According to BUPA UK, 175,000 heart attacks occur in the UK every year, so it’s no surprise that a heart attack (myocardial infarction) is one of the leading causes of death.
On average, men suffer more heart attacks than women, and there can be gender differences in symptoms too. But what are the signs of a heart attack? And what should you do when someone is having one?
The Signs of a Heart Attack
What is the main sign of a heart attack?
Most people say chest pain—and you’re not entirely wrong, but you’re not 100% right either. There can be no chest pain (a “silent” heart attack).
The key thing to listen for is someone saying their chest “feels heavy” or “like someone is sitting on my chest”—making it hard to take a breath. It’s often pressure/heaviness, not sharp pain.
Back Pain and Heart Attacks
When delivering First Aid courses, many people who’ve helped someone during a heart attack mention back pain.
This is worrying because lots of people—especially in care roles—already have back problems, which can mask the seriousness of symptoms. Every second counts in a heart attack, so don’t delay calling 999 because you’ve mistaken it for ordinary back pain. This delay happens more often than you’d think.
If you spot any other signs alongside back pain, call 999 immediately.
Other Symptoms
Typical signs include changes caused by shock (cardiogenic) and lack of oxygen (cyanosis):
- Pale, cold skin
- Bluish lips
Differences Between Men and Women
Although men and women can show the same symptoms, several nurses report the following pattern in women:
- A dull pain in the arm that spreads across the shoulders, neck, and jawline
- Pain may be less intense, so it’s easier to miss or ignore
If a colleague or family member feels unwell, looks pale and sweaty, and has upper-body pain, call for advice.
Angina Attacks vs Heart Attacks
Angina often isn’t a medical emergency, but the symptoms can be identical to a heart attack (heaviness on the chest; pain in arms, shoulders, neck, jaw).
How can you tell the difference?
- Angina usually calms down naturally (about 10 minutes).
- Heart attacks tend to start suddenly without warning and don’t ease.
Common triggers for angina include:
- Exercise / anything that raises breathing rate
- Long walks
- Carrying heavy objects
Use common sense and ask questions:
- “What happened?”
- “Do you take any medication?”
If it came on after exertion and they have angina medication (spray or tablet), they may already have an angina diagnosis.
Angina Medication (GTN)
GTN acts fast—sometimes within 1–2 minutes—but will have virtually no impact during a heart attack.
On First Aid courses we advise: call 999 if after the second GTN spray there’s no improvement.
Because heart attack and angina can look the same, let common sense prevail and call 999 or 111 for help and advice. If their medication isn’t helping, don’t hesitate to make the call.
What About Aspirin?
In general, aspirin can be worth giving if a heart attack is suspected because it thins the blood, helping to thin the clot causing the attack. Dispersible aspirin is best as it enters the bloodstream faster.
Important:
- Aspirin will not stop a heart attack.
- Get permission from the ambulance controller (calls are recorded).
- Get the casualty’s consent before they take aspirin.
Typical first-aid advice:
- Give the aspirin to the casualty and let them take it themselves (first aiders don’t dispense).
- Encourage them to place a ~300 mg tablet under the tongue and not chew it; let saliva break it down.
To Summarise
- Every second counts. If you’re in any doubt, call 999 immediately—better safe than sorry.
- Learn to spot less obvious signs (back pain, pallor, cyanosis, sweating, upper-body discomfort—especially in women).
- GTN helping quickly suggests angina; no improvement → call 999.
- Aspirin may help (with consent and controller approval), but it doesn’t stop a heart attack.
If any of this surprised you, it’s worth checking how many first aid myths you might still believe—and getting trained to respond confidently.