Cardiac arrest! Heart attack! The very words seem to shout with a sudden, out-of-the-blue urgency. And that's how most everyone has come to understand heart attacks: they hit hard, with no warning.

The truth is, happily, a little less abrupt and severe, at least for middle-aged men. Your body will give you a heads up – but you need to know how to look for it.

A 2013 study focused upon the population of Portland, Oregon, assessed the records of every man between the ages of 35 and 65 who had a sudden cardiac arrest within a period of almost 12 years. The scientists also took into account the the accounts of family members, emergency medical personnel, witnesses and medical records from the time period around the heart attack Thirty-one percent of the records did not present enough data to identify whether symptoms were present before the attack, and of the remaining cases, 53 percent had symptoms that ranged from episodes of chest pain to feeling like they had the flu.

A study has shown that most men get chest pains between four weeks and one hour before a sudden cardiac arrest. That is, the point when the heart stops abruptly. Other men participating had noted shortness of breath, and a small percentage experienced fainting, heart palpitations or dizziness.

In a nutshell, data supports current recommendations for anyone having these kinds of symptoms – particularly chest pain, shortness of breath and dizziness – to seek medical attention. About 360,000 out-of-hospital cardiac arrests are reported each year in the United States, according to the American Heart Association. Less than 10 percent of those who have a heart attack outside of a hospital survive.

And men, please note: you're on your own here. A 2017 study highlights just how poor a job doctors do of flagging these symptoms of pending cardiac arrest for you. Researchers from the Imperial College of London found that physicians in England are missing “subtle signs” of imminent heart attacks. They learned that around 16 per cent of people who die from cardiac arrest are admitted to hospital for other reasons in the 28 days prior to their death.

“Doctors are very good at treating heart attacks when they are the main cause of admission,” said lead author Dr Perviz Asaria. “But we don’t do very well treating secondary heart attacks or at picking up subtle signs which might point to a heart attack death in the near future.”