You probably have at least a rough idea how to identify a heart attack, you’ve no doubt seen it played out countless times on TV or in movies: the character, almost always a man over 50, suddenly winces in agony, clutches his chest dramatically and collapses in a heap within seconds.

But in reality, while women have a lower overall risk of developing coronary heart disease (CHD) – the culprit behind most heart attacks – it’s still the leading cause of death for both sexes. The crushing chest pain as depicted on screen can be just one of several tell-tale symptoms of a heart attack, and in some cases, more often in women, there may not be any chest pain at all.

And though a major heart attack can be fatal, especially if prompt medical attention isn’t sought, according to the British Heart Foundation, 70% of women and 68% of men in England are now surviving heart attacks.

What exactly is a heart attack?

A heart attack occurs when the flow of oxygen-rich blood to the heart is suddenly blocked, usually by a clot. If blood flow isn’t restored, a section of the heart muscle dies, resulting in permanent damage.

CHD is the major underlying cause of heart attacks. The disease develops when deposits of cholesterol, fat and other substances build up in the arteries supplying the heart with blood. These deposits, called plaque, thicken and harden the arteries, restricting blood flow.

When an area of plaque ruptures, blood cells stick to the damaged area and form a clot. If the clot blocks the artery completely, a heart attack occurs. Deprived of oxygen-rich blood, a section of the heart muscle then begins to die. The longer the blood clot is left untreated, the more heart muscle is permanently damaged. Knowing the warning symptoms and when to call an ambulance is therefore super-important.

For a better understanding, watch this video on what causes a heart attack.

Heart attacks can run the full gambit from relatively mild and “uncomplicated”, with subtle symptoms that build up slowly, to immediate, extreme and life-threatening, with debilitating  symptoms that are impossible to ignore.

The classic heart attack symptom of sudden intense pressure and stabbing pain in the centre or left side of the chest is common, but for some people, mainly women, chest discomfort may be absent completely. In fact, for many women, shortness of breath, fatigue and nausea that come on gradually are the most obvious symptoms.

In a minority of cases, there may not be any symptoms at all; the so-called “silent” heart attack. Symptomless heart attacks are most common in the elderly, women over 40 and people with diabetes, so it’s sensible to get regular heart health check-ups if you’re in an at-risk group.

Most common signs and symptoms:

•    Pain and discomfort in the centre or left side of the chest, which can be stabbing, crushing, aching or feel like heartburn, and may radiate to the arms, jaw, neck, back and stomach
•    Shortness of breath

Other potential signs and symptoms:

•    Nausea and vomiting
•    Breaking out in a cold sweat
•    Feeling faint and dizzy
•    Feeling anxious with a sense of impending doom, like a panic attack
•    Feeling unusually weak and tired
•    Coughing and wheezing

We really can’t stress this enough: if you experience a cluster of symptoms or even remotely suspect that you may be having a heart attack, call 999 immediately and ask for an ambulance. 

If you’re at all worried about any of these warning signs, visit our symptom checker for more advice

How is it diagnosed and treated?

The emergency medical team will evaluate the symptoms and run tests, which may include an ECG, X-rays, ultrasound scans and a coronary angiography. Depending on the severity of the heart attack or progression of the CHD, treatment may range from simple aspirin to major surgery.

Gold-standard treatments

•    Blood-thinning medication, like aspirin
•    Thrombolytics to dissolve blood clots
•    Cholesterol-lowering drugs, like statins
•    Antiplatelet medication to prevent clots forming
•    Nitrates to widen the arteries
•    Beta-blockers and ACE inhibitors to treat high blood pressure
•    Painkillers to deal with any discomfort
•    Surgery such as coronary angioplasty, or coronary artery bypass graft to unblock or bypass the arteries
•    Heart transplant in severe cases

What are the risk factors?

Figuring out whether you’re in an at-risk group is a wise move and key if you’re keen on reducing your chances of developing CHD, or experiencing a heart attack.

Main risk factors:

•    High blood pressure – the most important risk factor, according to the NHS
•    High blood cholesterol
•    Smoking
•    A family history of CHD
•    Diabetes
•    Lack of exercise
•    Being overweight or obese
•    Ethnicity – CHD rates are highest in people from a South Asian background

Other risk factors:

•    Age and gender – men over 40 and women over 55 are more at risk than younger people of both sexes
•    Excessive alcohol consumption
•    A diet high in refined sugar and saturated fats
•    Stress
•    Recreational drug use – particularly stimulants like cocaine and amphetamines
•    Pre-eclampsia – a condition that causes high blood pressure in pregnant women and increases the life-long risk of developing CHD
•    Certain autoimmune conditions, such as rheumatoid arthritis or lupus
•    HIV

If you’re in any of these risk groups, it’s a good idea to brush up on the signs and symptoms and take steps to reduce your chances of developing CHD.

What can I do to minimise my risk?

There’s nothing you can do about unmodifiable risk factors such as gender or age of course, but there’s an awful lot you do lifestyle-wise to lessen your chances of developing clogged arteries and CHD. The British Heart Foundation has come up with 10 handy tips:

•        Give up smoking
•        If you’re over 40, take up your free NHS health check
•        Maintain a healthy weight
•        Lead an active lifestyle
•        Ditch the salt
•        Eat your five a day of fruit and vegetables
•        Cut down on refined sugar and saturated fat
•        Read food labels to find out if something is healthy for you
•        Don’t drink too much alcohol
•        Watch food portion sizes

If you’ve been diagnosed with CHD or high blood pressure, diabetes or angina, make sure you monitor your condition and take any prescribed medication, on top of making as many positive lifestyle changes as you can manage.

Want to find out more about National Heart Month, CHD in general and how you can reduce your risk of developing the condition? Make a beeline for the British Heart Foundation website.