Symptoms of Heart Disease Vs. Heart Attack: What’s the Difference?

You feel chest pain. You’re short of breath. You’re fatigued. Are you feeling symptoms of heart disease … or could it be an actual heart attack?

Most Americans don’t know all the signs that could point to heart problems. In a survey of 72,000 people conducted by the Centers for Disease Control and Prevention (CDC), 92% of respondents recognized chest pain as a symptom of a heart attack, but only 27% were aware of all major symptoms.

At the risk of sounding a bit dramatic, not educating yourself on the tell-tale signs of heart disease or a heart attack could be a matter of life or death—especially if you have any risk factors for coronary heart disease. Catching coronary heart disease early can prevent a heart attack, and catching a heart attack early could save your life.

The Difference Between Coronary Artery Disease and a Heart Attack

Coronary artery disease (also called coronary heart disease) is a chronic condition that can develop over many years. “When somebody has coronary artery disease, often times it’s actually a longstanding process, meaning years and years of not taking care of yourself, having high cholesterol, or having diabetes,” says Michelle Weisfelner Bloom, MD, a cardiologist at Stony Brook University Medical Center. Over time, cholesterol plaque builds up on the insides of the artery walls, which slowly starts to block blood flow in that artery. “At some point there’s not enough blood going through those arteries to supply the heart with enough blood. And that’s when patients start to develop symptoms of coronary artery disease,” says Dr. Bloom.

A heart attack occurs when that plaque buildup ruptures and forms a blood clot that blocks the artery. “If you have an occlusion of the artery, meaning it blocks it off, [you] have decreased blood flow to the area that the artery was providing blood supply, which is normally the muscle of the heart,” says Rachel Bond, MD, a cardiologist at Lenox Hill Hospital.

What Coronary Artery Disease Feels Like

Coronary heart disease is often called “silent CHD” because some people—especially women—have no symptoms at all. (Here’s more on how heart disease symptoms in women can be different.) When heart disease symptoms do present, a person might feel:

• Fatigue
• Dull chest pain or discomfort (angina)
• Pain, discomfort, or numbness in the neck, abdomen, or back
• Shortness of breath

Often times this pain gets worse with physical activity or emotional stress, and gets better with rest.

A coronary artery disease symptom commonly missed is a sudden decline in your exercise tolerance, says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital. “All of a sudden walking up a hill becomes more troublesome to you. You get more short of breath. Activities of daily living become more of a battle for you. [These] could be early signs of worsening coronary artery disease.”

What a Heart Attack Feels Like

Heart attack signs are similar to those of coronary artery disease, with a few key differences. When someone is having a heart attack, they might feel:

• Uncomfortable chest pain or pressure that lasts more than a few minutes, or goes away and comes back
• Pain or discomfort in one or both arms, the back, neck, jaw, or stomach
• Shortness of breath (with or without chest discomfort)
• Breaking out in a cold sweat
• Nausea
• Lightheadedness

When you’re having a heart attack, symptoms tend to come out of nowhere. “Tightness or pressure comes on all of a sudden; you can be awakened from your sleep or just doing nothing,” says cardiologist Nieca Goldberg, MD, medical director at NYU Langone Health in New York. Whereas with coronary artery disease, symptoms are likely to have a trigger, like physical activity or stress. Symptoms of a heart attack also tend to get progressively worse.

If you’re feeling any symptoms of potential heart trouble (even if chest pain isn’t on the list), don’t wait to find out whether it’s heart disease or a heart attack. When you first experience chest tightness, shortness of breath, or notice that your exercise endurance has gone down, it’s important to seek medical attention right away, says Dr. Goldberg.

When it comes to your heart, the adage is true: It’s better to be safe, than sorry. Every minute matters—it can save your life.