Heart attack in older adults: recognising less typical symptoms and getting help

The NHS says a heart attack happens when blood flow to your heart is blocked, is life-threatening and needs emergency treatment in hospital. The BHF explains that most are caused by coronary heart disease, in which coronary arteries narrow with a gradual build-up of fatty deposits (atheroma); if a piece breaks off a blood clot forms and can block the artery, starving heart muscle of blood and oxygen. Less common causes include spontaneous coronary artery dissection (SCAD), cocaine and amphetamine use, and sudden drops in oxygen levels.

In hospital the BHF says you may hear a heart attack called acute coronary syndrome, myocardial infarction or coronary thrombosis. A heart attack is different from cardiac arrest, when the heart suddenly stops pumping, according to both sources.

The NHS lists chest pain that may feel crushing or squeezing and may spread to the arm, neck and jaw; shortness of breath; nausea or vomiting; an indigestion-like burning and fullness; sweating; and pale, blue or grey skin. The BHF lists pain spreading to either arm, neck, jaw, upper back or stomach, feeling sick, sweaty, light-headed or breathless, and less common symptoms such as suddenly feeling anxious like a panic attack, severe tummy pain, and a lot of coughing or wheezing. It says the pain can feel very bad for some people while for others it is more uncomfortable, like heaviness, pressure, squeezing or burning like indigestion.

Because symptoms vary and you may not have all of them, an older person may notice only breathlessness, sweating or feeling unwell, which can be put down to age, a chest infection or indigestion. The BHF says not to worry about wasting anyone's time: a heart attack is a medical emergency, and delay can mean serious heart damage and more intensive care and longer in hospital. It also says women tend not to recognise symptoms as a heart attack as quickly, because heart attacks are wrongly seen as a man's problem.

The NHS says call 999 for chest pain that feels tight or like squeezing, chest pain spreading to the arms, neck or jaw, severe difficulty breathing, pale, blue or grey lips or skin, or someone who has passed out and is not responding normally. It advises calling NHS 111 for being suddenly more short of breath than usual, chest pain with nausea or vomiting, or chest pain with a racing, slow, skipping or fluttering heartbeat. While waiting for help, sit and rest on the floor with knees bent and back supported or on a chair, take aspirin (300mg) if you have it, unless allergic, use your GTN spray if you have angina, and keep checking someone who may be having a heart attack is responding and breathing. If they stop responding and breathing, start CPR.

The BHF says to sit down, stay calm, take 300mg aspirin if you have it and are not allergic, and wait for the ambulance. The 999 operator can advise on aspirin and on what to do next.

The BHF says paramedics do an ECG (electrocardiogram) to check the heart's electrical activity; if it shows a heart attack, you are taken to a specialist centre. Whether or not the ECG confirms a heart attack, further tests follow, including an assessment of symptoms and history, blood tests to see if there has been damage to heart muscle, more ECGs and an echocardiogram. The NHS adds a coronary angiogram to find exactly where blood flow is blocked, sometimes treated at the same time.

The NHS says treatment depends on severity and may include medicines to treat the blockage and improve blood flow, coronary angioplasty with a stent, or coronary artery bypass surgery. The BHF describes thrombolysis with clot-busting medicine as another emergency option. It says quick treatment to restore blood flow reduces permanent damage and can save your life.

You are usually admitted to a coronary care unit, then perhaps a cardiac ward. The BHF says hospital stay is about 2 to 5 days, and that doctors will not discharge you until certain you are well enough, assessing things like climbing stairs. If it is not safe to go home alone, you may be able to stay longer or have a small temporary package of care or equipment.

The NHS says you will be given medicines long term to treat the causes and reduce the chance of another heart attack: antiplatelets to help stop arteries getting blocked, statins to lower cholesterol, and other medicines to lower high blood pressure such as ACE inhibitors and beta-blockers. The BHF says antiplatelets such as clopidogrel or ticagrelor are commonly prescribed for 1 year, most people are prescribed lifelong aspirin, and ACE inhibitors or ARBs are among the others. It says it is essential to take medicines even if you feel well. Older people often take several medicines, so a pharmacist review soon after discharge helps avoid duplication, dizziness and bleeding problems.

The NHS says for some people recovery takes several weeks with little impact on life, for others months or years. After a heart attack you will usually need to rest and be referred to cardiac rehabilitation, which can be in person or remote using video calls or apps. The BHF describes cardiac rehab as talks and information from experts, exercise sessions, regular assessments and the chance to meet others, and suggests building up activity gradually at home and having someone stay with you for the first days or weeks.

Feeling worried, scared, frustrated or isolated is natural; the NHS says to talk to your GP if you feel anxious or have low mood, and the BHF has emotional support pages and a Heart Helpline. The NHS lists stopping smoking, healthy cholesterol and blood pressure, a balanced diet with less salt and saturated fat, healthy weight, regular exercise and less alcohol as ways to reduce the risk of another heart attack.