Most of us know the basics of what a heart attack looks like — someone clutches their chest and falls to the floor, right?
Wrong. Despite what popular movies show, this isn’t how most heart attacks happen.
A 2024 study looking at portrayals of heart attacks in movies found that movies get a lot wrong. And many of us believe outdated information about heart attacks.
Here to set the record straight on five key misconceptions is cardiovascular disease specialist Dr. Desiree Dawson of Novant Health Heart & Vascular Institute - Steele Creek.
Exceptional cardiovascular care.
1. A heart attack usually starts with discomfort — not drama.
A heart attack is the name for a medical condition when blood flow to the heart is suddenly blocked.
The two most common symptoms of heart attacks shown in movies are suddenly falling to the floor and losing consciousness — but these aren’t common heart attack symptoms in real life.
Most people experience mild pain or discomfort at first, rather than a sudden onset of dramatic pain.
For some, these symptoms start in the weeks leading up to a heart attack, including being more tired or weaker than usual, feeling chest pain or tightness, feeling short of breath, not being able to exercise like usual, having new acid reflux symptoms, feeling anxious, or feeling a faster heartbeat or “fluttering” in their chest.
Others don’t experience symptoms until the heart attack begins, when they feel a continuous or periodic squeezing or pain in the chest, nausea or indigestion, shortness of breath, sweating or clamminess, anxiety, lightheadedness or dizziness, or pain in the arm or arms, back, jaw, neck or stomach.
Women in particular are more likely to have fewer classical symptoms like nausea, vomiting or a feeling of tiredness, while men are more likely to have classical symptoms like chest pain and shortness of breath.
It’s rare to lose consciousness; usually, a person can communicate about their symptoms. (If someone suddenly collapses and is unresponsive, they may be experiencing sudden cardiac arrest — a more serious and fatal heart condition.)
2. ‘Clogged arteries’ aren’t the only cause for heart attacks.
Someone in the U.S. has a heart attack every 40 seconds. You’re probably familiar with the most common reason for heart attacks: coronary artery disease. That’s when fatty deposits, called plaque, build up or “clog” the arteries. And when a deposit of plaque inside the arteries breaks off and forms a clot that reduces or blocks the blood flow to the heart, that causes a heart attack.
But not all heart attacks are caused by coronary artery disease. There are other conditions and events that can cause a heart attack, including a coronary spasm, a coronary artery embolism (a clot formed outside the heart), or spontaneous coronary artery dissection (SCAD). These are more common causes in women and those under 65 years old.
There’s also a spectrum of heart attack severity, including “silent” or “mild heart attack,” where there’s a partial — rather than total — blockage of the artery.
3. Young people aren’t exempt.
If you’re under 65, you’re not off the hook: “We regularly have young patients coming into the emergency room with heart attacks and cardiac arrest,” Dawson said. In general, she said patients are “looking older but at much younger ages” due to family history, higher rates of hypertension, diabetes and other risk factors in younger populations.
Dawson’s observations reflect national statistics, which find that those having heart attacks are increasingly younger. In one large, multistate study, 30% of those hospitalized with a heart attack were 35 to 54 years old.
4. Don’t wait to ‘see if you feel better.’ Now is the time to go see a doctor.
Since symptoms can be mild, you may not feel a sense of urgency to get help — but you should, especially if you are experiencing multiple symptoms, and especially if you’ve been diagnosed with heart disease already or have risk factors like:
- High blood pressure
- High cholesterol
- Smoking
- Having Type 1 or Type 2 diabetes
- Obesity/overweight
- Stress
- An unhealthy diet
- Excessive alcohol use
- A family history of heart disease
- Lack of regular exercise
- Using a medication that increases your risk for blood clots
- Age (the older you are, the more your risk goes up)
“Don’t write it off: ‘Oh, it’s menopause,’ or ‘I’m just going through one of those spells again,’” Dawson said. “Instead of just guessing, ‘It’s nothing,’ we would rather you come get checked out. Let us put the pieces together. You deserve to get the workup done.”
She said cardiologists use the phrase, “Time is heart muscle.” This means that if you delay treatment during a heart attack, you could damage more of your heart muscle.
So if you suspect that you are having a heart attack, call 911 — that way, emergency medical services can start treating you on the way to the hospital if needed and “avoid wasting time,” Dawson said. The 911 operator may tell you to chew and swallow an aspirin while you wait.
If you’re helping someone with a suspected heart attack, call 911 for them but “Don’t let them work themselves up,” Dawson advises. Remind them that help is on the way and try to stay calm yourself. If you found them unconscious, or if they go unconscious while you’re with them, put 911 on speaker, check their pulse, and if you don’t feel a pulse, begin chest compressions until EMS arrives.
5. The good news: If you get to a hospital quickly, heart attacks aren’t as deadly as they used to be.
Since 1950, the death rate from heart attack has dropped by 89% thanks to an improved understanding about the cause of heart attacks, the urgency of treatment, and more targeted treatments.
You should still aim to avoid having one, though — especially because many who survive a heart attack eventually experience heart failure down the road.
To lower your risk, see your primary care doctor yearly for testing and make sure to follow their recommendations, Dawson said, adding, “You’ve got to help yourself.”
Dawson has worked with many patients who have made lifestyle changes after their first heart attack, hoping to prevent a future one. “Most of the time, they say, ‘Why did I wait so long? It was stupid. I got a wakeup call, and I’m glad I did.’” Although changing their lifestyle may be hard and takes time, she said, “They say they’re living better, feel better, and they wish they’d done this sooner.”
