According to the Centers for Disease Control and Prevention (CDC), someone in the United States has a heart attack, or myocardial infarction (MI), every 40 seconds. That’s an alarmingly high number. And while heart attacks are scary and can lead to a lot of dangerous complications—or even death, many people do survive a heart attack. A heart attack occurs when some part of the heart muscle isn’t able to get enough blood. This happens for a variety of reasons, but usually it is caused by a blockage in the vessels that bring blood directly to the heart. 
The earlier you can recognize that a heart attack is occurring, the better your chance of survival is and the better your chance of minimizing any further damage and complications. The faster you recognize a heart attack, the faster you can seek help with the aim of getting blood flow restored to the part of the heart that is being cut off from blood supply before permanent damage is done. Although it might seem hard to believe, it’s entirely possible to have a heart attack and not even realize it. This means that even if a person doesn’t recognize what’s happening, their heart muscle has been permanently damaged. In fact, 1 in every 5 people who experience a heart attack do not realize that they are having a heart attack, and 210,000 of the 790,000 Americans who have a heart attack every year have already had a first heart attack and may have not realized it. It’s important to be aware of what causes a heart attack, what lifestyle and other factors place a person at risk for a heart attack, and what the main warning signs of a heart attack actually are, so that if a heart attack happens to you or a loved one, you are prepared.
What causes a heart attack?
There are actually a few different causes for a heart attack. The most common cause of a heart attack is coronary artery disease (CAD), which is a condition that occurs over time as a person’s coronary arteries (the blood vessels that flow into the heart and supply it with blood and oxygen) get blocked with substances such as plaque and cholesterol. The arteries will continue to get narrower over time, or there might be so much “stuff” inside the artery that blood flow gets completely blocked. The Mayo Clinic explains that what usually happens during a heart attack is that a plaque in the artery ruptures, causing a blood clot to form, which then blocks blood flow in the artery. There are also two other less common causes of heart attacks: a coronary artery spasm or a tear in the heart artery. A spasm generally occurs as a result of using tobacco or stimulant drugs. Richard C. Becker, MD, FAHA, endowed chair and professor of medicine with the University of Cincinnati College of Medicine, explains that another form of heart attack, often referred to as a type II, occurs in the setting of other serious illness or condition, such as a stroke, very high blood pressure, pneumonia, or sudden stress. In those cases, there may be typical heart attack symptoms, but more often the symptoms will be those of the condition causing the heart attack instead of the symptoms of the heart attack itself. A broken heart can also actually cause a literal broken heart. Pamela Marcovitz, MD, a cardiologist at Ministrelli Women’s Heart Center in Beaumont Hospital in Royal Oak, Michigan, notes that takotsubo syndrome (sometimes known as stress-induced cardiomyopathy or “broken heart syndrome”) is a type of heart attack commonly seen in women. Unlike with most heart attacks, it doesn’t happen because of blocked arteries but instead happens after a big life stress such as hearing about the death of a loved one.
These are the main warning signs of a heart attack.
There may be different causes for a heart attack, but usually the signs and symptoms are pretty similar. The warning signs of a heart attack can vary from person to person, however, and may be noticeably different in men vs. women or in older adults vs. younger adults. 
The classic signs of a heart attack in men are: ? Substernal chest pressure and/or pain that may radiate to the neck, jaw, arms, and back ? Sweating ? Nausea with or without vomiting ? Cold/clammy skin 
In women, the following signs are common: ? Sudden-onset shortness of breath with or without chest pressure or a burning sensation in the chest ? Generalized fatigue ? Nausea with or without vomiting ? Confusion (particularly in older women) The less common warning signs of a heart attack that can happen in both men and women include: ? Shortness of breath ? Flu-like symptoms ? Dizziness ? Extreme fatigue ? Brief loss of consciousness when the heart attack begins In rare situations, a heart attack can happen without any symptoms whatsoever, which is known as a silent heart attack. 
A silent heart attack is more common in people who also have diabetes, says Dr. Pantila Vanichakarn, a cardiologist at Indiana University Health. More frequently, however, what makes heart attacks so dangerous is that many people tend to write off their symptoms or wave them off as no big deal, especially when those symptoms aren’t the “classic” signs, such as arm pain.
A small percentage of people can even have a silent heart attack with no pain at all
“Some people won’t pay attention to arm pain or pain in the upper abdomen,” comments Jonathan G. Howlett, MD, editorial board member for Merck Manuals and clinical professor of medicine at the University of Calgary. “Sometimes people overlook significant nausea or shortness of breath, and sometimes you could be feeling bad all day, which is a very nonspecific symptom and hard to diagnose. A small percentage of people can even have a silent heart attack with no pain at all, which is very uncommon.” 
Another important way you can spot a heart attack is identifying when the pain begins. Howlett explains that most heart attacks actually occur when the heart is at rest as opposed to during vigorous exertion or stress. When it comes to educating yourself about heart attacks, one of the most important points that Becker makes is that more often than not, the body gives out plenty of warning signs weeks before a heart attack actually happens.
Fatigue and problems sleeping may precede heart attacks in women by weeks or months
“At least 3 of every 4 people will experience episodes of chest pressure, shortness of breath, fatigue, restlessness, and impaired stamina within 1 to 2 weeks of a heart attack,” he explains. Howlett notes that the most commonly reported symptom of a heart attack is just “overall feeling awful.” And Marcovitz adds that one other common warning sign the body gives off before a heart attack is trouble sleeping at night, especially in women. 
“One study reported … that fatigue and problems sleeping may precede heart attacks in women by weeks or months,” she explains. “It’s possible that these symptoms may represent the manifestation of increased psychosocial stress leading up to a heart attack.” Bottom line? Pay attention to your body. If you’re feeling “off,” it might be time to schedule a checkup with your doctor, even if you think it’s nothing. It’s always better to be safe.
Are you at risk for a heart attack?
According to Becker, the main risk factors that put a person in the path of a heart attack include hypertension (high blood pressure), smoking, diabetes, high cholesterol, obesity, inactivity, and a strong family history of heart disease. 
He notes that there is also an increasing number of heart attacks associated with street drug use, especially stimulants. Unfortunately, a history of chemotherapy and radiation to any area near the heart—such as the lungs, breast, or esophagus—also increases an individual’s risk of having a heart attack later in life. Studies have shown that chemo and radiation can damage the blood vessels or intensify existing heart disease, further increasing the risk of a heart attack following treatment. 
Howlett also notes that there are two categories of risk factors for heart attacks: those you can control and those you cannot. Risk factors you can control are things such as a lack of exercise, poor eating habits, and most importantly, smoking—while other things, like genetics or family history, are out of your control. For women in particular, having diabetes is also a risk factor for a heart attack. Marcovitz explains that there is an estimated 3- to 7-fold increase in risk of heart attack in women with diabetes compared with 2- to 3-fold increase in men. “In one study, diabetes and psychosocial stress raised the risk of subsequent heart attack more in women than in men, while lifestyle modifications helped prevent heart attack more in women,” she says. 
Wondering at what age heart attacks most commonly occur? Men tend to experience a first attack between the ages of 60 and 65 years, whereas women tend to have heart attacks later, between the ages of 65 and 70 years. Becker notes, however, that there has been an increase of heart attacks among women of color who are between 45 and 55 years old. Of course, heart attacks can occur at younger ages as well, although those incidents are much less common.
If you suspect a heart attack…
If you have any suspicions that you or a loved one might be experiencing a heart attack, do not delay in seeking medical attention. You should never wait or try to drive to the ER yourself. Instead, call 911 immediately and wait for an ambulance.
If you wait over four hours, there is usually little they can do to reverse or restore the situation.
The interventions and oxygen the emergency attendants can provide you en route to the hospital might just save your life, because when it comes to a heart attack, minutes matter. Howlett also points out that one of the symptoms of a heart attack is passing out, so if you try to drive yourself to the ER or wait your symptoms out to see if they get worse, you run the risk of passing out before you can call for help. So it’s always best to call 911 immediately. 
“The faster you get medical attention, the greater chance of restoring blood flow to the heart muscle,” explains Teri Dreher, RN, CCRN, iRNPA, a private professional patient advocate from Chicago. “If you wait over four hours, there is usually little they can do to reverse or restore the situation. ‘Time is muscle’ as they say in the medical field—the longer the artery is blocked, the less chance of preventing that part of the heart’s muscle being saved.” Although heart attacks are a scary topic to think about, it’s more important than ever to educate ourselves and each other on how they can happen and how to recognize the symptoms when they are happening. Becker explains that major health organizations such as the CDC, the World Health Organization, and American Heart Association all have recently reported that death rates from cardiovascular disease have risen in the U.S. for the first time in the 50 years. “This is a call to action of large proportion,” he says.
