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​​​​​If you, or someone you know, a​re experiencing symptoms of a heart attack,
call 9-1-1 immediately.

What Causes a Heart Attack?

Coronary Heart Disease

Most heart attacks occur as a result of coronary heart disease (CHD).

CHD is a condition in which a waxy substance called plaque builds up inside of the coronary arteries. These arteries supply oxygen-rich blood to your heart.

When plaque builds up in the arteries, the condition is called atherosclerosis. The buildup of plaque occurs over many years.

Eventually, an area of plaque can rupture inside of an artery. This causes a blood clot to form on the plaque's surface. If the clot becomes large enough, it can mostly or completely block blood flow through a coronary artery.

If the blockage isn't treated quickly, the portion of heart muscle fed by the artery begins to die. Healthy heart tissue is replaced with scar tissue. This heart damage may not be obvious, or it may cause severe or long-lasting problems.

Coronary Artery Spasm

A less common cause of heart attack is a severe spasm (tightening) of a coronary artery. The spasm cuts off blood flow through the artery. Spasms can occur in coronary arteries that aren't affected by atherosclerosis.

What causes a coronary artery to spasm isn't always clear. A spasm may be related to:

  • Taking certain drugs, such as cocaine
  • Emotional stress or pain
  • Exposure to extreme cold
  • Cigarette smoking

Heart Attack Symptoms

Some people can have few symptoms and are surprised to learn they've had a heart attack. If you've already had a heart attack, your symptoms may not be the same for another one.

Most Common Heart Attack Symptoms

The most common warning symptoms of a heart attack for both men and women are:

  • ​Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest. The discomfort usually lasts for more than a few minutes or goes away and comes back. It can feel like pressure, squeezing, fullness, or pain. It also can feel like heartburn or indigestion. The feeling can be mild or severe.
  • Upper body discomfort. You may feel pain or discomfort in one or both arms, the back, shoulders, neck, jaw, or upper part of the stomach (above the belly button).
  • Shortness of breath. This may be your only symptom, or it may occur before or along with chest pain or discomfort. It can occur when you are resting or doing a little bit of physical activity.

Other Less Common Heart Attack Symptoms

Pay attention to these other possible symptoms of a heart attack:

  • Breaking out in a cold sweat
  • Feeling unusually tired for no reason, sometimes for days (especially if you are a woman)
  • Nausea (feeling sick to the stomach) and vomiting
  • Light-headedness or sudden dizziness
  • Any sudden, new symptoms or a change in the pattern of symptoms you already have (for example, if your symptoms become stronger or last longer than usual)

In women​, symptoms may be slightly different. Most women will experience pain or discomfort in their chest, but some may not. Other symptoms that a woman might experience include:

  • Nausea or vomiting
  • Extreme fatigue
  • Pain in the​ abdomen
  • Shortness of breath
  • Pain or discomfort in the center of the back or in the jaw

Facts About Heart Attack Symptoms

Not all heart attacks begin with the sudden, crushing chest pain that often is shown on TV or in the movies. In one study, for example, one-third of the patients who had heart attacks had no chest pain. These patients were more likely to be older, female, or diabetic.

It is important for you to remember these heart attack facts:

  • Heart attacks can start slowly and cause only mild pain or discomfort. Symptoms can be mild or more intense and sudden. Symptoms also may come and go over several hours.
  • People who have high blood sugar (diabetes) may have no symptoms or very mild ones.
  • The most common symptom, in both men and women, is chest pain or discomfort.
  • Women are somewhat more likely to have shortness of breath, nausea and vomiting, unusual tiredness (sometimes for days), and pain in the back, shoulders, and jaw.
  • Some people don't have symptoms at all. Heart attacks that occur without any symptoms or with very mild symptoms are called silent heart attacks.

The symptoms of angina can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually when they're active. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack. All chest pain should be checked by a doctor.

Responding to Heart Attack Warning Signs

If you or someone you know exhibits any of the above warning signs, act immediately. Call 9-1-1, or your local emergency number.

Source: National Heart, Lung, and Blood Institute; National Institutes of Health; U.S. Department of Health and Human Services.​​

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