The death of shooter and coach Jaspal Rana has renewed attention on the warning signs of a heart attack, particularly symptoms that are often mistaken for acidity, indigestion or fatigue.
Chest discomfort remains the most common warning sign. However, cardiologists say it does not always come as severe pain. Patients often describe it as pressure, heaviness, tightness, burning, or a squeezing sensation in the centre of the chest.
"The most common symptom is discomfort in the centre of the chest which may feel like pressure, tightness, heaviness, burning, or squeezing rather than severe pain. This sensation can last several minutes or come and go," says Dr Atul Mathur, Chairman, Cardiology and Chief of Cath Labs, Fortis Escorts Heart Institute, New Delhi.
According to Dr Mathur, a heart attack occurs when blood flow in a coronary artery supplying the heart muscle is blocked, usually by clot formation over an underlying cholesterol blockage. This deprives the heart muscle of oxygen and nutrients and can result in irreversible damage over the next few hours if treatment is delayed.
Dr Mathur says the discomfort may also spread beyond the chest to the shoulders, one or both arms, the neck, jaw, throat or back. Shortness of breath, cold sweat, nausea, dizziness, and unexplained fatigue may also accompany a heart attack.
Why people delay seeking medical help
Dr Mathur says women, older adults and people with diabetes often experience less typical symptoms, which can make recognition more difficult. Instead of severe chest pain, they may report unusual tiredness, weakness, breathlessness, nausea, or discomfort in the jaw, neck and back. He notes that these symptoms are frequently mistaken for other conditions, delaying medical attention when it is needed most.
"Many individuals delay seeking help because they assume symptoms are caused by indigestion, stress, or muscle strain," says Dr Mathur.
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He says chest heaviness is frequently dismissed as acidity, while breathlessness, sweating or fatigue may not immediately be linked to a heart problem. "Doctors often say 'time is muscle', meaning early treatment can reduce heart damage and improve survival chances," he says.
Who is at greater risk?
People with a family history of heart disease, diabetes, high blood pressure, high cholesterol, smoking habits, obesity and physical inactivity face a higher risk of developing coronary artery disease, according to Dr Sanjeeva Kumar Gupta, Consultant, Department of Cardiology at CK Birla Hospital, Delhi. "These risk factors increase the likelihood of developing heart blockages or plaques," he says.
Dr Gupta says heart attacks are often the result of plaque build-up in the arteries that develop silently over several years before causing a blockage.
Can heart attacks be prevented?
Dr Gupta recommends screening high-risk individuals before symptoms appear. "The best approach is screening these high-risk individuals for initial plaque formation, which slowly progresses to cause heart attacks," he says.
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Apart from routine blood sugar and cholesterol testing, he recommends evaluating additional markers such as Lipoprotein(a), C-reactive protein (CRP) and Apolipoprotein B, which can provide a more comprehensive assessment of cardiovascular risk.
A CT Coronary Calcium Score is also among the most reliable predictors of underlying coronary plaque in adults and can help identify people who may benefit from early intervention, according to Dr Gupta.
What symptoms should never be ignored
According to Dr Gupta, an ECG along with a Troponin I blood test can help determine whether chest discomfort is related to a heart attack and guide to immediate treatment decisions. He says persistent chest discomfort, particularly when accompanied by breathlessness, sweating, nausea, dizziness or pain spreading to the arm, neck, jaw or back, warrants immediate medical attention.
Dr Mathur says heart attacks do not always begin with dramatic chest pain. A feeling of pressure, heaviness, tightness or burning in the chest, especially when accompanied by breathlessness, sweating, nausea, fatigue or discomfort radiating to the jaw, neck, back or arms, may be the heart's first warning that something is wrong. "If symptoms suggest a heart attack, seek emergency medical care immediately," says Dr Mathur.
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