Four early warning signs before a heart attack: experts urge recognition and quick action

Heart disease remains the No. 1 killer of both men and women in the United States, and cardiovascular specialists say warning signs of a coming heart attack can appear days or weeks beforehand. The concern is underscored by observations that mortality from heart disease rose during the COVID-19 pandemic, a trend that has sharpened calls for awareness of risk factors and early signals. Dr. Abha Khandelwal, a clinical associate professor of cardiovascular medicine at Stanford Health Care, noted that recognizing risk and signs can be lifesaving and may prompt earlier testing and treatment.

Experts describe four early warning signs that may precede a heart attack by days or weeks. Chest pain or pressure is the most recognizable signal, but it can show up in other forms such as a squeezing sensation, fullness or discomfort that isn’t necessarily painful. The second sign involves the neck, shoulder or jaw; while many associate a heart attack with left-arm pain, older patients may experience radiating pain in these areas or numbness that travels to the jaw. Third, becoming easily winded after ordinary activity—like installing a light fixture or gardening—can signal trouble. Fourth, nausea or other stomach problems, including abdominal discomfort or fatigue, can appear as a warning. But physicians note that not all patients have clear symptoms, and some may have mild or no symptoms before a cardiac event.

Dr. Roger Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, explained that angina stems from restricted blood flow caused by plaque buildup and can manifest as chest discomfort or pressure. He cautioned that angina can be felt outside the chest, including the neck, shoulder or upper back, and not all patients experience the classic left-arm pain. Dr. Abha Khandelwal emphasized that older adults may encounter subtler signals, with numbness or jaw discomfort accompanying more typical chest symptoms.

Experts emphasize that the timing of symptoms relative to a heart attack varies. Khandelwal said roughly two-thirds of her patients recall a period in the month before the event when chest pain occurred. In some cases, symptoms intensify in the days or week leading up to a heart attack, becoming more frequent, last longer or feel more severe. If symptoms emerge suddenly and severely, emergency services should be contacted immediately—call 911. For people with no known history of heart disease, even mild signs should be discussed with a physician, who can determine whether testing is warranted. Timely medical attention can save lives, and clinicians note that those who receive prompt treatment often have better outcomes.

In addition to recognizing signs, prevention in daily life matters. While some risk factors are beyond personal control, several lifestyle choices can reduce risk. A daily walk, healthier eating and weight management, along with monitoring blood pressure, cholesterol and blood sugar, can help lower the chance of a cardiac event. The American Heart Association lists traditional risk factors as smoking, diabetes, high cholesterol, high blood pressure and obesity, underscoring the central role of risk-factor awareness and management. CardioSmart, an American College of Cardiology resource, provides tools to quit smoking, improve exercise habits and adopt heart-healthy eating. Beyond at-home measures, maintaining regular contact with a health professional helps identify and treat risk factors before they contribute to a heart attack, according to Dr. Nikhil Sikand of Yale Medicine.

Those who seek help promptly after warning signs are observed can access lifesaving treatment, and clinicians stress the importance of acting quickly when symptoms are new, severe or unusual. Even in patients with known heart disease, ongoing risk-factor modification and appropriate medical therapy can mitigate the likelihood of a recurrent event. Health experts emphasize that awareness, timely action and consistent medical care together form the best defense against heart attack and its potentially life-altering consequences.