer than usual).\nTable 2\n. Heart Attack Warning Signs\nChest discomfort: Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, or fullness.\nDiscomfort in other areas of the upper body: Symptoms can include discomfort in 1 or both arms or in the back, neck, jaw, or stomach.\nShortness of breath: This symptom often accompanies chest discomfort. However, it can also occur before the chest discomfort.\nOther signs: These may include breaking out in a cold sweat, nausea, or light-headedness.\nThe media (and often health professionals) mistakenly use the term heart attack when a person suffers a cardiac arrest, which is the term used when the heart suddenly stops beating (often as a result of a rhythm disturbance in the heart). Within seconds, a cardiac arrest victim loses consciousness and may have a few seconds of seizure activity (shaking of the body) as the flow of blood and oxygen to the brain stops. The victim lies pulseless but may continue to have abnormal (“agonal”) breathing for several minutes, which can confuse laypersons into thinking that the individual has just fainted. In such a case, it is critical for bystanders to call 9-1-1 immediately. The 9-1-1 operator will coach the bystander to do chest compressions on the victim and will dispatch emergency personnel and equipment needed to resuscitate the victim. A cardiac arrest can occur as a complication of a heart attack but can also be caused by other disorders.\nCall 9-1-1\nTiming is everything. People who experience the warning signs of a heart attack often deny how serious the situation is and take a wait-and-see approach. But time is very important, and anyone with these warning signs needs to get medical evaluation and treatment right away. Do not wait more than a few minutes—5 minutes at most—to call 9-1-1. If your physician has prescribed nitroglycerin because you have chest discomfort that comes on with physical exertion and is relieved by rest (a condition called angina pectoris that is usually caused by partial blockage of 1 or more of the arteries nourishing the heart), you may take the medication as prescribed. If your symptoms are not relieved within 5 minutes, you should call 9-1-1 immediately and go to the hospital so that the physicians can determine whether you are having a heart attack. In the past, patients were often told to “take 1 nitroglycerin tablet every 5 minutes for up to 3 doses” if their symptoms were not relieved. This recommendation has been changed to allow only 1 nitroglycerin tablet with a maximum 5-minute period of observation to ensure that, if a heart attack is the cause of the symptoms, the patient will be transported to the hospital as soon as possible to get the blocked artery opened, to minimize heart damage, and to increase the odds of survival.\nBy calling 9-1-1 and taking an ambulance, you will get to the hospital in the fastest and safest way possible. There also are other benefits to calling 9-1-1:\n•\nEmergency personnel can begin treatment immediately, even before you arrive at the hospital.\n•\nYour heart may stop beating during a heart attack. Emergency personnel have the knowledge and equipment needed to start it beating again.\n•\nPatients having a heart attack who arrive by ambulance tend to receive faster treatment on their arrival at the hospital.\nNote: If you are having heart attack symptoms and for some reason cannot call 9-1-1, have someone else drive you at once to the hospital. Never drive yourself unless there is absolutely no other choice because you could pass out while driving.\nQuestions You Will Likely Be Asked in the Emergency Department\nWhen you get to the emergency department, you should be ready to answer, as best as you can, the following questions about your symptoms:\n1.\nWhat time did your discomfort begin?\n2.\nWhat were you doing when your discomfort began?\n3.\nWas it at its most intense level immediately, or did it gradually build up to a peak?\n4.\nDid you notice any additional symptoms in association with the discomfort such as nausea, sweating, or shortness of breath?\n5.\nOn a scale of 0 to 10, with 10 being the worst, what number would you use to describe your discomfort at this time?\nRemember: Do Not Delay\nThe best way to find out whether symptoms are caused by a heart attack is to get checked at a hospital emergency department (\nTable 3\n).\nTable 3\n. Tests to See Whether You Are Having a Heart Attack\nElectrocardiogram: This is a graphic record of the electric activity of the heart as it contracts and rests. It can often detect areas of damage, inadequate blood flow, heart enlargement, and abnormal heartbeats. The electrocardiogram does not always show the damage that is occurring, particularly if it involves the left side or back walls of the heart. In such cases, blood tests or other studies that can image the blood flow of the heart are used.\nBlood tests: Blood tests are often used to check for biochemical markers that are released into the blood within the first few hours after heart damage occurs. In some cases, some of these blood tests can identify high-risk conditions in which a heart attack may be imminent.\nNuclear scan: This is sometimes used to show damaged areas of the heart and to reveal problems with its pumping action, which is particularly helpful in cases where the electrocardiogram does not detect the damage. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records the nuclear material, which is delivered by the coronary arteries and either taken up by the heart muscle (healthy areas) or not taken up (damaged areas). In particular cases, the camera can also evaluate how the heart muscle as a unit pumps the blood. This test can be done during both rest and exercise.\nCoronary angiography (or arteriography): This test is used to take detailed pictures of the coronary arteries. A fine tube (catheter) is threaded through an artery of an arm or leg up into the heart. A fluid that shows up on an x-ray is then injected, and the heart and blood vessels are filmed as the heart pumps. The picture is called an angiogram or arteriogram. It can show problems such as a blockage caused by atherosclerosis.\nIn a heart attack, every minute that passes causes more of the heart muscle to die. You can save a life, your own or someone else’s, by calling 9-1-1 right away. Never delay calling 9-1-1 to take aspirin or do anything else you think might help.\nDoctors and emergency personnel want anyone who may be having a heart attack to come to the emergency department without delay, even if the symptoms turn out to be a false alarm.\nPlan Ahead\nMake a plan now for what you would do if a heart attack should happen. It will save time and could help save a life. To plan ahead, do the following:\n•\nLearn the heart attack warning signs listed in this article.\n•\nTalk to your doctor about your heart attack risk and what you can do to reduce it.\n•\nAsk specifically about aspirin and the use of nitroglycerin.\n•\nTalk with your doctor, family members, friends, and coworkers about the heart attack warning signs and the importance of acting fast. Discuss the benefits of calling 9-1-1 instead of going to the hospital by car. Knowing what to do if a heart attack occurs could save your life or theirs.\nFor more information on lowering your risk of heart disease, check out the following American Heart Association and National Heart, Lung, and Blood Institute Web sites:\n•\n•\n•\n•\n•\n•\nReferences\n1.\nGo AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association.\nCirculation\n. 2013;\n127\n:e6–e245.","attrs_markdown":"[Skip to main content](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#main)\n\n[Advertisement](https:\/\/www.ahajournals.org\/action\/clickThrough?id=501065&url=%2Fadvertising-disclaimer&loc=%2Fdoi%2F10.1161%2FCIRCULATIONAHA.113.006126&pubId=41140226&placeholderId=501029&productId=501016 \"ad disclaimer\")\n\n- [Become a member](http:\/\/professional.heart.org\/professional\/membership\/membership-tiers.jsp)\n- [Volunteer](http:\/\/professional.heart.org\/professional\/registration\/volunteerForm.jsp)\n- [Donate](https:\/\/mygiving.heart.org\/-\/XZTZBDFD?s_src=20U2W1UEMG&s_subsrc=ahajournals_top_donate_button)\n\n![American Heart Association Logo](https:\/\/www.ahajournals.org\/pb-assets\/images\/icons\/AHA_HT_RGB-1711480382163.svg)\n\n[![Go to homepage](https:\/\/www.ahajournals.org\/pb-assets\/images\/logo-publisher-white-1696767979407.svg)](https:\/\/www.ahajournals.org\/ \"Go to homepage\")\n\n- [Journals](https:\/\/www.ahajournals.org\/action\/showPublications)\n- [Browse](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n  \n  [Collections](https:\/\/www.ahajournals.org\/collections)[Subjects](https:\/\/www.ahajournals.org\/subjects)[AHA Journal Podcasts](https:\/\/www.ahajournals.org\/podcasts)[Trend Watch](https:\/\/www.ahajournals.org\/trend-watch)\n- [Resources](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n  \n  [CME](https:\/\/www.ahajournals.org\/cme)[AHA Journals @ Meetings](https:\/\/www.ahajournals.org\/meetings)[Journal Metrics](https:\/\/www.ahajournals.org\/metrics)[Early Career Resources](https:\/\/www.ahajournals.org\/early-career)\n- [Information](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n  \n  [For Authors](https:\/\/www.ahajournals.org\/author-hub)[For Reviewers](https:\/\/www.ahajournals.org\/for-reviewers)[For Subscribers](https:\/\/www.ahajournals.org\/custserv)[For International Users](https:\/\/www.ahajournals.org\/international-users)\n- [Alerts](https:\/\/www.ahajournals.org\/action\/showPreferences?menuTab=Alerts)\n\n- [Shopping cart with 0 item Cart](https:\/\/www.ahajournals.org\/action\/showCart?FlowID=1 \"Cart\")\n- [Search](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#header-quick-search-wrapper \"Search\")\n- [Sign in](https:\/\/www.ahajournals.org\/action\/ssostart?idp=https:\/\/ahasso.heart.org&redirectUri=%2Fdoi%2F10.1161%2FCIRCULATIONAHA.113.006126)   [REGISTER](https:\/\/www.ahajournals.org\/action\/ssostart?idp=https:\/\/ahasso.heart.org&redirectUri=%2Fdoi%2F10.1161%2FCIRCULATIONAHA.113.006126)\n\nSearching:\n\nThis Journal\n\n[This Journal](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#quick-search-form-bf098d8d-a87d-4b3f-ac41-9efb62de42ac-0)[Anywhere](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#quick-search-form-bf098d8d-a87d-4b3f-ac41-9efb62de42ac-1)[Citation](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#quick-search-form-bf098d8d-a87d-4b3f-ac41-9efb62de42ac-2)\n\n[Advanced Search](https:\/\/www.ahajournals.org\/search\/advanced)\n\nSearch\n\n[navigate the sidebar menu](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n\n[Sign in](https:\/\/www.ahajournals.org\/action\/ssostart?idp=https:\/\/ahasso.heart.org&redirectUri=%2Fdoi%2F10.1161%2FCIRCULATIONAHA.113.006126)   [REGISTER](https:\/\/www.ahajournals.org\/action\/ssostart?idp=https:\/\/ahasso.heart.org&redirectUri=%2Fdoi%2F10.1161%2FCIRCULATIONAHA.113.006126)\n\n- [Publications](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#publications)\n  - 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[About Circulation](https:\/\/www.ahajournals.org\/circ\/about)\n  - [Author Instructions](https:\/\/www.ahajournals.org\/circ\/author-instructions)\n  - [Editorial Board](https:\/\/www.ahajournals.org\/circ\/editorial-board)\n  - [Information for Advertisers](https:\/\/www.wolterskluwer.com\/en\/solutions\/lippincott-hcp-access\/media-kits\/circulation)\n- [Features](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n  - [Circ On The Run Podcast](https:\/\/www.ahajournals.org\/circ\/podcast)\n  - [Special Issues](https:\/\/www.ahajournals.org\/circ\/special-themed-issues)\n  - [Circulation at Major Meetings](https:\/\/www.ahajournals.org\/circ\/circ-major-meetings)\n  - [Supplements](https:\/\/www.ahajournals.org\/circ\/supplements)\n  - [Hospitals of History](https:\/\/www.ahajournals.org\/circ\/hospitals-history)\n\n[Submit](https:\/\/www.ahajournals.org\/all-submission-sites \"Submit\")\n\nReference \\#1\n\nResearch Article\n\nOriginally Published 18 March 2014\n\nFree Access\n# Warning Signs of a Heart Attack\n[Joseph P. Ornato, MD](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#con1), and [Mary M. Hand, MSPH, RN](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#con2)[Author Info & Affiliations](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#tab-contributors)\n\nCirculation\n\n[Volume 129, Number 11](https:\/\/www.ahajournals.org\/toc\/circ\/129\/11)\n\n<https:\/\/doi.org\/10.1161\/CIRCULATIONAHA.113.006126>\n\n[17,4657](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126 \"Metrics\")\n\n### Metrics\n### Total Downloads17,465\n- Last 12 Months1,793\n\n### Total Citations7\n- Last 12 Months1\n\n[View all metrics](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126?doi=10.1161\/CIRCULATIONAHA.113.006126#tab-metrics-inner \"Go to metrics page\")\n\n[Track Citations](https:\/\/www.ahajournals.org\/action\/addCitationAlert?doi=10.1161%2FCIRCULATIONAHA.113.006126)[Add to favorites](https:\/\/www.ahajournals.org\/personalize\/addFavoritePublication?doi=10.1161%2FCIRCULATIONAHA.113.006126)\n\n[PDF\/EPUB](https:\/\/www.ahajournals.org\/doi\/reader\/10.1161\/CIRCULATIONAHA.113.006126)\n\nContents\n\n- [Introduction](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#sec-1)\n- [Learn the Signs](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#sec-2)\n- [Call 9-1-1](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#sec-3)\n- [Questions You Will Likely Be Asked in the Emergency Department](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#sec-4)\n- [Remember: Do Not Delay](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#sec-5)\n- [Plan Ahead](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#sec-6)\n- [References](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#bibliography)\n- [eLetters](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#comments)\n\n- [Information & Authors](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-info)\n- [Metrics & Citations](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-metrics)\n- [View Options](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-fulltext-options)\n- [References](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-references)\n- [Figures](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-figures)\n- [Tables](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-tables)\n- [Media](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-media)\n- [Share](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-share)\n\n## Introduction\nEach year, approximately 715 000 Americans experience a heart attack, approximately 162 000 of which are fatal ([Table 1](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#T1)).[1](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-collateral-R1) Of those who die, almost half die suddenly before they can get to a hospital. Although a heart attack is a frightening event, if you learn the signs of a heart attack and what steps to take, you can save a life, perhaps even your own. During a heart attack, a clot in one of the arteries of the heart suddenly blocks the flow of blood to the heart, and within minutes, heart muscle begins to die. This is technically called a myocardial infarction, meaning death of heart muscle. The more time that passes without treatment, the greater the damage. The part of the heart that dies during a heart attack cannot grow back or be repaired.\n\nOpen in Viewer\n\nTable 1. Who Is at Risk\n\n|   |\n|---|\n| Many people think that heart attacks are a “man’s problem,” yet heart disease is actually the No.1 killer of both men and women in the United States. In men, the risk for heart attack increases significantly after the age of 45. In women, heart attacks are more likely to occur in the years after menopause (usually after the age of 50). However, younger men and women can also have heart attacks. |\n| Besides age, factors that increase the risk for heart attack are the following: |\n| A previous heart attack or procedure to open up the coronary arteries |\n| Family history of early heart disease: |\n| Father or brother diagnosed before age 55 |\n| Mother or sister diagnosed before age 65 |\n| Diabetes mellitus |\n| High blood cholesterol |\n| High blood pressure |\n| Cigarette smoking |\n| Overweight |\n| Physical inactivity |\n| If you have 1 or more of these factors, see your healthcare provider to find out how to reduce your risk of having a heart attack |\n\nExpand Table\n\nFortunately, clot-dissolving drugs and other artery-opening treatments such as angioplasty (often followed by insertion of a stent, which helps to keep the artery open after the procedure) can stop a heart attack in its tracks. Given soon after symptoms begin, these treatments can prevent or limit damage to the heart. The quicker they are started, the more good they will do and the greater the chances are of a full recovery. These treatments are most effective if they are started in the first hour after the onset of heart attack symptoms. The benefit of opening the blocked artery decreases with each passing hour from symptom onset until treatment.\n\n## Learn the Signs\nMany people think that a heart attack is sudden and intense, like the ‘“Hollywood” heart attack depicted in the movies where a person clutches his or her chest and falls over. The truth is that many heart attacks start as a mild discomfort in the center of the chest. Someone who feels such a “non-Hollywood” warning may not be sure what is wrong. The discomfort (and other symptoms) may even come and go. Even people who have had a heart attack may not recognize the signs because the next one can have entirely different symptoms. The warning signs of a heart attack are shown in [Table 2](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#T2). Learn them, but also remember the following: Even if you are not sure it is a heart attack, you should still check it out promptly. This includes any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, your symptoms become stronger, become more frequent, or last longer than usual).\n\nOpen in Viewer\n\nTable 2. Heart Attack Warning Signs\n\n|   |\n|---|\n| Chest discomfort: Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, or fullness. |\n| Discomfort in other areas of the upper body: Symptoms can include discomfort in 1 or both arms or in the back, neck, jaw, or stomach. |\n| Shortness of breath: This symptom often accompanies chest discomfort. However, it can also occur before the chest discomfort. |\n| Other signs: These may include breaking out in a cold sweat, nausea, or light-headedness. |\n\nExpand Table\n\nThe media (and often health professionals) mistakenly use the term heart attack when a person suffers a cardiac arrest, which is the term used when the heart suddenly stops beating (often as a result of a rhythm disturbance in the heart). Within seconds, a cardiac arrest victim loses consciousness and may have a few seconds of seizure activity (shaking of the body) as the flow of blood and oxygen to the brain stops. The victim lies pulseless but may continue to have abnormal (“agonal”) breathing for several minutes, which can confuse laypersons into thinking that the individual has just fainted. In such a case, it is critical for bystanders to call 9-1-1 immediately. The 9-1-1 operator will coach the bystander to do chest compressions on the victim and will dispatch emergency personnel and equipment needed to resuscitate the victim. A cardiac arrest can occur as a complication of a heart attack but can also be caused by other disorders.\n\n## Call 9-1-1\nTiming is everything. People who experience the warning signs of a heart attack often deny how serious the situation is and take a wait-and-see approach. But time is very important, and anyone with these warning signs needs to get medical evaluation and treatment right away. Do not wait more than a few minutes—5 minutes at most—to call 9-1-1. If your physician has prescribed nitroglycerin because you have chest discomfort that comes on with physical exertion and is relieved by rest (a condition called angina pectoris that is usually caused by partial blockage of 1 or more of the arteries nourishing the heart), you may take the medication as prescribed. If your symptoms are not relieved within 5 minutes, you should call 9-1-1 immediately and go to the hospital so that the physicians can determine whether you are having a heart attack. In the past, patients were often told to “take 1 nitroglycerin tablet every 5 minutes for up to 3 doses” if their symptoms were not relieved. This recommendation has been changed to allow only 1 nitroglycerin tablet with a maximum 5-minute period of observation to ensure that, if a heart attack is the cause of the symptoms, the patient will be transported to the hospital as soon as possible to get the blocked artery opened, to minimize heart damage, and to increase the odds of survival.\n\nBy calling 9-1-1 and taking an ambulance, you will get to the hospital in the fastest and safest way possible. There also are other benefits to calling 9-1-1:\n\n•\n\nEmergency personnel can begin treatment immediately, even before you arrive at the hospital.\n\n•\n\nYour heart may stop beating during a heart attack. Emergency personnel have the knowledge and equipment needed to start it beating again.\n\n•\n\nPatients having a heart attack who arrive by ambulance tend to receive faster treatment on their arrival at the hospital.\n\nNote: If you are having heart attack symptoms and for some reason cannot call 9-1-1, have someone else drive you at once to the hospital. Never drive yourself unless there is absolutely no other choice because you could pass out while driving.\n\n## Questions You Will Likely Be Asked in the Emergency Department\nWhen you get to the emergency department, you should be ready to answer, as best as you can, the following questions about your symptoms:\n\n1\\.\n\nWhat time did your discomfort begin?\n\n2\\.\n\nWhat were you doing when your discomfort began?\n\n3\\.\n\nWas it at its most intense level immediately, or did it gradually build up to a peak?\n\n4\\.\n\nDid you notice any additional symptoms in association with the discomfort such as nausea, sweating, or shortness of breath?\n\n5\\.\n\nOn a scale of 0 to 10, with 10 being the worst, what number would you use to describe your discomfort at this time?\n\n## Remember: Do Not Delay\nThe best way to find out whether symptoms are caused by a heart attack is to get checked at a hospital emergency department ([Table 3](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#T3)).\n\nOpen in Viewer\n\nTable 3. Tests to See Whether You Are Having a Heart Attack\n\n|   |\n|---|\n| Electrocardiogram: This is a graphic record of the electric activity of the heart as it contracts and rests. It can often detect areas of damage, inadequate blood flow, heart enlargement, and abnormal heartbeats. The electrocardiogram does not always show the damage that is occurring, particularly if it involves the left side or back walls of the heart. In such cases, blood tests or other studies that can image the blood flow of the heart are used. |\n| Blood tests: Blood tests are often used to check for biochemical markers that are released into the blood within the first few hours after heart damage occurs. In some cases, some of these blood tests can identify high-risk conditions in which a heart attack may be imminent. |\n| Nuclear scan: This is sometimes used to show damaged areas of the heart and to reveal problems with its pumping action, which is particularly helpful in cases where the electrocardiogram does not detect the damage. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records the nuclear material, which is delivered by the coronary arteries and either taken up by the heart muscle (healthy areas) or not taken up (damaged areas). In particular cases, the camera can also evaluate how the heart muscle as a unit pumps the blood. This test can be done during both rest and exercise. |\n| Coronary angiography (or arteriography): This test is used to take detailed pictures of the coronary arteries. A fine tube (catheter) is threaded through an artery of an arm or leg up into the heart. A fluid that shows up on an x-ray is then injected, and the heart and blood vessels are filmed as the heart pumps. The picture is called an angiogram or arteriogram. It can show problems such as a blockage caused by atherosclerosis. |\n\nExpand Table\n\nIn a heart attack, every minute that passes causes more of the heart muscle to die. You can save a life, your own or someone else’s, by calling 9-1-1 right away. Never delay calling 9-1-1 to take aspirin or do anything else you think might help.\n\nDoctors and emergency personnel want anyone who may be having a heart attack to come to the emergency department without delay, even if the symptoms turn out to be a false alarm.\n\n## Plan Ahead\nMake a plan now for what you would do if a heart attack should happen. It will save time and could help save a life. To plan ahead, do the following:\n\n•\n\nLearn the heart attack warning signs listed in this article.\n\n•\n\nTalk to your doctor about your heart attack risk and what you can do to reduce it.\n\n•\n\nAsk specifically about aspirin and the use of nitroglycerin.\n\n•\n\nTalk with your doctor, family members, friends, and coworkers about the heart attack warning signs and the importance of acting fast. Discuss the benefits of calling 9-1-1 instead of going to the hospital by car. Knowing what to do if a heart attack occurs could save your life or theirs.\n\nFor more information on lowering your risk of heart disease, check out the following American Heart Association and National Heart, Lung, and Blood Institute Web sites:\n\n•\n\nWhat Is A Heart Attack (<http:\/\/www.nhlbi.nih.gov\/health\/health-topics\/topics\/heartattack>), information on heart attacks\n\n•\n\nHeart and Vascular Diseases (<http:\/\/www.nhlbi.nih.gov\/health\/public\/heart\/index.htm>), a directory of heart disease prevention and treatment information for patients and the public\n\n•\n\nHigh Blood Cholesterol: What You Need to Know (<http:\/\/www.nhlbi.nih.gov\/health\/public\/heart\/chol\/hbc_what.htm>), a patient brochure\n\n•\n\nRisk Assessment Tool for Estimating Your 10-Year Risk of Having a Heart Attack (<http:\/\/cvdrisk.nhlbi.nih.gov\/calculator.asp>), a 10-year heart attack risk calculator\n\n•\n\nMission: Lifeline Glossary (<http:\/\/www.heart.org\/HEARTORG\/HealthcareResearch\/MissionLifelineHomePage\/Mission-Lifeline-Glossary_UCM_308046_Article.jsp>), information on the American Heart Association Mission: Lifeline program\n\n•\n\nHeart Attack: Know the Symptoms, Take Action (<http:\/\/www.nhlbi.nih.gov\/health\/public\/heart\/mi\/heart_attack_wallet_card.pdf>), a wallet card with heart attack symptom and response information\n\n## References\n1\\.\n\nGo AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. *Circulation*. 2013;*127*:e6–e245.\n\n[Go to Citation](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#core-R1-1)\n\n[Crossref](https:\/\/www.ahajournals.org\/servlet\/linkout?suffix=e_1_3_2_2_2&dbid=4&doi=10.1161%2FCIRCULATIONAHA.113.006126&key=10.1161%2Fcir.0b013e31828124ad&site=aha-site)\n\n[PubMed](https:\/\/pubmed.ncbi.nlm.nih.gov\/23239837\/)\n\n[Google Scholar](https:\/\/scholar.google.com\/scholar_lookup?title=Heart+disease+and+stroke+statistics%E2%80%942013+update%3A+a+report+from+the+American+Heart+Association.&author=AS+Go&author=D+Mozaffarian&author=VL+Roger&author=EJ+Benjamin&author=JD+Berry&author=WB+Borden&author=DM+Bravata&author=S+Dai&author=ES+Ford&author=CS+Fox&author=S+Franco&author=HJ+Fullerton&publication_year=2013&journal=Circulation&pages=e6-e245&doi=10.1161%2Fcir.0b013e31828124ad&pmid=23239837)\n\n## eLetters\neLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.\n\nComments and feedback on AHA\/ASA Scientific Statements and Guidelines should be directed to the AHA\/ASA Manuscript Oversight Committee via its [Correspondence](https:\/\/professional.heart.org\/en\/guidelines-and-statements\/correspondence) page.\n\n[Sign In to Submit a Response to This Article](https:\/\/www.ahajournals.org\/action\/ssostart?idp=https:\/\/ahasso.heart.org&redirectUri=\/doi\/full\/10.1161\/CIRCULATIONAHA.113.006126)\n\n## Information & Authors\nInformation\n\nAuthors\n\n### Information\n#### Published In\n[![Go to Circulation ](https:\/\/www.ahajournals.org\/cms\/asset\/7e995630-4e10-4df0-8f91-4ddbc3116e23\/circ.2014.129.issue-11.cover.gif)](https:\/\/www.ahajournals.org\/toc\/circ\/129\/11 \"Go to Circulation \")\n\nCirculation\n\n[Volume 129 • Number 11 • 18 March 2014](https:\/\/www.ahajournals.org\/toc\/circ\/129\/11)\n\nPages: e393 - e395\n\nPubMed: [24637436](https:\/\/pubmed.ncbi.nlm.nih.gov\/24637436\/ \"Link to PubMed\")\n\n#### Copyright\n© 2014 American Heart Association, Inc.\n\n#### History\n**Published online**: 18 March 2014\n\n**Published in print**: 18 March 2014\n\n#### Permissions\nRequest permissions for this article.\n\n[Request permissions](https:\/\/s100.copyright.com\/AppDispatchServlet?publisherName=WoltersKluwer&publication=circulationaha&title=Warning+Signs+of+a+Heart+Attack&publicationDate=2014-03-18&author=Joseph+P.+Ornato%2C+Mary+M.+Hand&contentID=10.1161%2FCIRCULATIONAHA.113.006126&volumeNum=129&issueNum=11&startPage=e393&endPage=e395&orderBeanReset=true&imprint=American+Heart+Association&issn=0009-7322&rpt=n)\n\n#### Subjects\n1. [Cardiopulmonary Resuscitation and Emergency Cardiac Care](https:\/\/www.ahajournals.org\/topic\/aha-collection\/10055)\n\n### Authors\n#### AffiliationsExpand All\n##### Joseph P. Ornato, MD\nFrom the Department of Emergency Medicine, Virginia Commonwealth University, Richmond (J.P.O.); and Bethesda, MD (M.M.H.).\n\n[View all articles by this author](https:\/\/www.ahajournals.org\/authored-by\/Ornato\/Joseph+P)\n\n##### Mary M. Hand, MSPH, RN\nFrom the Department of Emergency Medicine, Virginia Commonwealth University, Richmond (J.P.O.); and Bethesda, MD (M.M.H.).\n\n[View all articles by this author](https:\/\/www.ahajournals.org\/authored-by\/Hand\/Mary+M)\n\n#### Notes\nThe information contained in this *Circulation* Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional.\n\nCorrespondence to Joseph P. Ornato, MD, Department of Emergency Medicine, Virginia Commonwealth University, 1250 E Marshall St, Richmond, VA, 23298-0401.\n\n#### Disclosures\nNone.\n\n## Metrics & Citations\nMetrics\n\nCitations7\n\n### Metrics\nArticle Metrics\n\n[View all metrics](https:\/\/www.ahajournals.org\/doi\/metrics\/10.1161\/CIRCULATIONAHA.113.006126 \"Go to metrics page\")\n\n- [Downloads](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126 \"Downloads\")\n- [Citations](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126 \"Citations\")\n\nNo data available.\n\n0\n\n500\n\n1,000\n\n1,500\n\n2,000\n\nJan 2016\n\nJan 2018\n\nJan 2020\n\nJan 2022\n\nJan 2024\n\nJan 2026\n\n17,465\n\n7\n\n- [Total](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n- [6 Months](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n- [12 Months](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n\nTotal number of downloads and citations\n\n### Citations\nDownload Citations\n\nIf you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.\n\n1. - Akimasa Tashiro,\n   - David A. Bereiter,\n   - Yuna Kani,\n   - Yuji Morimoto,\n   Estrogen-dependent effects of vagotomy and endogenous opioids on temporomandibular joint-responsive neurons in trigeminal subnucleus caudalis, The Journal of Physiological Sciences, **75**, 3, (100046), (2025).<https:\/\/doi.org\/10.1016\/j.jphyss.2025.100046>\n   [Crossref](https:\/\/doi.org\/10.1016\/j.jphyss.2025.100046)\n2. - Jacob Michael Lurie,\n   - Harlan Linver Pietz,\n   - Claudia Hatef,\n   - Faten Taki,\n   - Annabel Lee,\n   - Sargun Virk,\n   - Tanzilya Oren,\n   - Catherine Gbekie,\n   - Andrew R. Milewski,\n   - Richard Boyer,\n   - Gunisha Kaur,\n   Psychological stress, cardiovascular disease and somatic pain in asylum seekers: a retrospective cross-sectional study, Nature Mental Health, **2**, 12, (1442-1450), (2024).<https:\/\/doi.org\/10.1038\/s44220-024-00312-3>\n   [Crossref](https:\/\/doi.org\/10.1038\/s44220-024-00312-3)\n3. - Elizabeth K. Hewett Brumberg,\n   - Matthew J. Douma,\n   - Kostas Alibertis,\n   - Nathan P. Charlton,\n   - Michael P. Goldman,\n   - Katrina Harper-Kirksey,\n   - Seth C. Hawkins,\n   - Amber V. Hoover,\n   - Amy Kule,\n   - Stefan Leichtle,\n   - Sarah Frances McClure,\n   - George Sam Wang,\n   - Mark Whelchel,\n   - Lynn White,\n   - Eric J. Lavonas,\n   2024 American Heart Association and American Red Cross Guidelines for First Aid, Circulation, **150**, 24, (e519-e579), (2024).[\/doi\/10.1161\/CIR.0000000000001281](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000001281 \"Abstract\")\n   [Abstract](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIR.0000000000001281)\n4. - Adersikha Pradhan,\n   - Manodeep Chakraborty,\n   - Oonglim Lepcha,\n   - Ananya Bhattacharjee,\n   - Devid Chutia,\n   - Nihar Ranjan Bhuyan,\n   Cardioprotective effects of Rhododendron arboreum leaf extract against Doxorubicin-induced cardiotoxicity in Wistar rats by modulating electrocardiographic and cardiac biomarkers, Clinical Phytoscience, **9**, 1, (2023).<https:\/\/doi.org\/10.1186\/s40816-023-00361-8>\n   [Crossref](https:\/\/doi.org\/10.1186\/s40816-023-00361-8)\n5. - Daniel E. Myers,\n   Review of visceral throat and chest disorders causing nonodontogenic orofacial pain, The Journal of the American Dental Association, **153**, 8, (769-775), (2022).<https:\/\/doi.org\/10.1016\/j.adaj.2022.01.007>\n   [Crossref](https:\/\/doi.org\/10.1016\/j.adaj.2022.01.007)\n6. - Daniel E. Myers,\n   The receptive field for visceral pain referred orofacially by the vagus nerves, Clinical Anatomy, **34**, 1, (24-29), (2020).<https:\/\/doi.org\/10.1002\/ca.23604>\n   [Crossref](https:\/\/doi.org\/10.1002\/ca.23604)\n7. - Ashruta Patel,\n   - Jing Fang,\n   - Cathleen Gillespie,\n   - Erika Odom,\n   - Cecily Luncheon,\n   - Carma Ayala,\n   Awareness of Heart Attack Signs and Symptoms and Calling 9-1-1 Among U.S. Adults, Journal of the American College of Cardiology, **71**, 7, (808-809), (2018).<https:\/\/doi.org\/10.1016\/j.jacc.2017.10.104>\n   [Crossref](https:\/\/doi.org\/10.1016\/j.jacc.2017.10.104)\n\nLoading...\n\n## View Options\n### View options\n#### PDF and All Supplements\n[Download PDF and All Supplements](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126)\n\nDownload is in progress\n\n#### PDF\/EPUB\n[View PDF\/EPUB](https:\/\/www.ahajournals.org\/doi\/reader\/10.1161\/CIRCULATIONAHA.113.006126 \"Open full-text in eReader\")\n## Figures\n## Tables\nOpen all in viewer\n\nTable 1. Who Is at Risk\n\n[Go to Table](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#T1)\n\nOpen in Viewer\n\nTable 2. Heart Attack Warning Signs\n\n[Go to Table](https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.113.006126#T2)\n\nOpen in Viewer\n\nTable 3. 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Boilerpipe Text	Introduction Each year, approximately 715 000 Americans experience a heart attack, approximately 162 000 of which are fatal ( Table 1 ). 1 Of those who die, almost half die suddenly before they can get to a hospital. Although a heart attack is a frightening event, if you learn the signs of a heart attack and what steps to take, you can save a life, perhaps even your own. During a heart attack, a clot in one of the arteries of the heart suddenly blocks the flow of blood to the heart, and within minutes, heart muscle begins to die. This is technically called a myocardial infarction, meaning death of heart muscle. The more time that passes without treatment, the greater the damage. The part of the heart that dies during a heart attack cannot grow back or be repaired. Table 1 . Who Is at Risk Many people think that heart attacks are a “man’s problem,” yet heart disease is actually the No.1 killer of both men and women in the United States. In men, the risk for heart attack increases significantly after the age of 45. In women, heart attacks are more likely to occur in the years after menopause (usually after the age of 50). However, younger men and women can also have heart attacks. Besides age, factors that increase the risk for heart attack are the following: A previous heart attack or procedure to open up the coronary arteries Family history of early heart disease: Father or brother diagnosed before age 55 Mother or sister diagnosed before age 65 Diabetes mellitus High blood cholesterol High blood pressure Cigarette smoking Overweight Physical inactivity If you have 1 or more of these factors, see your healthcare provider to find out how to reduce your risk of having a heart attack Fortunately, clot-dissolving drugs and other artery-opening treatments such as angioplasty (often followed by insertion of a stent, which helps to keep the artery open after the procedure) can stop a heart attack in its tracks. Given soon after symptoms begin, these treatments can prevent or limit damage to the heart. The quicker they are started, the more good they will do and the greater the chances are of a full recovery. These treatments are most effective if they are started in the first hour after the onset of heart attack symptoms. The benefit of opening the blocked artery decreases with each passing hour from symptom onset until treatment. Learn the Signs Many people think that a heart attack is sudden and intense, like the ‘“Hollywood” heart attack depicted in the movies where a person clutches his or her chest and falls over. The truth is that many heart attacks start as a mild discomfort in the center of the chest. Someone who feels such a “non-Hollywood” warning may not be sure what is wrong. The discomfort (and other symptoms) may even come and go. Even people who have had a heart attack may not recognize the signs because the next one can have entirely different symptoms. The warning signs of a heart attack are shown in Table 2 . Learn them, but also remember the following: Even if you are not sure it is a heart attack, you should still check it out promptly. This includes any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, your symptoms become stronger, become more frequent, or last longer than usual). Table 2 . Heart Attack Warning Signs Chest discomfort: Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, or fullness. Discomfort in other areas of the upper body: Symptoms can include discomfort in 1 or both arms or in the back, neck, jaw, or stomach. Shortness of breath: This symptom often accompanies chest discomfort. However, it can also occur before the chest discomfort. Other signs: These may include breaking out in a cold sweat, nausea, or light-headedness. The media (and often health professionals) mistakenly use the term heart attack when a person suffers a cardiac arrest, which is the term used when the heart suddenly stops beating (often as a result of a rhythm disturbance in the heart). Within seconds, a cardiac arrest victim loses consciousness and may have a few seconds of seizure activity (shaking of the body) as the flow of blood and oxygen to the brain stops. The victim lies pulseless but may continue to have abnormal (“agonal”) breathing for several minutes, which can confuse laypersons into thinking that the individual has just fainted. In such a case, it is critical for bystanders to call 9-1-1 immediately. The 9-1-1 operator will coach the bystander to do chest compressions on the victim and will dispatch emergency personnel and equipment needed to resuscitate the victim. A cardiac arrest can occur as a complication of a heart attack but can also be caused by other disorders. Call 9-1-1 Timing is everything. People who experience the warning signs of a heart attack often deny how serious the situation is and take a wait-and-see approach. But time is very important, and anyone with these warning signs needs to get medical evaluation and treatment right away. Do not wait more than a few minutes—5 minutes at most—to call 9-1-1. If your physician has prescribed nitroglycerin because you have chest discomfort that comes on with physical exertion and is relieved by rest (a condition called angina pectoris that is usually caused by partial blockage of 1 or more of the arteries nourishing the heart), you may take the medication as prescribed. If your symptoms are not relieved within 5 minutes, you should call 9-1-1 immediately and go to the hospital so that the physicians can determine whether you are having a heart attack. In the past, patients were often told to “take 1 nitroglycerin tablet every 5 minutes for up to 3 doses” if their symptoms were not relieved. This recommendation has been changed to allow only 1 nitroglycerin tablet with a maximum 5-minute period of observation to ensure that, if a heart attack is the cause of the symptoms, the patient will be transported to the hospital as soon as possible to get the blocked artery opened, to minimize heart damage, and to increase the odds of survival. By calling 9-1-1 and taking an ambulance, you will get to the hospital in the fastest and safest way possible. There also are other benefits to calling 9-1-1: • Emergency personnel can begin treatment immediately, even before you arrive at the hospital. • Your heart may stop beating during a heart attack. Emergency personnel have the knowledge and equipment needed to start it beating again. • Patients having a heart attack who arrive by ambulance tend to receive faster treatment on their arrival at the hospital. Note: If you are having heart attack symptoms and for some reason cannot call 9-1-1, have someone else drive you at once to the hospital. Never drive yourself unless there is absolutely no other choice because you could pass out while driving. Questions You Will Likely Be Asked in the Emergency Department When you get to the emergency department, you should be ready to answer, as best as you can, the following questions about your symptoms: 1. What time did your discomfort begin? 2. What were you doing when your discomfort began? 3. Was it at its most intense level immediately, or did it gradually build up to a peak? 4. Did you notice any additional symptoms in association with the discomfort such as nausea, sweating, or shortness of breath? 5. On a scale of 0 to 10, with 10 being the worst, what number would you use to describe your discomfort at this time? Remember: Do Not Delay The best way to find out whether symptoms are caused by a heart attack is to get checked at a hospital emergency department ( Table 3 ). Table 3 . Tests to See Whether You Are Having a Heart Attack Electrocardiogram: This is a graphic record of the electric activity of the heart as it contracts and rests. It can often detect areas of damage, inadequate blood flow, heart enlargement, and abnormal heartbeats. The electrocardiogram does not always show the damage that is occurring, particularly if it involves the left side or back walls of the heart. In such cases, blood tests or other studies that can image the blood flow of the heart are used. Blood tests: Blood tests are often used to check for biochemical markers that are released into the blood within the first few hours after heart damage occurs. In some cases, some of these blood tests can identify high-risk conditions in which a heart attack may be imminent. Nuclear scan: This is sometimes used to show damaged areas of the heart and to reveal problems with its pumping action, which is particularly helpful in cases where the electrocardiogram does not detect the damage. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records the nuclear material, which is delivered by the coronary arteries and either taken up by the heart muscle (healthy areas) or not taken up (damaged areas). In particular cases, the camera can also evaluate how the heart muscle as a unit pumps the blood. This test can be done during both rest and exercise. Coronary angiography (or arteriography): This test is used to take detailed pictures of the coronary arteries. A fine tube (catheter) is threaded through an artery of an arm or leg up into the heart. A fluid that shows up on an x-ray is then injected, and the heart and blood vessels are filmed as the heart pumps. The picture is called an angiogram or arteriogram. It can show problems such as a blockage caused by atherosclerosis. In a heart attack, every minute that passes causes more of the heart muscle to die. You can save a life, your own or someone else’s, by calling 9-1-1 right away. Never delay calling 9-1-1 to take aspirin or do anything else you think might help. Doctors and emergency personnel want anyone who may be having a heart attack to come to the emergency department without delay, even if the symptoms turn out to be a false alarm. Plan Ahead Make a plan now for what you would do if a heart attack should happen. It will save time and could help save a life. To plan ahead, do the following: • Learn the heart attack warning signs listed in this article. • Talk to your doctor about your heart attack risk and what you can do to reduce it. • Ask specifically about aspirin and the use of nitroglycerin. • Talk with your doctor, family members, friends, and coworkers about the heart attack warning signs and the importance of acting fast. Discuss the benefits of calling 9-1-1 instead of going to the hospital by car. Knowing what to do if a heart attack occurs could save your life or theirs. For more information on lowering your risk of heart disease, check out the following American Heart Association and National Heart, Lung, and Blood Institute Web sites: • • • • • • References 1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation . 2013; 127 :e6–e245.
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Ornato, MD](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#con1), and [Mary M. Hand, MSPH, RN](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#con2)[Author Info & Affiliations](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#tab-contributors) Circulation [Volume 129, Number 11](https://www.ahajournals.org/toc/circ/129/11) <https://doi.org/10.1161/CIRCULATIONAHA.113.006126> [17,4657](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126 "Metrics") ### Metrics ### Total Downloads17,465 - Last 12 Months1,793 ### Total Citations7 - Last 12 Months1 [View all metrics](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126?doi=10.1161/CIRCULATIONAHA.113.006126#tab-metrics-inner "Go to metrics page") [Track Citations](https://www.ahajournals.org/action/addCitationAlert?doi=10.1161%2FCIRCULATIONAHA.113.006126)[Add to favorites](https://www.ahajournals.org/personalize/addFavoritePublication?doi=10.1161%2FCIRCULATIONAHA.113.006126) [PDF/EPUB](https://www.ahajournals.org/doi/reader/10.1161/CIRCULATIONAHA.113.006126) Contents - [Introduction](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#sec-1) - [Learn the Signs](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#sec-2) - [Call 9-1-1](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#sec-3) - [Questions You Will Likely Be Asked in the Emergency Department](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#sec-4) - [Remember: Do Not Delay](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#sec-5) - [Plan Ahead](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#sec-6) - [References](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#bibliography) - [eLetters](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#comments) - [Information & Authors](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-info) - [Metrics & Citations](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-metrics) - [View Options](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-fulltext-options) - [References](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-references) - [Figures](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-figures) - [Tables](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-tables) - [Media](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-media) - [Share](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-share) ## Introduction Each year, approximately 715 000 Americans experience a heart attack, approximately 162 000 of which are fatal ([Table 1](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#T1)).[1](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#core-collateral-R1) Of those who die, almost half die suddenly before they can get to a hospital. Although a heart attack is a frightening event, if you learn the signs of a heart attack and what steps to take, you can save a life, perhaps even your own. During a heart attack, a clot in one of the arteries of the heart suddenly blocks the flow of blood to the heart, and within minutes, heart muscle begins to die. This is technically called a myocardial infarction, meaning death of heart muscle. The more time that passes without treatment, the greater the damage. The part of the heart that dies during a heart attack cannot grow back or be repaired. Open in Viewer Table 1. Who Is at Risk \| \| \|---\| \| Many people think that heart attacks are a “man’s problem,” yet heart disease is actually the No.1 killer of both men and women in the United States. In men, the risk for heart attack increases significantly after the age of 45. In women, heart attacks are more likely to occur in the years after menopause (usually after the age of 50). However, younger men and women can also have heart attacks. \| \| Besides age, factors that increase the risk for heart attack are the following: \| \| A previous heart attack or procedure to open up the coronary arteries \| \| Family history of early heart disease: \| \| Father or brother diagnosed before age 55 \| \| Mother or sister diagnosed before age 65 \| \| Diabetes mellitus \| \| High blood cholesterol \| \| High blood pressure \| \| Cigarette smoking \| \| Overweight \| \| Physical inactivity \| \| If you have 1 or more of these factors, see your healthcare provider to find out how to reduce your risk of having a heart attack \| Expand Table Fortunately, clot-dissolving drugs and other artery-opening treatments such as angioplasty (often followed by insertion of a stent, which helps to keep the artery open after the procedure) can stop a heart attack in its tracks. Given soon after symptoms begin, these treatments can prevent or limit damage to the heart. The quicker they are started, the more good they will do and the greater the chances are of a full recovery. These treatments are most effective if they are started in the first hour after the onset of heart attack symptoms. The benefit of opening the blocked artery decreases with each passing hour from symptom onset until treatment. ## Learn the Signs Many people think that a heart attack is sudden and intense, like the ‘“Hollywood” heart attack depicted in the movies where a person clutches his or her chest and falls over. The truth is that many heart attacks start as a mild discomfort in the center of the chest. Someone who feels such a “non-Hollywood” warning may not be sure what is wrong. The discomfort (and other symptoms) may even come and go. Even people who have had a heart attack may not recognize the signs because the next one can have entirely different symptoms. The warning signs of a heart attack are shown in [Table 2](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#T2). Learn them, but also remember the following: Even if you are not sure it is a heart attack, you should still check it out promptly. This includes any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, your symptoms become stronger, become more frequent, or last longer than usual). Open in Viewer Table 2. Heart Attack Warning Signs \| \| \|---\| \| Chest discomfort: Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, or fullness. \| \| Discomfort in other areas of the upper body: Symptoms can include discomfort in 1 or both arms or in the back, neck, jaw, or stomach. \| \| Shortness of breath: This symptom often accompanies chest discomfort. However, it can also occur before the chest discomfort. \| \| Other signs: These may include breaking out in a cold sweat, nausea, or light-headedness. \| Expand Table The media (and often health professionals) mistakenly use the term heart attack when a person suffers a cardiac arrest, which is the term used when the heart suddenly stops beating (often as a result of a rhythm disturbance in the heart). Within seconds, a cardiac arrest victim loses consciousness and may have a few seconds of seizure activity (shaking of the body) as the flow of blood and oxygen to the brain stops. The victim lies pulseless but may continue to have abnormal (“agonal”) breathing for several minutes, which can confuse laypersons into thinking that the individual has just fainted. In such a case, it is critical for bystanders to call 9-1-1 immediately. The 9-1-1 operator will coach the bystander to do chest compressions on the victim and will dispatch emergency personnel and equipment needed to resuscitate the victim. A cardiac arrest can occur as a complication of a heart attack but can also be caused by other disorders. ## Call 9-1-1 Timing is everything. People who experience the warning signs of a heart attack often deny how serious the situation is and take a wait-and-see approach. But time is very important, and anyone with these warning signs needs to get medical evaluation and treatment right away. Do not wait more than a few minutes—5 minutes at most—to call 9-1-1. If your physician has prescribed nitroglycerin because you have chest discomfort that comes on with physical exertion and is relieved by rest (a condition called angina pectoris that is usually caused by partial blockage of 1 or more of the arteries nourishing the heart), you may take the medication as prescribed. If your symptoms are not relieved within 5 minutes, you should call 9-1-1 immediately and go to the hospital so that the physicians can determine whether you are having a heart attack. In the past, patients were often told to “take 1 nitroglycerin tablet every 5 minutes for up to 3 doses” if their symptoms were not relieved. This recommendation has been changed to allow only 1 nitroglycerin tablet with a maximum 5-minute period of observation to ensure that, if a heart attack is the cause of the symptoms, the patient will be transported to the hospital as soon as possible to get the blocked artery opened, to minimize heart damage, and to increase the odds of survival. By calling 9-1-1 and taking an ambulance, you will get to the hospital in the fastest and safest way possible. There also are other benefits to calling 9-1-1: • Emergency personnel can begin treatment immediately, even before you arrive at the hospital. • Your heart may stop beating during a heart attack. Emergency personnel have the knowledge and equipment needed to start it beating again. • Patients having a heart attack who arrive by ambulance tend to receive faster treatment on their arrival at the hospital. Note: If you are having heart attack symptoms and for some reason cannot call 9-1-1, have someone else drive you at once to the hospital. Never drive yourself unless there is absolutely no other choice because you could pass out while driving. ## Questions You Will Likely Be Asked in the Emergency Department When you get to the emergency department, you should be ready to answer, as best as you can, the following questions about your symptoms: 1\. What time did your discomfort begin? 2\. What were you doing when your discomfort began? 3\. Was it at its most intense level immediately, or did it gradually build up to a peak? 4\. Did you notice any additional symptoms in association with the discomfort such as nausea, sweating, or shortness of breath? 5\. On a scale of 0 to 10, with 10 being the worst, what number would you use to describe your discomfort at this time? ## Remember: Do Not Delay The best way to find out whether symptoms are caused by a heart attack is to get checked at a hospital emergency department ([Table 3](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126#T3)). Open in Viewer Table 3. Tests to See Whether You Are Having a Heart Attack \| \| \|---\| \| Electrocardiogram: This is a graphic record of the electric activity of the heart as it contracts and rests. It can often detect areas of damage, inadequate blood flow, heart enlargement, and abnormal heartbeats. The electrocardiogram does not always show the damage that is occurring, particularly if it involves the left side or back walls of the heart. In such cases, blood tests or other studies that can image the blood flow of the heart are used. \| \| Blood tests: Blood tests are often used to check for biochemical markers that are released into the blood within the first few hours after heart damage occurs. In some cases, some of these blood tests can identify high-risk conditions in which a heart attack may be imminent. \| \| Nuclear scan: This is sometimes used to show damaged areas of the heart and to reveal problems with its pumping action, which is particularly helpful in cases where the electrocardiogram does not detect the damage. A small amount of radioactive material is injected into a vein, usually in the arm. A scanning camera positioned over the heart records the nuclear material, which is delivered by the coronary arteries and either taken up by the heart muscle (healthy areas) or not taken up (damaged areas). In particular cases, the camera can also evaluate how the heart muscle as a unit pumps the blood. This test can be done during both rest and exercise. \| \| Coronary angiography (or arteriography): This test is used to take detailed pictures of the coronary arteries. A fine tube (catheter) is threaded through an artery of an arm or leg up into the heart. A fluid that shows up on an x-ray is then injected, and the heart and blood vessels are filmed as the heart pumps. The picture is called an angiogram or arteriogram. It can show problems such as a blockage caused by atherosclerosis. \| Expand Table In a heart attack, every minute that passes causes more of the heart muscle to die. You can save a life, your own or someone else’s, by calling 9-1-1 right away. Never delay calling 9-1-1 to take aspirin or do anything else you think might help. Doctors and emergency personnel want anyone who may be having a heart attack to come to the emergency department without delay, even if the symptoms turn out to be a false alarm. ## Plan Ahead Make a plan now for what you would do if a heart attack should happen. It will save time and could help save a life. To plan ahead, do the following: • Learn the heart attack warning signs listed in this article. • Talk to your doctor about your heart attack risk and what you can do to reduce it. • Ask specifically about aspirin and the use of nitroglycerin. • Talk with your doctor, family members, friends, and coworkers about the heart attack warning signs and the importance of acting fast. Discuss the benefits of calling 9-1-1 instead of going to the hospital by car. Knowing what to do if a heart attack occurs could save your life or theirs. For more information on lowering your risk of heart disease, check out the following American Heart Association and National Heart, Lung, and Blood Institute Web sites: • What Is A Heart Attack (<http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack>), information on heart attacks • Heart and Vascular Diseases (<http://www.nhlbi.nih.gov/health/public/heart/index.htm>), a directory of heart disease prevention and treatment information for patients and the public • High Blood Cholesterol: What You Need to Know (<http://www.nhlbi.nih.gov/health/public/heart/chol/hbc_what.htm>), a patient brochure • Risk Assessment Tool for Estimating Your 10-Year Risk of Having a Heart Attack (<http://cvdrisk.nhlbi.nih.gov/calculator.asp>), a 10-year heart attack risk calculator • Mission: Lifeline Glossary (<http://www.heart.org/HEARTORG/HealthcareResearch/MissionLifelineHomePage/Mission-Lifeline-Glossary_UCM_308046_Article.jsp>), information on the American Heart Association Mission: Lifeline program • Heart Attack: Know the Symptoms, Take Action (<http://www.nhlbi.nih.gov/health/public/heart/mi/heart_attack_wallet_card.pdf>), a wallet card with heart attack symptom and response information ## References 1\. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245. 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[Request permissions](https://s100.copyright.com/AppDispatchServlet?publisherName=WoltersKluwer&publication=circulationaha&title=Warning+Signs+of+a+Heart+Attack&publicationDate=2014-03-18&author=Joseph+P.+Ornato%2C+Mary+M.+Hand&contentID=10.1161%2FCIRCULATIONAHA.113.006126&volumeNum=129&issueNum=11&startPage=e393&endPage=e395&orderBeanReset=true&imprint=American+Heart+Association&issn=0009-7322&rpt=n) #### Subjects 1. [Cardiopulmonary Resuscitation and Emergency Cardiac Care](https://www.ahajournals.org/topic/aha-collection/10055) ### Authors #### AffiliationsExpand All ##### Joseph P. Ornato, MD From the Department of Emergency Medicine, Virginia Commonwealth University, Richmond (J.P.O.); and Bethesda, MD (M.M.H.). [View all articles by this author](https://www.ahajournals.org/authored-by/Ornato/Joseph+P) ##### Mary M. Hand, MSPH, RN From the Department of Emergency Medicine, Virginia Commonwealth University, Richmond (J.P.O.); and Bethesda, MD (M.M.H.). [View all articles by this author](https://www.ahajournals.org/authored-by/Hand/Mary+M) #### Notes The information contained in this Circulation Cardiology Patient Page is not a substitute for medical advice, and the American Heart Association recommends consultation with your doctor or healthcare professional. Correspondence to Joseph P. Ornato, MD, Department of Emergency Medicine, Virginia Commonwealth University, 1250 E Marshall St, Richmond, VA, 23298-0401. #### Disclosures None. ## Metrics & Citations Metrics Citations7 ### Metrics Article Metrics [View all metrics](https://www.ahajournals.org/doi/metrics/10.1161/CIRCULATIONAHA.113.006126 "Go to metrics page") - [Downloads](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126 "Downloads") - [Citations](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126 "Citations") No data available. 0 500 1,000 1,500 2,000 Jan 2016 Jan 2018 Jan 2020 Jan 2022 Jan 2024 Jan 2026 17,465 7 - [Total](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126) - [6 Months](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126) - [12 Months](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126) Total number of downloads and citations ### Citations Download Citations If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. 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Myers, The receptive field for visceral pain referred orofacially by the vagus nerves, Clinical Anatomy, 34, 1, (24-29), (2020).<https://doi.org/10.1002/ca.23604> [Crossref](https://doi.org/10.1002/ca.23604) 7. - Ashruta Patel, - Jing Fang, - Cathleen Gillespie, - Erika Odom, - Cecily Luncheon, - Carma Ayala, Awareness of Heart Attack Signs and Symptoms and Calling 9-1-1 Among U.S. Adults, Journal of the American College of Cardiology, 71, 7, (808-809), (2018).<https://doi.org/10.1016/j.jacc.2017.10.104> [Crossref](https://doi.org/10.1016/j.jacc.2017.10.104) Loading... ## View Options ### View options #### PDF and All Supplements [Download PDF and All Supplements](https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.113.006126) Download is in progress #### PDF/EPUB [View PDF/EPUB](https://www.ahajournals.org/doi/reader/10.1161/CIRCULATIONAHA.113.006126 "Open full-text in eReader") ## Figures ## Tables Open all in viewer Table 1. 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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Magid D, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Nichol G, Paynter NP, Schreiner PJ, Sorlie PD, Stein J, Turan TN, Virani SS, Wong ND, Woo D, Turner MB; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–e245. 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