Chest pain is the most common heart attack sign but it is important to understand that there are different kinds of chest pain. Many people with coronary artery disease suffer from angina pectoris which is chest pain or discomfort when the heart is not receiving enough blood. It normally occurs when the heart is working harder, such as during exercise or physical activity, but goes away when the activity is stopped.

The chest pain associated with a heart attack can occur at any time, most notably in the morning, and is of long duration and continuous. People with a history of angina may experience more frequent anginal attacks in the weeks or days before they have a heart attack.

The chest pain is often described as severe, as if something was crushing the heart attack victim's chest; a heavy, squeezing or extreme pressure sensation. Some people have described it as a tightness of the chest or burning sensation. The pain itself usually begins in the center of the chest. Then it can radiate outwards and affect the shoulders, neck, jaw, or arms. These chest pains will last 15 to minutes and are not relieved by resting or taking nitroglycerin.

The signs of a heart attack for women and older adults can be different. Often their symptoms present as atypical chest pains. This means it feels more like indigestion or heartburn and can include nausea and vomiting. Women are more likely than men to have a silent or unrecognized heart attack. For women they will also experience shortness of breath and fatigue and weakness of the shoulders and upper arms.

Older adults will often seek medical attention for a variety of symptoms including difficulty breathing, confusion, fainting, dizziness, abdominal pain or cough. They often think they are having a stroke when in fact they are suffering a heart attack.

Other symptoms that occur during a heart attack are responses to the damage that the heart is undergoing during the attack. Anxiety, tachycardia (rapid heart beat), and vasoconstriction (narrowing of the blood vessels) occur in response to sympathetic nervous system stimulation. This results in cool, clammy, mottled skin. The respiratory center of the brain responds to pain and blood chemistry changes by increasing respiration rate. Death of heart tissue causes inflammation that causes an increase in white blood cells and an elevation in temperature.

Depending of the location and amount of infracted (dead) heart tissue other signs of heart can include high blood pressure, low blood pressure, nausea, vomiting, or bradycardia (slow heart rate). Irritation of the diaphragm can cause the hiccups as well. In extreme cases the first sign of a heart attack is a sudden death. This is particularly likely in the event that a major blood vessel is completely blocked.

It is utmost importance to seek medical attention at the first signs of heart attack. The sooner a heart attack victim receives medical attention the better their chances of survival.