Warning signs of a heart attack a month before


Cardiovascular disease poses a significant burden on the population of South-East Asia, accounting for nearly one-third of all deaths in the region and claiming the lives of 4 million individuals annually 1.

Notably, South-East Asia exhibits a strikingly elevated occurrence of stage A heart failure (HF) risk factors compared to the United Kingdom and the United States. These risk factors include hypertension, tobacco smoking, physical inactivity, and raised blood glucose levels. Surprisingly, despite a relatively low prevalence of overweight or obesity, South-East Asian countries demonstrate a higher prevalence of symptomatic HF when compared to the rest of the world. Moreover, patients in this region present with acute HF at a younger age and experience more severe clinical features, higher rates of mechanical ventilation, longer hospital stays, and increased in-hospital mortality rates2.

Recognizing the importance of early intervention, it is crucial for individuals to be aware of the warning signs that may precede a major cardiac event. By promptly seeking medical treatment upon noticing these symptoms, individuals can significantly improve their chances of a swift and complete recovery3.

This article aims to explore the symptoms indicative of underlying coronary artery disease, the associated risk of heart attack, and appropriate response strategies.

Early signs of heart attack risk3

Here are some of the most common signs of a heart attack that may be experienced a month before the actual event:

Chest Pain: Chest pain or discomfort, often described as pressure or tightness, is a common sign of a heart attack. The pain may radiate to the arms, neck, jaw, back, or stomach, and can be accompanied by shortness of breath, sweating, nausea, or vomiting.

Fatigue: Feeling excessively tired or unable to rest despite adequate sleep can be a warning sign of a heart attack. This fatigue may result from reduced blood flow to the heart, leading to increased exertion on the heart muscle. Women, in particular, may experience fatigue before a heart attack.

Dizziness: Feeling lightheaded or dizzy, especially when accompanied by chest pain or shortness of breath, may indicate an impending heart attack. This dizziness can be caused by decreased blood flow to the brain or an irregular heart rhythm.

Indigestion or Nausea: Abdominal pain, upset stomach, nausea (with or without food), or a bloated feeling can occur during a heart attack, especially in more than 50% of cases. Acid reflux or heartburn can also be overlooked symptoms of a heart attack.

Sweating: Excessive sweating or sudden cold sweats, unrelated to exercise or menopause, may be a sign that a heart attack is imminent. Sweating is the body’s response to stress and can occur when the body senses trouble.

Swelling in the Legs, Ankles, and/or Feet: Unusual swelling in the lower extremities may indicate improper blood circulation throughout the body, potentially signaling a heart problem.

Irregular Heartbeat: A rapid or irregular heartbeat, not caused by excessive caffeine consumption, could be a symptom of a heart condition like atrial fibrillation (afib). Insufficient blood flow affects the entire body, leading to various complications.

Pain in Other Body Parts: Although chest pain is the most common heart attack symptom, pain or discomfort in other areas such as the arms, back, neck, jaw, or stomach can also occur. This pain may feel like pressure, squeezing, or fullness and may come and go or persist for several minutes or longer.

Shortness of Breath: Difficulty breathing, a sense of breathlessness, wheezing, or coughing can indicate a heart attack when the heart fails to pump enough blood to meet the body’s demands.

It is crucial to be aware of these warning signs, as recognizing them promptly can help facilitate swift medical intervention, potentially improving the chances of a successful recovery.

A survey conducted in 2003 focused on 515 women who survived a heart attack and found that they commonly experienced the following symptoms about a month before their cardiac event [4]:

Abnormal Fatigue: A significant majority (70.7%) of women reported feeling unusually tired or fatigued. Disrupted Sleep: Nearly half (47.8%) of the women experienced sleep disturbances leading up to their heart attacks.

Shortness of Breath: Approximately 42.1% of the women reported experiencing difficulty breathing or shortness of breath.

Interestingly, only 29.7% of the women in the survey mentioned experiencing chest discomfort. It’s important to note that this survey focused on self-reported symptoms specifically in women, as these symptoms can differ from those in men.

Causes and risk factors5

Coronary artery disease (CAD) is the main cause of heart attacks, resulting from a narrowed coronary artery due to plaque buildup. Other less common causes include sudden artery spasms, blood clots from the heart, and tears in the coronary artery.

Risk factors for heart attacks include a high-sodium and high-fat diet, lack of exercise, smoking, metabolic syndrome conditions (obesity, diabetes, high blood sugar, cholesterol, blood pressure, and triglycerides), age, and family history of heart attacks.


Heart attacks often manifest as chest pain, along with sensations of discomfort in the arms, back, and neck, accompanied by breathlessness. Nevertheless, women may experience additional symptoms such as excessive fatigue, sleep disturbances, and shortness of breath up to a month before the occurrence of a heart attack.

Early recognition and prompt action upon encountering these warning signs are crucial for effective treatment and recovery. It is highly advisable to adopt preventive measures by embracing a heart-healthy diet, managing a healthy weight, engaging in regular exercise, and abstaining from smoking in order to reduce the risk of heart attacks.


  1. World Heart Federation. [Cited: 18 May 2023]. Available at:
  2. Lam CS. Heart failure in Southeast Asia: facts and numbers. ESC Heart failure. 2015 Jun;2(2):46-9.
  3. American Heart Association. Warning Signs of a Heart Attack. [Cited: 18 May 2023]. Available at:
  4. McSweeney JC, Cody M, O’Sullivan P, Elberson K, Moser DK, Garvin BJ. Women’s early warning symptoms of acute myocardial infarction. Circulation. 2003 Nov 25;108(21):2619-23.
  5. National Heart, Lung, and Blood. Heart Attack. Causes and Risk Factors. [Cited: 18 May 2023]. Available at:
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