Surprisingly subtle heart attack signs from nausea to cold sweats

Major signs of a heart attack include chest heaviness and upper body discomfort. But there are also subtle signs and risk factors to look out for.

• Signs of a heart attack can include pain in the center of the chest, jaw, neck, and left arm.
• Women and older adults may experience subtler signs of a heart attack like fatigue and nausea.
• You may be at risk for a heart attack if you have high cholesterol, high blood pressure, or diabetes.
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In the US, someone has a heart attack every 40 seconds, according to the Centers for Disease Control and Prevention. But contrary to popular belief, chest pain is not always present during a heart attack. 

Here's what you need to know about the main warning signs and risk factors of a heart attack.

Understanding the main signs of a heart attack 

According to Purvi Parwani, MD, and director of the Women's Heart Health Clinic at Loma Linda University International Heart Institute, you should seek medical attention immediately if experiencing the following symptoms:

• An oppressive discomfort or heaviness in the chest, typically in the center of the chest. 
• Chest discomfort that is also paired with discomfort in other areas of the upper body, like the neck, throat, jaw, and left side of the chest and arm.

However, in women and older adults, the earliest symptoms are often more subtle than chest discomfort, says Richard Wright, MD, a cardiologist at Pacific Heart Institute. 

Women are more likely to experience nausea, shortness of breath, indigestion, unusual fatigue, and cold sweats with a heart attack because they often experience blockages in smaller blood vessels, not just in their main arteries. They are also typically older when they have their first heart attack. Women experience their first heart attack at around age 72 whereas for men it's closer to 65. 

How to know if you're at risk of a heart attack

Even before you experience any symptoms, there are a few key risk factors that may increase your likelihood of having a heart attack. 

For example, growing older is associated with an increased build-up of plaque in the arteries, which leads to a greater risk of a heart attack. There are also many lifestyle factors associated with an increased risk of heart disease, like frequently smoking cigarettes or not exercising regularly. 

Other conditions that may increase heart attack risk include: 

• Family history of heart disease, with a father or brother who had a heart attack before the age of 55 and a mother or sister who had a heart attack before 65.
• High cholesterol causes plaque to build up on the walls of the arteries, which can lead to decreased blood flow and blocked arteries. 
• Hypertension (high blood pressure), when left untreated, can damage your blood vessels and your heart.
• Obesity was recently linked with an increased risk for multiple heart attacks by a 2020 study.
• Diabetes can damage blood vessels over time, and the risk of heart disease increases the longer you have diabetes.
• Elevated levels of C-reactive protein occur when there is inflammation in the body (often indicating a chronic disease) and can increase your chance of heart attack by three times.

That being said, it is entirely possible to have a heart attack without these traditional risk factors, according to Parwani. 

And even though older people are more likely to have a heart attack, Parwani says that no one should assume they are too young — individuals under the age of 45 still account for 4% to 10% of all heart attacks in the US, according to Harvard Men's Health Watch. 

"Generally, there is no difference [in symptoms] between younger and older individuals," Parwani says. However, older people with another disease like diabetes may be more likely to have a silent heart attack or one without any obvious symptoms. 

Insider's takeaway

Signs of a heart attack vary from person to person but telltale symptoms include heaviness or pain in the center of the chest accompanied by pain in other parts of the upper body like the jaw, neck, and left arm.

Women tend to experience more subtle signs of a heart attack like nausea, shortness of breath, and cold sweats.

If you're experiencing any symptoms of a heart attack — no matter how small — seek medical attention immediately. Wright recommends contacting a medical professional, going to an emergency room, or calling for paramedic assistance.