Heart attack in younger adults (under 45): causes, symptoms and recovery

A heart attack happens when the blood supply to part of the heart muscle is suddenly blocked. The BHF explains that without enough blood and oxygen the heart can be seriously damaged. The NHS describes it as a life-threatening emergency that needs treatment in hospital.

It is not the same as cardiac arrest. The NHS notes that cardiac arrest is when the heart stops suddenly and a person loses consciousness; it needs different treatment from a heart attack. A heart attack can lead to cardiac arrest, which is one reason speed matters.

Heart attack is more often associated with older age, and the sources used for this page do not give age-specific figures. They are consistent, however, that the symptoms and the emergency response are the same, and that you should not delay calling for help or worry about wasting anyone's time. The BHF says to call 999 straight away and that you dramatically increase your chance of survival if you do.

The BHF lists symptoms for which to call 999: chest pain or discomfort that happens suddenly and does not go away; pain spreading to either arm, the neck, jaw, upper back or stomach; feeling sick; feeling sweaty; light-headedness; and shortness of breath. It also lists less common symptoms such as suddenly feeling anxious, similar to a panic attack, severe tummy pain and a lot of coughing or wheezing. The pain can feel like heaviness, pressure, squeezing or a burning pain similar to indigestion, and you may not have all of the symptoms.

The NHS adds that you may feel like you have indigestion, with a burning feeling in the chest and feeling full or bloated, and that skin may look pale, blue or grey, which can be easier to see on the palms of the hands on black or brown skin. It says to call NHS 111 if you are suddenly more short of breath than usual, or have chest pain with feeling or being sick, or with a racing, slow, skipping or fluttering heartbeat.

• Call 999 for an ambulance and sit down, staying calm.

• The BHF and NHS advise taking 300mg of aspirin if you have it and are not allergic, while waiting.

• Do not drive yourself to A&E.

• If someone stops responding and stops breathing, start CPR and use a defibrillator if one is available.

The usual mechanism is the same at any age: the BHF explains that fatty plaque (atheroma) builds up in the coronary arteries, and if a piece breaks off, a blood clot forms and blocks blood flow. The NHS says you are more likely to have a heart attack if you smoke, have high blood pressure, have high cholesterol, have a close relative who has had a heart attack, have diabetes or are living with overweight or obesity.

The BHF also lists less common causes that are relevant at younger ages: spontaneous coronary artery dissection (SCAD), when a tear appears in the wall of a coronary artery; using harmful drugs such as cocaine and amphetamines; and hypoxia, a sudden drop in oxygen levels in the body. It adds that some risk factors cannot be controlled, such as family history, getting older, ethnic background and sex assigned at birth, and having had a previous heart attack.

The sources do not give a breakdown of causes by age, and a cause is not always found at first. The hospital team investigates the individual case, including family history, which matters because a close relative with a heart attack is listed as a risk factor.

The BHF says the paramedics will do an electrocardiogram (ECG) to measure the electrical activity of the heart. In hospital the NHS says you will need an ECG and blood tests, and may have further tests such as an echocardiogram to see whether the heart has been damaged, and a coronary angiogram to find out exactly where blood flow to the heart is blocked, with the blockage sometimes treated at the same time.

A doctor will discuss what your test results mean for you. Because the BHF lists SCAD and drug use among the other causes of heart attack, it is important to tell the team about any recreational drug use, so that the cause can be considered properly.

The NHS says treatment depends on how severe the heart attack is and may include medicines to treat the blockage and improve blood flow, a procedure to improve blood flow called coronary angioplasty, in which blocked arteries are opened using a small plastic tube called a stent, or coronary artery bypass surgery. The BHF says you will usually stay in hospital for about 2 to 5 days, around 2 or 3 days after angioplasty or stents, and at least a week after bypass surgery.

After a heart attack you will be given long-term medicines to treat the causes and reduce the risk of another one: the NHS lists antiplatelets, statins and medicines to lower blood pressure such as ACE inhibitors and beta-blockers. Your team will explain which apply, because the right combination depends on the cause.

The NHS says you will usually need to rest, including taking time off work, and be referred to cardiac rehabilitation, which may involve in-person appointments or taking part remotely using video calls or apps. Most people can continue with their normal activities once they have recovered. The BHF advises building up activity gradually when you get home, starting with simple steps such as getting up, washing and dressing and light household tasks.

For younger adults, recovery often has to fit around work, caring responsibilities and plans for the future. The NHS notes that you may feel anxious or worried about going back to usual tasks or work, and advises talking to your GP if you are anxious or have low mood. National charities, including the BHF, offer information and support, and the NHS suggests that talking to others who have had a heart attack can help.

The NHS says you cannot always prevent a heart attack, but lifestyle changes can reduce the risk: stop smoking, keep cholesterol and blood pressure at a healthy level, eat a healthy balanced diet with less salt and saturated fat, maintain a healthy weight, exercise regularly and cut down on alcohol. The BHF notes that everyone aged 40 to 74 in England is eligible for a free NHS Health Check and suggests letting your GP know if there is a family history of cardiovascular disease.

A suspected heart attack is an emergency treated through 999, the ambulance service and an NHS hospital with facilities for angiography. Follow-up, including cardiac rehabilitation and long-term medicines, is arranged by the hospital and your GP.

Some people choose to see a private cardiologist later, for example for a second opinion on the cause or for family screening advice. That consultation works best with copies of your hospital reports and test results, and your GP can help coordinate.