A printout from an electrocardiogram machine. An electrocardiogram, or EKG, can show if there's any damage to the heart from a suspected heart attack.

A few years ago, a friend of mine, in her 60s, was walking in the woods behind her home — something she did nearly every day — when she felt a squeezing pain in her chest. She didn’t think she was having a heart attack, but the pain wouldn’t go away, and she was worried that it was a warning sign.

For some people, there will be no doubt they’re having a heart attack because the pain will be sudden and intense. But many times, a heart attack starts slowly with only mild discomfort. Either way, it’s important to get medical care right away.

Here are the most common heart attack symptoms:

–Chest pain or discomfort that is usually in the center of the chest, lasts more than a few minutes or comes and goes, and can feel like uncomfortable pressure, squeezing, fullness or pain.

–Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

–Shortness of breath (with or without chest discomfort).

–Unusual fatigue.

–Breaking out in a cold sweat or feeling nauseous or lightheaded.

The No. 1 symptom in men and women is chest pain or discomfort. According to the American Heart Association, women are somewhat more likely than men to also experience other common symptoms, especially shortness of breath, nausea and vomiting, and back or jaw pain. Someone with diabetes may have very mild or even no symptoms.

Whatever your symptoms, if you have a concern, err on the side of caution, and call 911.

My friend went to the ER, where the doctor asked her a lot of questions about her symptoms, lifestyle, level of daily activity, and her medical and family history. There happens to be a strong history of heart disease on one side of her family.

She had an electrocardiogram, or EKG, which can show if there’s any damage to the heart — where and how much. It also measures the heart’s electrical activity.

They tested her blood. If the heart muscle is damaged, enzymes and proteins inside its cells are released into the bloodstream. Higher-than-normal levels of proteins in the blood may indicate a heart attack. Measuring the enzymes can help determine the size of an attack and approximately when it started.

Some other tests that might be done include an echocardiogram, MRI, CT scan, and/or heart catheterization.

The tests my friend underwent showed she wasn’t having a heart attack, but the ER doctor decided to keep her overnight for observation. He also ordered a morning stress test. Thankfully, she passed it with flying colors.

Most heart attacks happen because an artery to the heart is blocked by a buildup of plaque — something that happens gradually.

The more blocked the artery becomes, the less blood can flow to that part of the heart.

If the plaque ruptures or breaks open, a blood clot can form at the site and totally block the artery.

Some people will experience warning signs that an artery is narrowing — the first one is usually angina (chest pain). But you may not have any symptoms at all until you are having a heart attack.

Thanks to years of research, we know quite a bit about heart attack risk factors.

Some risk factors you can’t change. For instance, you can’t change your age (risk increases with age), sex (more heart attacks in men), or family history, but there are several things you can do to lower your risk of developing heart disease and having a heart attack.

–If you smoke, quit!

–Avoid second-hand smoke.

–Control high blood pressure.

–Eat foods that are low in saturated fat, trans fat, cholesterol and salt.

–Be physically active.

–Maintain a healthy weight.

–If you have diabetes, keep your glucose under control.

Taking a low-dose aspirin every day may lower your risk of heart attack, but you should always check with your doctor first. You shouldn’t do it if you:

–have an aspirin allergy or intolerance;

–are at risk for gastrointestinal bleeding or hemorrhagic stroke;

–drink alcohol regularly;

–are undergoing any simple medical or dental procedures; or

–take other medications that could interact with aspirin.

In the fall of 2021, the U.S. Preventive Services Task Force added to those guidelines, stating that you should not take a low-dose aspirin every day if:

–You’ve never had any heart-related problems or events, such as a stent or heart attack;

–You have an increased risk of bleeding; and

–You’re over age 60 and aren’t already taking daily aspirin.

As for taking aspirin, if you think you’re having a heart attack, your first step should always be to call 911. Never take an aspirin and then wait to see if your symptoms go away before calling for help.

Aspirin or not, some people decide to wait things out at home, but the delay could cause serious damage to your heart if you are having a heart attack. It might even make the difference between life and death.

My friend thought about waiting. Here are some of the “good reasons” she came up with:

–It’s probably nothing.

–If I tell my husband, he’ll be worried.

–I don’t want to waste the ER’s time.

–I can go in tomorrow if it’s not any better.

In the end, she was so alarmed by her symptoms, she went to the ER. It was the right thing to do. She needed further testing to figure out what caused her pain, but she had peace of mind knowing that her heart was healthy.

Please, if you think you’re having a heart attack or you’re with someone who may be having one, forget the excuses. Call 911. And take a second to share this valuable advice with others.

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Diane Atwood, Health contributor

Diane Atwood has been sharing stories about health and wellness for more than 30 years, first as a reporter on WCSH6 and then as the marketing and public relations manager for Northern Light Mercy Hospital....