If you heard the words ‘heart attack’, you’d be forgiven for picturing someone collapsing on the ground while clutching their chest, like you see on TV.

But while some heart attacks can be sudden, there are also a number that come on gradually – and people don’t necessarily know about them.

Heart attack symptoms that occur over a period of hours are often “not taken seriously”, one researcher has said, which could prove life-threatening.

A 2019 study published in the European Journal of Cardiovascular Nursing revealed patients with gradual symptoms took eight hours to get medical help compared to those with abrupt symptoms, who took 2.6 hours.

A maximum delay of two hours is recommended to get fast treatment and the best outcomes for health. Delays of more than two hours are likely to end in serious complications or death.

Gradual heart attacks begin with mild discomfort that slowly gets worse, while abrupt onset refers to sudden and severe pain from the start.

“Both are a medical emergency and require urgent help,” said study author Dr Sahereh Mirzaei, from the University of Illinois, in the US. “But our study shows that gradual symptoms are not taken seriously.”

Dr Mirzaei’s study of 474 patients showing up at A&E with acute coronary syndrome – a condition that causes sudden, low blood flow to the heart – found symptoms came on abruptly in 56% of patients and emerged gradually in 44%.

Both women and men sought medical help more quickly when they experienced abrupt pain.

What are the symptoms of a gradual heart attack?

Chest pain, chest discomfort and chest pressure are warning signs that an artery may be blocked, which could cause a heart attack. Patients experiencing any of these should call the emergency medical services immediately, said Dr Mirzaei.

Other symptoms can also include pain in the throat, neck, back, stomach or shoulders, as well as nausea, cold sweats, weakness, shortness of breath, or fear.

Some people may be more at risk than others.

In the study, a number of men with heart disease, or those who had a family history of it, had symptoms triggered by physical exertion. Risky activities included climbing stairs, pulling, pushing, shovelling, heavy gardening, running and jogging.

Study author Dr Mirzaei said men with ischaemic heart disease or other risk factors including hypertension (high blood pressure), diabetes, or high cholesterol should be aware that chest pain or discomfort after physical effort could be a heart attack. Chest pain or discomfort, whether severe and sudden or mild and slow, “should not be ignored”, she warned.

Barbara Kobson, senior cardiac nurse at the British Heart Foundation (BHF), tells HuffPost UK symptoms can vary hugely from person to person, which is why knowing the common signs and symptoms of a heart attack is “vital” to ensure that people seek medical attention quickly when one strikes – and receive treatment sooner for a better chance of full recovery.

“People may not associate heart attacks with a slow onset because they may be expecting typical symptoms such as a crushing central chest pain, tightness or heaviness in the chest,” says Kobson. “Even if you feel unsure of the symptoms, especially when they present as mild symptoms, it is still important to seek medical advice.”

If you do experience any of the above symptoms which don’t go away, call 999 immediately.

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