1. Fatigue
Significant changes in your energy and tolerance for physical activity can be an indication of an impending heart attack.
“It’s different from regular tiredness because it’s the kind of fatigue or exhaustion that feels out of proportion to the amount of work you’re doing,” says Parikh. “If you’re exercising and you feel significantly more tired than usual, don’t ignore this glaring symptom.”
While the overall cause of this fatigue is decreased blood flow to the heart, experts say this precursor symptom is more common in women than men.
“There are many gender-based differences in the structure of the heart,” says Skyler St. Pierre, a Stanford University doctoral candidate who researches the mechanics of biological tissue in the Living Matter Lab in California.
2. Shortness of Breath
Shortness of breath is a common early sign of a heart attack, occurring as a result of the heart not pumping blood properly. Eventually, this dysfunction can cause fluid to build up in the lungs.
“It can also be due to reduced blood flow to the lungs,” says Parikh. “Many of my patients have experienced this symptom in the middle of the night, and it wakes them up.”
3. Chest Discomfort
This classic symptom of a heart attack can differ dramatically based on your gender. While portrayed in movies as a significant and sudden pain in the chest, Parikh says it’s not always so obvious.
“The pain can be mild to severe, and many people describe it as an anxious or nervous feeling in their chest,” she says. “Symptoms of an anxiety attack can mimic this same symptom of heart attack.”
Even if your chest discomfort isn’t persistent, you shouldn’t dismiss it.
4. Sleep Disturbances
The relationship between sleep and heart attacks is complicated.
First, insomnia and overall poor sleep quality are significant risk factors for a heart attack because of the stress they place on heart health. Experts also say early symptoms and actual heart attacks most commonly occur at night.
“Many heart attacks actually occur at 3 a.m. because that’s when adrenaline and cortisol levels surge,” says Parikh. “More often than not, we see heart attacks occurring at this time of day.”
5. Indigestion, Nausea, or Stomach Pain
“Oftentimes, that digestive discomfort happens because the bottom of the heart isn’t getting as much blood flow [as it should]. That part of your heart sits on the diaphragm and the stomach. That lack of blood flow can lead to nausea.”
Parikh says diarrhea and general changes in bowel movements can be an early indicator of a heart attack as well.
“Any abnormal nausea during your routine exercise habits can also be a big sign of an impending heart attack,” says Parikh.
6. Dizziness or Lightheadedness
“Dizziness can be related to reduced blood flow to the brain,” says Parikh. “We underestimate how hard the heart works to pump blood throughout the body, including the brain.”
“Women are more likely [than men] to experience this lightheadedness, and even fainting,” says Parikh.
7. Pain in Other Areas
While intense chest pain is usually the heart attack event itself, pain or discomfort in other areas of the upper body are more likely to present in the weeks preceding a heart attack and potentially during the heart attack itself, says Parikh.