Warning signs of a heart attack that can occur a month beforehand include chest discomfort, fatigue, and shortness of breath.

A heart attack is a medical emergency in which the blood supply to the heart is suddenly blocked. Every year, around 805,000 people in the United States have a heart attack, or myocardial infarction, roughly one heart attack every 40 seconds.

Heart attacks have distinct symptoms, meaning people can seek emergency treatment immediately upon noticing them. However, while heart attacks occur suddenly, there may be signs ahead of a major cardiac event, such as chest discomfort.

Being aware of these heart attack warning signs can help people seek treatment quickly, improving the chance of a swift and full recovery.

This article discusses symptoms that can point to underlying coronary artery disease, the risk of heart attack, and how to respond.

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Medical Illustration by Bailey Mariner

New symptoms, such as chest pain, can indicate a heart attack and require urgent treatment. However, people sometimes experience other symptoms that might indicate an increased risk for a heart attack. Having a healthcare professional check these symptoms may help diagnose and prevent heart disease sooner.

An older 2003 survey of 515 women who survived a heart attack found that they most commonly experienced the following symptoms a month before their cardiac event:

  • abnormal levels of fatigue — 70.7% of women in the study reported this
  • disrupted sleep — 47.8%
  • shortness of breath — 42.1%

Only 29.7% reported experiencing chest discomfort. This survey looks at self-reported symptoms and only gave warning signs in women, which can differ from those in men.

A note about sex and gender

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

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A person should not wait more than 5 minutes to contact 911 if they suspect heart attack symptoms.

Even if physicians at a hospital determine that a heart attack is not in progress, an evaluation is vital to rule out a potentially deadly consequence.

Acute heart attack symptoms include:

  • Discomfort, squeezing, pressure, or fullness in the middle of the chest: This may last for a few minutes, or it could start to feel better and then return.
  • Discomfort elsewhere: Early heart attack symptoms in other parts of the body can affect one or both arms, the back, neck, jaw, or stomach.
  • Breathlessness: This might happen before a person feels discomfort in their chest, but it often occurs alongside the chest discomfort.
  • Other early symptoms: A person might break out in cold sweats, feel nauseous, or experience lightheadedness early in a heart attack.

Learn more about recognizing the signs of a heart attack here.

Coronary artery disease (CAD) is the most common cause of heart attacks. The hearts of people with CAD do not receive enough oxygen-rich blood, as the coronary artery, which leads to the heart, becomes narrower. This is due to a buildup of a waxy plaque on the artery walls that worsens over several years.

When plaque breaks off, it can lead to a blood clot that completely blocks blood flow to the heart, meaning the heart muscles start to die without prompt treatment.

Less common causes include:

  • the blockage of the coronary artery due to a sudden spasm, which is more likely in smokers and users of illegal drugs, such as cocaine
  • a coronary artery embolism is more common in those with atrial fibrillation and is when a blood clot travels from the heart into the coronary artery, blocking it
  • a tear in the coronary artery, which happens more often in women under 50 years of age, pregnant people, or those with Marfan syndrome

Risk factors for a heart attack

Several controllable factors can impact heart attack risk, including:

  • a diet high in sodium and saturated and trans fat
  • a sedentary lifestyle that does not involve much exercise or moving around
  • smoking

Many medical conditions that fall under the category of metabolic syndrome can also increase your risk of heart disease. These include obesity, diabetes, and high levels of the following:

The risk of heart attack increases with age. People with a family history of heart attack, particularly those with relatives who had heart attacks at a young age, also have an increased risk.

A heart attack requires emergency treatment to increase the chances of survival and improve the speed of recovery. There are many approaches to treatment, many of which require surgical intervention. These include:

  • Percutaneous coronary intervention: A cardiologist threads a balloon-tipped catheter to open the blockage and places a stent to keep the blood vessel open.
  • Bypass surgery: A cardiac surgeon uses a graft to bypass areas of blockage.
  • Heart transplant: A person may have a heart transplant for severe heart failure due to coronary disease when a surgeon cannot perform revascularization.

Some doctors may implant a medical device after certain types of heart attacks.

A doctor may also prescribe one or several medications to reduce clotting, widen arteries, and manage how hard and fast the heart has to work. These heart attack medications include:

  • antiplatelets
  • ACE inhibitors
  • beta-blockers
  • cholesterol-lowering medications
  • nitrates

A person may need further medications if a heart attack causes heart failure.

There is no established life expectancy after a heart attack, as different factors affect the likelihood of survival and quality of life after the event.

However, a long, full, active life is possible after a heart attack for people who follow a doctor’s guidance, lead a heart-healthy lifestyle, and take medications as prescribed.

Addressing the heart attack risk factors is the most effective way to prevent a heart attack:

  • Quitting smoking is an important step in reducing heart attack risk.
  • Reducing blood pressure by limiting salt intake, exercising regularly, and taking blood pressure medications, as advised.
  • Keeping blood cholesterol in check by reducing cholesterol, saturated fat, and trans fat intake, moving regularly, and taking cholesterol-lowering medication prescriptions.
  • Aiming for a healthy body mass index (BMI) to prevent obesity.
  • Taking all possible measures to manage a diabetes diagnosis.
  • Reducing alcohol intake, as it can affect blood pressure.

Chest pain, discomfort in the arms, back, and neck, and breathlessness are common symptoms of heart attacks. However, heart attacks can also cause unusual levels of fatigue, sleep problems, and shortness of breath up to a month before in women.

Treatment and recovery are possible, but only for those who recognize and act on these warning signs by immediately calling 911. It is best to try and prevent heart attacks by eating a heart-healthy diet, maintaining a healthy weight, exercising regularly, and avoiding smoking.