Most people think of a heart attack as sudden, intense chest pain, often visualising someone clutching their chest in distress. However, heart attacks do not always present this way, and the symptoms can be more subtle, especially in women. One less commonly recognised but important sign is back pain, particularly in the upper back between the shoulder blades. This type of pain may be dull, pressure-like, or persistent and can occur alongside other atypical symptoms such as nausea, shortness of breath, fatigue, or dizziness. Recognising these warning signs early and seeking urgent medical care can be life-saving.How back pain can signal a heart attackHeart attacks occur when blood flow to part of the heart is blocked, often due to a blood clot in a coronary artery. This deprives heart muscles of oxygen and can cause permanent damage if not treated promptly. While chest discomfort is the most common symptom, back pain may sometimes be the first indication that something is wrong. According to a study published in PLOSOne, chronic low back pain is associated with a significantly higher risk of myocardial infarction (heart attack) even after accounting for genetic and familial factors. Back pain associated with a heart attack is typically dull, pressure-like, or tight, often centred in the upper back or between the shoulder blades. Some people describe it as a sensation of a heavy weight or even as if a rope is being pulled around the chest and back. Unlike ordinary back pain, it is not triggered by movement or posture, and it may come and go unpredictably.Other accompanying symptoms may include:Shortness of breath, even without physical activityDizziness or light headednessNausea or vomitingCold sweats or clammy skinThese additional symptoms can help distinguish heart-related back pain from musculoskeletal causes, such as a pulled muscle or strain, and may indicate an urgent medical condition requiring immediate evaluation, especially if combined with chest discomfort, radiating pain, or sudden weakness.Back pain in women: More common than in men and a possible heart attack signWomen are more likely than men to experience atypical heart attack symptoms, which can lead to delays in diagnosis and treatment. While chest pain remains common, many women report subtler signs that can easily be mistaken for other conditions.Some of the symptoms women are more likely to experience include:Upper back pain or pain between the shoulder bladesJaw, neck, or shoulder discomfortShortness of breath or difficulty breathingNausea or vomiting, often mistaken for stomach upsetUnexplained fatigue, sometimes for several days before the heart attackResearch also indicates that silent heart attacks, where chest pain is absent, occur more frequently in women. This highlights the importance of paying attention to non-chest symptoms, particularly in women with known risk factors like high blood pressure, diabetes, high cholesterol, smoking, or a family history of heart disease.Other common heart attack symptomsHeart attack symptoms vary greatly between individuals. Besides back pain, you may notice:Chest discomfort – Often described as heaviness, tightness, or pressure in the centre or left side of the chestArm pain – Discomfort or tingling in one or both armsShoulder pain – Sometimes radiating to the neck, jaw, or upper backExcessive sweating – Sudden cold or clammy perspiration without exertionNausea or vomiting – Often accompanied by general weaknessFatigue – Unexplained tiredness, sometimes for multiple days before the heart attackLight headedness or dizziness – Feeling faint or weakSome heart attacks may even occur without any noticeable symptoms, known as silent heart attacks. These are more common in people with diabetes or women, making regular check-ups crucial for those at risk.When to seek urgent careImmediate medical attention is critical if you suspect a heart attack. Even mild or unusual discomfort should not be ignored, particularly if you have known risk factors.Chest discomfort or pressureUpper back, jaw, neck, or arm painShortness of breathCold sweatsNausea or vomitingLight headedness or faintingEarly medical intervention can reduce heart damage, improve survival rates, and allow doctors to provide treatments such as clot-busting medication or emergency surgery.Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making any changes to your health routine or treatment.Also read | 10 effective ways to lower diabetes risk if it runs in your family