Chest pain or heart attack? Signs and when to call 192

In July 1991, American physician Bernadine Healy, then director of the U.S. National Institutes of Health (NIH), published a short editorial in the New England Journal of Medicine under an unusual title: "The Yentl Syndrome."

Healy was commenting on two studies published in the same issue of the journal. They showed that women hospitalized with coronary artery disease received fewer tests and procedures than men, even when the diagnosis was a heart attack.

More than three decades later, the lesson still applies to everyone: a heart attack does not always look like the movies, with a hand clutched to the chest and a dramatic collapse. So when could chest pain be a heart attack, and what should you do in the first minutes?

What happens in the heart during a heart attack?

The heart is a muscle that works nonstop and is fed by its own arteries, the coronary arteries. A heart attack, known medically as acute myocardial infarction, happens when blood flow through one of those arteries is blocked. It is an emergency that requires hospital treatment.

That is why time matters so much. According to Brazil's Health Ministry, urgent care in the first minutes is decisive in reducing the risk of death. In the hospital, treatment can include medication and procedures to restore blood flow to the heart. The Brazilian Society of Cardiology has its own guideline on treating heart attacks.

The scale of the problem in Brazil is large. According to the Health Ministry, heart attack is the leading cause of death in the country, with an estimated 300.000 to 400.000 cases a year and one death for every 5 to 7 cases.

What are the symptoms of a heart attack?

The best-known symptom is pain or discomfort in the chest. Many people do not call it "pain" at all. They describe heaviness, tightness, pressure or burning, as if something were squeezing the chest. It is usually severe and long-lasting.

The pain can spread (doctors say it "radiates") to:

• the left arm and, less often, the right;
• the back;
• the neck or jaw;
• the upper abdomen.

Other signs can appear alongside it: cold sweats, pallor, shortness of breath, nausea or vomiting, and a feeling that you are about to faint. Some people feel something close to severe indigestion, with burning and a sense of fullness in the stomach.

The picture is not always complete. The Health Ministry notes that in older adults the main sign can be shortness of breath, and that in people with diabetes and in older adults a heart attack can occur without the typical signs. For that reason, a sudden, unexplained feeling of being unwell in these groups deserves attention.

Are heart attack symptoms different in women?

This is where Bernadine Healy's story comes back. In 2016, the American Heart Association published its first scientific statement devoted to heart attacks in women. The document says there are differences between the sexes in how a heart attack shows up, in the mechanisms behind it and in the outcomes.

Chest discomfort is still the most common symptom in women, too. But women are more likely than men to report symptoms outside the classic picture: shortness of breath, nausea or vomiting, pain in the back, neck or jaw, weakness and unusual fatigue. Some have a heart attack with no chest pain at all. That is why the picture does not always resemble the one from the movies.

When symptoms fall outside the classic picture, they are easy to mistake for stress, gastritis or tiredness. If something feels wrong and does not go away, it is worth calling.

Is chest pain always a heart problem?

No. The UK's National Health Service (NHS) notes that in most cases chest pain does not come from the heart. Some common causes:

• Heartburn and indigestion: starts after eating, sometimes with a bitter taste in the mouth and a feeling of fullness in the stomach.
• Muscle pain: appears after exertion, a blow or exercise, may get worse when you breathe deeply and eases with rest.
• Anxiety and panic attacks: pain that is often sharp and constant, with a racing heart, sweating and dizziness, tied to a stressful situation.
• Respiratory infections, such as pneumonia, where the pain worsens with breathing and comes with a cough that brings up phlegm, and fever.
• Shingles, which starts with tingling and then forms blisters on the skin.

There are also heart-related causes that are not a heart attack, such as pericarditis (inflammation of the membrane surrounding the heart), which tends to cause a stabbing pain that worsens with a deep breath or when lying down, and angina, which has symptoms similar to a heart attack.

The key point is this: only tests done at a hospital or clinic, such as an electrocardiogram and blood tests, can reliably tell a heart attack from another cause. When in doubt, seek care rather than waiting to see if it passes.

Who is at higher risk of a heart attack?

Any adult can have a heart attack, but the risk rises with age and with a few well-known factors. The Health Ministry lists smoking, a sedentary lifestyle, a poor diet, high cholesterol and excess stress as the main ones. For readers who want to quit smoking, our article on how to stop smoking can help. People with diabetes or high blood pressure are two to four times more likely to have a heart attack. To make sense of blood sugar test results, see our article on fasting blood glucose and glycated hemoglobin (A1C). Having relatives who had a heart attack or angina before age 60 also raises the risk, according to the NHS.

High blood pressure, by the way, often causes no symptoms. If you do not know where yours stands, our article on the blood pressure chart explains the numbers.

What should you do if you suspect a heart attack?

The first minutes count the most. If you or someone near you shows signs of a heart attack:

1. Call 192 (SAMU) immediately. Give the full address, say what the person is feeling and since when. Outside Brazil, call the local emergency number.
2. Do not drive to the hospital if you have symptoms. If your condition worsens on the way, you are left without help and you put other people at risk.
3. Stay at rest. Sit in a comfortable position with your back supported, and avoid any exertion, including climbing stairs.
4. Follow the dispatcher's instructions. Do not take any medication on your own or on the advice of neighbors or the internet: health professionals give the guidance, and they can assess your situation by phone or on the scene.
5. Leave the door unlocked and, if possible, ask someone to wait for the ambulance at the entrance.

If the person does not respond and is not breathing, or is only gasping, the heart may have stopped. Call 192 and put the phone on speaker. Start CPR (cardiopulmonary resuscitation): push hard and fast in the center of the chest, interrupting as little as possible until help arrives. The pace is about 100 to 120 compressions per minute, and the 192 dispatcher will coach you. If a defibrillator is nearby, ask someone to bring it. Learn more in our article on the AED, the automated external defibrillator.

Chest pain: when to see a doctor

Call 192 right away if you have chest pain, tightness or burning that does not ease within a few minutes; pain that spreads to the arms, back, neck, jaw or abdomen; chest pain with cold sweats, shortness of breath, nausea, pallor or dizziness; sudden, severe shortness of breath; or if someone faints and does not respond.

Seek care the same day if chest pain comes with a racing, skipping or very slow heartbeat, or if shortness of breath is much worse than usual.

Make an appointment, starting with your primary care doctor, if you have chest pain that comes and goes, even if it passes quickly, or if the pain has passed but the doubt remains. A cardiologist is the specialist who treats heart disease, and your doctor can refer you to one. People with risk factors also benefit from a routine checkup before any symptoms appear.

Bottom line: when in doubt, call

Bernadine Healy drew attention to a problem that is simple to understand and hard to change: when a heart attack does not look like the image everyone has of it, it takes longer to be recognized. That is true for women, for older adults, for people with diabetes and for anyone who would rather believe it is "just heartburn."

Most chest pain is not a heart attack. But what settles the question is a medical exam, with an electrocardiogram and blood tests, not a hunch. If the pain tightens, does not go away or comes with other signs, call 192. Calling for help and finding out it was something else is always better than waiting too long.

Frequently asked questions

Can a heart attack happen without chest pain?

Yes. In older adults and people with diabetes, a heart attack sometimes shows up only as shortness of breath, a general feeling of being unwell or sudden fatigue, or with almost no symptoms.

Is pain on the left side of the chest always from the heart?

No. Chest pain can be muscular, or come from heartburn, anxiety or another source. Only tests at a hospital or clinic can confirm whether the heart is involved.

Can an anxiety attack feel like a heart attack?

Yes. Sweating, dizziness and a racing heart show up in both. That is why a first attack, or a pain that is different from earlier ones, should be seen by a doctor at a medical facility.

Can I wait for the pain to pass to see if it gets better?

If the chest pain is severe, lasts more than a few minutes or comes with other warning signs, no. Care in the first minutes does the most to reduce the risk of death.

Which tests show whether chest pain is a heart attack?

At a hospital or clinic, an electrocardiogram and blood tests help tell a heart attack from other causes of chest pain. The doctor orders and interprets the tests.

Sources

• Ministério da Saúde (Brazil's Health Ministry). Infarto. gov.br/saude
• NHS. Chest pain. nhs.uk
• NHS. Heart attack: symptoms. nhs.uk
• Mehta LS et al. Acute Myocardial Infarction in Women: A Scientific Statement From the American Heart Association. Circulation, 2016. pubmed.ncbi.nlm.nih.gov
• Sociedade Brasileira de Cardiologia (Brazilian Society of Cardiology). V Diretriz da SBC sobre Tratamento do Infarto Agudo do Miocárdio com Supradesnível do Segmento ST. Arq Bras Cardiol, 2015. pubmed.ncbi.nlm.nih.gov
• Silva PGMBE, Soeiro AM, Ornelas CE, Feitosa-Filho GS et al. Brazilian Guideline for the Evaluation and Diagnosis of Chest Pain in the Emergency Department, 2025. Arq Bras Cardiol, 2025. Further reading. pubmed.ncbi.nlm.nih.gov
• Healy B. The Yentl syndrome. N Engl J Med, 1991. pubmed.ncbi.nlm.nih.gov

Text by Rai, RaisLife's virtual reporter (artificial intelligence), with automated editorial review.