Heart Attack Symptoms: What to Do in the First Hour

Most people who have a heart attack are not alone when it starts. A husband, a daughter, a colleague is usually close by, and what that person does in the next hour matters. This page is written so that you can follow it even when you are frightened.

Key points

Warning signs include chest pain, pressure, squeezing or heaviness; pain spreading to the arm, jaw, neck or back; breathlessness; a cold sweat; nausea or light-headedness.
Call 108 for an ambulance, or 112, as soon as you suspect a heart attack. Do not wait to see if it settles.
Do not drive yourself to hospital.
Sit down and rest while help comes.
Chew aspirin only if a doctor or the emergency call-taker advises it and you are not allergic to it.
Head for a hospital that can do emergency angioplasty.
If the person collapses and is not breathing normally, it is now a cardiac arrest: call for help and start hands-only CPR.

Why every minute counts

A heart attack usually happens when a clot suddenly blocks a coronary artery, one of the vessels that feed the heart muscle. For as long as that artery stays blocked, the muscle beyond it is short of oxygen, and every minute adds to the damage. Opening the artery quickly, with emergency angioplasty or, where that cannot be done in time, clot-dissolving medicine, limits that damage. That is why the time lost at home, waiting to see whether the pain passes, matters so much.

This is not a rare problem. The World Health Organization estimates that cardiovascular diseases caused about 19.8 million deaths in 2022, around 32% of all deaths worldwide, and that about 85% of those deaths were due to heart attack and stroke.

What to do, minute by minute

The times below show the order of steps, not a stopwatch. The aim is simply to act in this sequence without losing time.

Minute 0 to 1: take the symptoms seriously. Chest discomfort that lasts more than a few minutes, or goes away and comes back, especially with sweating, breathlessness, nausea or light-headedness, should be treated as a possible heart attack. Do not try home remedies first.
Minute 1 to 2: call 108 or 112. Say clearly, "possible heart attack". Give the person's age, the main symptoms and your full address with a landmark. Keep the phone switched on and the line free so the ambulance crew can call back.
Minute 2 to 3: sit the person down and keep them still. A half-sitting position, leaning against a wall or pillows, is comfortable for most people. Loosen tight clothing. No walking about, climbing stairs or lifting.
Minute 3 to 5: ask about aspirin. Tell the call-taker or your doctor which medicines the person takes. Chew an aspirin only if they advise it and the person is not allergic to aspirin. Do not give other painkillers or someone else's heart tablets.
Minute 5 to 10: get ready to leave. Unlock the main door and send someone to guide the ambulance in from the main road. Put the current medicine list, old ECGs, reports and discharge summaries in one bag, but do not delay leaving for them.
On the way: go to the right hospital. A hospital with a cath lab that performs emergency angioplasty can open the blocked artery directly. Do not drive yourself. If no ambulance can come, let someone else drive while the patient sits still.
Throughout: watch the breathing. If the person suddenly collapses, stops responding or is not breathing normally, it has become a cardiac arrest. Start hands-only CPR straight away, as described below.

Our emergency page keeps these steps and the numbers to call in one place. Save it on your phone today, before you need it.

Signs people miss

Chest pain is the most common symptom, but it is not always dramatic, and some people hardly feel it. In these groups a heart attack is more easily mistaken for something else.

Women. Women do get chest pain, but they are more likely than men to also have breathlessness, nausea or vomiting, and pain in the back or jaw. These are often put down to acidity, stress or tiredness.
Older people. In the elderly, a heart attack may show up mainly as sudden breathlessness, unusual weakness, confusion or a faint, with little chest pain.
People with diabetes. Long-standing diabetes can dull the nerves that carry pain. A heart attack may then cause only breathlessness, sweating, tiredness or a vague feeling that something is wrong.
"Gas" that does not behave like gas. Upper-abdominal or chest discomfort that comes on with effort, brings a sweat, or simply does not settle should not be treated at home with antacids alone.

If you are unsure, call anyway. An ECG takes a few minutes and answers the question far sooner than waiting at home. Causes, tests and recovery are covered on our heart attack page.

Heart attack or cardiac arrest?

The two terms are often used as if they mean the same thing. They do not, and the first aid is different.

A heart attack is a blood-flow problem. An artery is blocked and part of the heart muscle is short of blood, but the heart keeps beating. The person is usually awake, talking and uncomfortable.

A cardiac arrest is an electrical problem. The heart suddenly stops pumping effectively. The person collapses, does not respond and is not breathing normally; there may be only occasional gasps. A heart attack is one of the causes of cardiac arrest.

If someone has a cardiac arrest:

Shout for help and call 108 or 112. Put the phone on speaker.
Place the heel of one hand in the centre of the chest and the other hand on top. Keep your arms straight.
Push hard and fast, about 100 to 120 times a minute, letting the chest come fully back up after each push.
Keep going until the ambulance team takes over or the person starts breathing normally. If an AED (automated external defibrillator) is nearby, switch it on and follow its voice instructions.

Hands-only CPR is far easier to do well once you have practised it on a manikin. A short certified CPR course is worth doing for every adult in the house.

After the first hour

Once the artery has been treated, steady follow-up matters just as much: medicines taken on time, and blood pressure, sugar and cholesterol kept under control. To understand what happens in the cath lab, read angiography vs angioplasty. High blood pressure is one of the main risk factors for heart attack, and blood pressure numbers explained shows how to read and track it. For a planned, non-emergency check-up, you can book an appointment.

Questions families ask

Can I drive to hospital myself if the pain is mild?

No. Even with mild pain, the heart rhythm can suddenly become dangerous, and you could lose consciousness at the wheel. An ambulance crew can do an ECG, start treatment on the way and alert the hospital before you arrive. If no ambulance is available, let someone else drive while you sit still.

Should everyone with chest pain take aspirin?

No. Aspirin helps in many heart attacks, but it is not safe for everyone, for example people who are allergic to it or have certain bleeding problems. Chest pain also has other causes where aspirin does not help. Chew aspirin only if a doctor or the emergency call-taker advises it.

The pain went away after ten minutes. Do I still need to go?

Yes. Pain that comes and goes can be an early warning that an artery has narrowed badly or a clot is forming. It needs an ECG and a doctor's assessment the same day, and urgently if it returns. Do not wait for a routine appointment next week to see if it happens again.

Can a young person have a heart attack?

Yes. Heart attacks become more common with age, but younger adults can have them too, especially with smoking or tobacco use, diabetes, high blood pressure, high cholesterol or a family history of early heart disease. Age is never a reason to ignore typical symptoms. Call 108 first and look for the cause later.

Sources

For understanding only — the right test or treatment is decided after examination.