Dr. Stacey E. Rosen, MD, a Go Red For Women cardiologist, says this is one of the most common symptoms she sees (especially in women heart attack patients). “In my 25 years of practice, people on the verge of a heart attack report feeling tired and not able to do their usual activities,” she says. During a heart attack, blood flow to the heart is reduced, putting extra stress on the muscle, which could make you feel exhausted, according to WebMD.
Don’t be afraid to ask your doctor to do an electrocardiogram (EKG), which checks heart activity. “Sometimes when people present with lethargy, doctors won’t immediately order an EKG, which can detect a heart attack; but you should request one from your doctor, just to be safe,” says Annapoorna Kini, MD, of The Mount Sinai Hospital.
Soreness in the back, arms, or chest
Noticeable pain or soreness in the back, chest, or either arm is often a silent heart attack sign. As MyHeartSisters.org explains it: “When heart muscle cells begin to run out of oxygen during a heart attack because of a blocked artery preventing oxygenated blood from feeding that muscle, they begin to send off pain signals through the nervous system. Your brain may confuse those nerve signals with signals coming from the arm (or the jaw, shoulder, elbow, neck or upper back) because of the nerve proximity.”
Because the pain is often not accompanied by the typical chest heaviness associated with heart attack, people tend to ignore it, says Dr. Rosen. “I’ve had patients say they only felt the pain when they were working out, so they assumed it was just from exercise, but that’s not right,” says Rosen. “If the symptom is something new, that’s worrisome and you should see a doctor.”
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Shortness of breath
If a flight of stairs up from the subway is usually no problem, but suddenly you find yourself gasping for air at the top, it could signal a heart attack. “Women especially tell me that walking up steps or carrying groceries they noticed feeling fatigued or breathless when they normally wouldn’t,” says Rosen. If you feel short of breath right after waking up, that’s also a sign that something could be wrong, says Dr. Kini. The heart plays a key role in transporting oxygen to the rest of your body and removing carbon dioxide from tissues, so blocked blood flow to the heart could affect your breathing, according to MayoClinic.com.
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Heartburn or belching
If you have an occasional heartburn flare-up after a heavy pizza lunch, it’s probably nothing to worry about, but if it’s out of the ordinary or heartburn has never bothered you before, call your doctor because it could signal a heart attack. Angina, a heartburn-like chest pain, is caused by lack of blood flow to the heart, which is what happens during a heart attack, says Ryan Madonick, MD, a gastroenterologist.
Heart attack symptoms can sometimes mimic stomach problems like nausea, vomiting, or overall GI upset—especially in women, says Dr. Rosen. “If you don’t feel well, always call your doctor. It could be that taco you had at 10 p.m. but it can also be a heart attack, which could turn out to be catastrophic,” she says.
Throat, neck, or jaw discomfort
Unexplained discomfort of the neck or jaw, or a tightness in the throat you’ve never felt before can indicate a heart attack, says Dr. Kini, and you should immediately contact a doctor. It’s especially important for people with diabetes to pay attention to subtle changes like this because they have trouble feeling sensations, says Dr. Rosen. They’re less likely to feel more typical symptoms like chest pain.
An overall feeling that something’s wrong
“Heart attack patients have told me they have a feeling of doom—like something’s just not right,” says Dr. Rosen. “Listen to that little voice in your head. If something feels off, it’s always better to be overly cautious and call a doctor.” Dr. Rosen says some of her patients have reported feeling “less mentally sharp” right before a heart attack.