Stroke vs. Heart Attack: Spot the Difference and Get Help

Stroke and heart attack are emergency conditions that may appear similar at first and even have some of the same risk factors, like high blood pressure, high cholesterol, smoking, diabetes, obesity, and a sedentary lifestyle. Understanding the difference between the two can help you respond and get treatment if you or someone you’re with is experiencing symptoms of stroke or heart attack.

Christopher D. Anderson, MD, MMSc, and Marc Sabatine, MD, MPH explain stroke, heart attack, and the difference between the two. Dr. Anderson is a Mass General Brigham Neuroscience Institute neurologist and chief of the stroke division. Dr. Sabatine is a Mass General Brigham Heart and Vascular Institute cardiologist and chair of the TIMI Study Group at Brigham and Women’s Hospital..

In the United States, a stroke happens every 45 seconds and a heart attack happens every 40 seconds. These are extremely common conditions and are both emergency situations. You can improve your odds of survival and reduce long-term damage by learning to recognize the signs and symptoms of each.

What is a stroke?

Stroke is an emergency condition that occurs when blood flow to your brain suddenly changes. The change in blood flow also means a lack of oxygen gets to your brain, which causes damage very quickly by causing brain cells to die.

There are two types of stroke:

1. Ischemic stroke: A blood vessel becomes plugged or blocked, usually by a blood clot. The cells beyond the blockage are damaged by the lack of oxygen.
2. Hemorrhagic stroke: An artery leaks or ruptures in the brain, causing a bleed (hemorrhage) in the brain tissue that pushes on the brain, causing damage.

You also may have heard of a transient ischemic attack (TIA) or ministroke—this is not a typical ischemic stroke, but a blockage that resolves within a few minutes on its own. A TIA can still feel like a stroke and can be a warning sign of an impending stroke—1 in 3 people that experiences a TIA has a major stroke within a year without treatment, according to the Centers for Disease Control (CDC). Even if the symptoms go away after a few minutes, it is still important to seek emergency care to prevent a more permanent stroke.

For any stroke symptoms, even those that resolve within a few minutes, it’s important to call 9-1-1 to get immediate medical attention.

“We like to say ‘time is brain,’” says Dr. Anderson. “It’s a common phrase in stroke care because the longer the brain goes without oxygen, the more damage is done and the more severe the disability and impact of the stroke. We have emergency treatments to try to reverse the symptoms of a stroke, but they all work best when given as soon as possible.”

Stroke symptoms

It’s helpful to remember the acronym FAST to recognize stroke symptoms:

• Facial drooping
• Arm weakness
• Speech difficulties
• Time to call 911 immediately

If you see or experience any of the symptoms in the acronym, call 9-1-1 immediately. Emergency medical services (EMS) starts treatment on the way to the hospital, reducing the damage and preparing the emergency room to treat you.

In more detail, stroke symptoms typically come on suddenly and can include:

• Numbness or weakness in the face, arm, or leg, especially on one side of the body
• Trouble with vision in one or both eyes
• Difficulty speaking or understanding speech
• Problems with walking, balance, and dizziness
• Confusion
• Severe, sudden headache

If you or someone you know is experiencing any of these symptoms—even if they resolve, or you feel a little better—call 9-1-1.

“People sometimes hesitate to call 9-1-1, especially women who have been shown to wait longer to seek care,” says Dr. Anderson. “Never hesitate to call 9-1-1 for stroke symptoms. Every minute counts. As doctors, we’d rather you come in and have it be a false alarm than to have you suffer long-term damage or even death from a stroke you didn’t seek emergency care for.”

What is a heart attack?

A heart attack—also called a myocardial infarction—is caused by a blockage in one of your coronary arteries, which supply blood flow to the heart, which reduces the amount of oxygen getting to your heart muscle. The blockage is often caused by rupture of a fatty deposit in the vessel wall, causing a blood clot to form which prevents blood flow to the heart muscle.

As your heart receives less or no blood flow, heart tissue starts to die. The longer it’s left untreated, the more damage a heart attack causes.

Symptoms of heart attack

Signs of a heart attack are varied, but the most commonly reported symptoms are:

• Chest pain, often radiating through the shoulder to the neck and jaw
• Difficulty breathing/shortness of breath
• Fainting
• Heart palpitations (being unpleasantly aware of your heartbeat)

Most people may not describe chest pain as “pain” specifically, but often describe it as pressure, tightness, squeezing, constriction, or “like someone is sitting on your chest,” says Dr. Sabatine.

In addition to the "classic" signs of a heart attack, you might experience these uncommon heart attack symptoms:

• Heartburn/indigestion
• Nausea/vomiting
• Cold sweat
• Fatigue

“Heart attack symptoms can also show up differently in women,” says Dr. Sabatine. "These patients may be less likely to experience the classic chest pain and more likely to have shortness of breath, fatigue, and insomnia compared to men or people assigned male at birth (AMAB).”

Symptoms usually start suddenly and are severe, but sometimes milder forms of the same symptoms can have a stuttering course in the hours or even days before a heart attack happens. “Pay attention if you have potential subtle symptoms of a heart attack,” Dr. Sabatine notes. “Chest pain isn’t always present.”

Heart attack is an emergency condition. If you’re experiencing symptoms of a heart attack, don’t hesitate to call 9-1-1. EMS starts treatment in the ambulance on the way to the hospital, improving outcomes and reducing damage.

Difference between stroke and heart attack

Both conditions are an emergency and involve blood flow being blocked to critical organs. “They can both cause a lot of damage in a short amount of time if not treated quickly, but the similarities end there,” notes Dr. Anderson.

“The symptoms and treatment of stroke and heart attack are completely different,” says Dr. Sabatine. “But time is critical in both situations. You don’t want to waste time deciding whether to call 9-1-1 or waiting to see if symptoms improve. The sooner EMS can get there, the better the outcomes for both stroke and heart attack.”

Can stroke cause heart attack?

Studies have shown that people who experience a stroke have a much higher risk of heart problems after their stroke. People are more than 20 times more likely to experience a major heart incident in the first 30 days after their stroke than those that haven’t had a stroke, and their risk is still twice as high more than a year later.

Cardiac issues after stroke are so common that researchers have given the field of study a new name: stroke-heart syndrome.

“In addition to monitoring patients for acute heart problems in the setting of a stroke, we also work to optimize long-term cardiovascular health given the shared risk factors between heart attack and stroke,” says Dr. Sabatine. Follow your provider’s recommendations after stroke for rehabilitation and preventive treatment.

Can you have more than one stroke?

It’s also common for someone who’s experienced stroke to have a secondary stroke. “There’s a risk of recurrent or secondary strokes if you don’t manage the risk factors that caused the first one,” says Dr. Anderson. Steps like quitting smoking, reducing stress, and starting a blood pressure medicine or daily aspirin if your provider recommends it can help reduce your risk for a second stroke.

What’s more serious, stroke or heart attack?

“Both are very serious and require immediate emergency medical attention,” Dr. Sabatine stresses.

“Both conditions can cause death, severe disability, and long-term complications, even when treated quickly,” Dr. Anderson adds. “So it’s critical to call 9-1-1, tell them the symptoms you’re seeing or experiencing, and follow their instructions until EMS arrives.”

What to do if you recognize a stroke or heart attack

First—whether you suspect stroke or heart attack—call 9-1-1. “This is the most important thing you can do, and it may even save a life,” Dr. Anderson says.

“Don’t drive yourself to the hospital. The trained medical care that people experiencing stroke and heart attack receive on the way to the hospital can make a critical difference in the amount of damage they have to their organs,” says Dr. Sabatine.

Note any symptoms you recognize and share details with the emergency dispatcher. Also note when symptoms first started—stroke care includes medicines to break up clots that are most effective within a small window of time.

If you recognize symptoms of a heart attack, it may be helpful to have the person chew an aspirin to decrease the damage to the heart muscle, as long as they’re not allergic to it.

If the person stops breathing, loses consciousness, or doesn’t have a pulse, start CPR after calling 9-1-1 and use an automated external defibrillator (AED) if one is available.