Heart Attack: the warning signs that save lives

Call 112, right away

Strong pain or pressure in the centre of the chest, lasting more than a few minutes, spreading to the left arm, the jaw or the back, along with sweating, nausea or breathlessness: treat this as a heart attack until proven otherwise. There is no room for debate on what to do — call 112 immediately, sit or lie down, never drive yourself to hospital, and don’t eat or drink anything. A heart attack happens when an artery feeding the heart suddenly blocks, cutting off oxygen to part of the heart muscle; the sooner that artery is reopened, the smaller and less permanent the damage. This is an emergency where minutes genuinely matter.

What the textbook pain feels like

The classic pattern is a central chest pain described as tightness, a heavy weight or crushing pressure — many describe a "vice" clamped on the chest. It doesn’t change with breathing or position, doesn’t ease with rest, and often comes with marked anxiety, pale skin, cold sweats. It can spread to the left arm, both arms, the neck, the jaw or between the shoulder blades. In some people, particularly those with diabetes whose nerve sensitivity to pain can be reduced, a heart attack can pass almost unnoticed — one more reason never to dismiss unusual malaise in a person with diabetes.

Atypical presentations, particularly in women

A heart attack doesn’t always announce itself with the textbook pain, and failing to recognise these atypical forms too often delays treatment. In women, symptoms are more frequently subtle or misleading: unexplained, intense fatigue in the days before, breathlessness on minimal exertion, nausea, pain in the back, stomach or jaw without clear chest pain. These symptoms are sometimes wrongly put down to stress or anxiety, including by the women experiencing them. Any unusual, sudden combination of these signs, especially in someone with cardiovascular risk factors, justifies calling 112 without waiting for "the" typical pain to appear.

Risk factors worth knowing

Several factors clearly raise the risk: smoking, high blood pressure, elevated cholesterol, diabetes, obesity, a sedentary lifestyle, a family history of early heart attacks, and chronic stress. Many of these factors stack and reinforce one another — which is why regular cardiology follow-up is particularly recommended once several are present, even before any symptoms appear.

In the emergency department: what happens next

On arrival of emergency services or at hospital, an ECG is done within minutes to confirm the heart attack and locate the affected artery, along with a blood test looking for markers of heart muscle damage. Depending on the results, urgent treatment — most often angioplasty, which reopens the blocked artery with a small balloon before placing a stent to keep it open — is carried out as quickly as possible. This procedure, now well established, dramatically changes outcomes when performed early.

After a heart attack: rehabilitation and prevention

Leaving hospital isn’t the end of the road. A cardiac rehabilitation programme, supervised by a cardiologist, allows a gradual, safe return to physical activity while working on modifiable risk factors. Regular cardiology follow-up, quitting smoking, a suitable diet, a gradual return to physical activity, and sticking to treatment — decided by the doctor, never stopped or changed on one’s own — meaningfully reduce the risk of another event. Many people return to a fully active life after a well-managed heart attack, including professional and sporting activity, with cardiologist approval.

Care pathway in Luxembourg

In an emergency, calling 112 routes directly to the appropriate service. Outside of an emergency, cardiology follow-up is provided by a cardiologist, coordinated with the GP. Consultations, cardiac investigations and cardiac rehabilitation are covered by the Caisse nationale de santé under the usual reimbursement rules; details are available at cns.lu.