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Chest pressure or pain that lasts more than a few minutes can signal a heart attack. Know the warning signs and why calling for help fast can help save lives.
What is a heart attack and what are the main warning signs?
A heart attack happens when blood flow to part of the heart muscle is blocked, usually by a clot forming over fatty plaque in the coronary arteries. The most common warning sign is discomfort in the center of the chest — described as pressure, squeezing, fullness, heaviness, or pain — that can last more than a few minutes or go away and come back. Cardiovascular disease is the leading cause of death in Brazil: according to the Virtual Health Library of Brazil's Ministry of Health, about 400,000 people died from cardiovascular problems in Brazil in 2022, roughly 30% of all deaths in the country. To put the frequency in perspective, in the United States, according to the Centers for Disease Control and Prevention (CDC), someone has a heart attack every 40 seconds. I am Dr. Élder Zago, cardiologist — CRM-SP 163971 · RQE 95171, and in my clinical practice I tell patients that recognizing chest discomfort early and seeking help right away is associated with better outcomes, according to SBC guidelines.
Where can heart attack pain spread, and what other symptoms should you watch for?
Heart attack pain can radiate (spread) to one or both arms, the back, neck, jaw, or stomach, and it is not always limited to the chest. According to the American Heart Association (AHA), beyond pain, important warning signs include shortness of breath — which can occur with or without chest pain — a cold sweat, nausea, dizziness or feeling faint, unusual fatigue, and a rapid or irregular heartbeat. According to the Brazilian Society of Cardiology (SBC) guideline, the typical chest pain of acute coronary syndrome is prolonged (usually more than 20 minutes), strong, and oppressive in character (tightness, burning, or heaviness), and may come with nausea, vomiting, sweating, and breathlessness. The same guideline recognizes the so-called anginal equivalents — shortness of breath, digestive symptoms, palpitations, and fainting (syncope) — as reasons that justify immediate transport in a monitored ambulance.
Are heart attack symptoms different in women?
In women, chest pain or discomfort is still the most common symptom, but atypical presentations are more likely. According to the American Heart Association (AHA), these include shortness of breath, nausea or vomiting, an upset stomach, pain in the shoulder, back, or jaw, anxiety, and unusual fatigue or weakness. Also according to the AHA, many women mistake these signs for acid reflux, the flu, or simply getting older, which delays care exactly when every minute counts. In my practice, I encourage women with risk factors — high blood pressure, diabetes, high cholesterol, smoking, or a family history — to take any of these symptoms seriously, even without the classic chest pain.
What is a silent heart attack, and who is most at risk?
A silent heart attack is one that occurs with minimal, unrecognized, or even absent symptoms, and it is more common than people expect: according to the CDC, about 1 in 5 heart attacks is silent. Also according to the CDC, in the United States, of roughly 805,000 heart attacks each year, an estimated 161,000 (around 20%, or 1 in 5) are silent. Because it causes few symptoms, it is often under-recognized and diagnosed late: according to the American Heart Association (AHA), it is frequently overlooked by both patients and health professionals. Its frequency by sex varies between studies — in the ARIC (Atherosclerosis Risk in Communities) cohort study, incidence was higher in men, although the associated increase in mortality was greater in women. People with diabetes deserve special attention, because nerve damage (neuropathy) can mask the pain that usually accompanies a heart attack: in the study by Acharya T. and colleagues (The American Journal of Medicine, 2013), which used myocardial perfusion scintigraphy (SPECT), silent heart attack had a prevalence of around 23% to 26% among investigated patients, reaching about 35.8% in people with diabetes versus about 24% in those without — which makes diabetes an independent predictor. And it is not harmless: data from the ARIC study indicate that a silent heart attack is associated with a higher risk of heart failure and that, over roughly 10 years of follow-up, its mortality was similar to that of a recognized heart attack. For this reason, regular cardiology follow-up is recommended for people with diabetes, given the higher risk of silent heart attack.
Why is cold weather associated with a higher risk of heart attack?
Winter is associated with higher cardiovascular risk, especially in people who already have heart disease. As the temperature drops, the body narrows its blood vessels to conserve heat, which raises blood pressure and the strain on the heart. Population studies show a seasonal pattern, with more heart attacks in the coldest months than in warmer seasons — according to data from the National Institute of Cardiology reported by Hospital Alemão Oswaldo Cruz, the risk of heart attack can rise by up to 30% in winter. Two large European registries have quantified the link with temperature: the Lille-WHO MONICA project in France (published in the journal Circulation in 1999) found about a 13% increase in coronary events for every 10°C drop in temperature, and the MONICA/KORA registry in Augsburg, Germany (Circulation, 2009) described a similar association between falling temperature and a rise in coronary events. A systematic review and meta-analysis (published in Environmental Pollution, 2018) confirms the finding: cold exposure is associated with a higher risk of acute myocardial infarction through mechanisms such as peripheral vasoconstriction and increased cardiac afterload, especially in people who already have cardiovascular disease. In the United States, according to the CDC, about half of adults have at least one of the three major risk factors — high blood pressure, high cholesterol, or smoking — so staying warm and keeping treatment on track makes a real difference.
When should you call emergency services, and why can acting fast help save lives?
Call your local emergency number immediately for sudden chest pain or any suspicion of a heart attack or stroke — in Brazil this is SAMU 192, and according to the Ministry of Health it is a free public service available 24 hours a day, 7 days a week. Acting fast can help save lives and improve the chances of survival because minutes matter: according to SBC guidelines, the longer the heart goes without blood flow, the greater the damage to the heart muscle, and calling emergency services is almost always the fastest way to get the treatment that restores that flow. Common questions I hear in the office: the pain went away — do I still need to go to the hospital? Yes, because heart attack pain can come and go. Can I drive myself to the ER? An ambulance is safer, because monitored care begins on the way. What if I'm not sure? When warning signs are present, it is safer to call for help and be evaluated than to wait and see.
Important note: when to seek an individual evaluation
This content is for information and education only and does not replace an individual medical consultation. Each person has a unique combination of risk factors, and only a clinical evaluation — with tests such as an electrocardiogram, blood markers, and, when indicated, cardiac MRI — can provide an accurate diagnosis. If you have high blood pressure, diabetes, high cholesterol, smoke, or have a family history of heart disease, seek a cardiology evaluation to understand your risk and your prevention plan. And if warning signs appear, do not wait — call emergency services (in Brazil, 192).
