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You Think You're Having a Heart Attack. Now What?



by American Medical Association staff

What Is a Heart Attack?

Blood reaches the heart through the coronary arteries. Fatty deposits called plaque can build up inside the walls of arteries, making them narrower. This process, called atherosclerosis, or hardening of the arteries, develops gradually over many years. If a plaque ruptures, a blood clot can form, reducing blood flow to the heart even more. If a clot suddenly cuts off most or all of the blood supply to the heart, a heart attack results. Cells in the heart muscle that don't receive enough oxygen-carrying blood begin to die. The more time that passes without treatment to restore blood flow to the heart, the greater the damage to the heart muscle.

Know the Symptoms

Symptoms of a heart attack vary in type and intensity from one person to another and from one heart attack to another in the same person. Some people may have a heart attack and have no symptoms. However, in most cases, the main symptom of a heart attack is sudden pain in the center of the chest. Some people describe the pain as a feeling of tightness, pressure, or fullness, or a squeezing sensation. The pain is usually severe and may spread to the back, left arm, neck, jaw, upper abdomen, and sometimes to the right arm. The pain may be continuous or may last for a few minutes, fade, and then return.

Here is a complete list of the most common symptoms:

•  Sudden squeezing pain or feeling of tightness, pressure, or fullness in the center of the chest that lasts for more than several minutes

•  Chest pain that extends to the shoulders, arms, back, neck, or jaw

•  Indigestion or persistent pain in the upper abdomen

•  Shortness of breath

•  Dizziness or fainting

•  Weakness or fatigue

•  Heavy sweating

•  Chills

•  Nausea and vomiting

•  Backache

•  Arm or jaw numbness

•  Restlessness or anxiety; sleeplessness

•  Paleness

•  Blueness of the lips, hands, feet

Most people who have a heart attack have recurring chest pain, shortness of breath, and fatigue for a few days before the attack. In some people, arrhythmia (irregular heartbeat) may also precede a heart attack. Unlike angina, the pain of a heart attack is not relieved with rest or after taking nitroglycerin (a medication prescribed to relieve angina). Also, heart attack pain is usually more severe and longer-lasting than angina. In rare cases, a heart attack does not cause symptoms and is detected by chance on an electrocardiogram, a recording of the electrical activity of the heart, performed for another purpose.

Some people may ignore their symptoms or assume they are caused by some other condition, such as indigestion or overexertion. However, because most deaths from a heart attack occur within an hour of the onset of symptoms, it is crucial to be able to recognize the symptoms and act quickly. The sooner treatment begins, the less damage to the heart muscle and the better the long-term prognosis.

A Special Word of Warning for Women

The symptoms of a heart attack are sometimes hard to identify because a heart attack can feel different to different people. Women's symptoms, especially, can vary considerably from the classic signs of a heart attack. Women are more likely than men to experience dizziness, shortness of breath, nausea, sweating, chills, weakness, faintness, restlessness and anxiety, and blueness of the lips, hands, or feet, along with chest pain.

What to Do If You're Having a Heart Attack

If you or someone else is having a heart attack, don't delay getting treatment-a heart attack does the most damage to the heart muscle in the first two hours. Even if you aren't sure it's really a heart attack because it feels like heartburn or indigestion, call for help anyway. It's better to be wrong than to sustain serious heart damage because you waited too long. Acting quickly can save your life.

•  At the first sign of symptoms, sit or lie down.

•  If your symptoms last longer than two minutes, call 911 or your local emergency number and say you may be having a heart attack.

•  If you have nitroglycerin tablets, take one every five minutes-up to three pills total.

•  If you don't have nitroglycerin, take an aspirin; it can thin the blood and may allow more blood to reach your heart.

•  Keep warm and calm.

•  Don't drive yourself to the hospital; wait for the emergency medical team to arrive. They have the special equipment needed to provide emergency care for a heart attack.

If You're at High Risk, Encourage Family Members to Learn CPR

Cardiopulmonary resuscitation (CPR) is a lifesaving technique that is performed to restart a person's breathing and heartbeat after they have stopped. The procedure involves keeping the person's airways open, performing rescue breathing, and doing chest compressions to pump blood through the heart. Because of the potential for serious injury, only people who have been fully trained in CPR should attempt this procedure. Before starting CPR, call 911 or your local emergency number. Once you have started CPR, do not stop until emergency medical personnel have taken over.

Ask your doctor about the availability of CPR classes in your community. Your local hospital or fire department may offer a class. If not, contact the local chapter of the American Red Cross or the American Heart Association. CPR training can mean the difference between life and death.

Finally, Ask Your Doctor about an Implantable or Portable Defibrillator

In people who have recurring episodes of ventricular tachycardia that does not respond to treatment with drugs, a device called an implantable defibrillator may be recommended. The device senses the onset of an arrhythmia and automatically provides a potentially lifesaving electrical shock to the heart muscle. Some implantable defibrillators also function as pacemakers.

If you live with someone who has had a heart attack or who has severe heart disease, talk to your doctor about purchasing an automated external defibrillator for use at home. This portable electronic device can be used to restore the heartbeat of a person whose heart is beating irregularly (fibrillating) or has stopped beating. With the push of a button, a person who has been trained to use the device can administer an electric shock to another person's heart through conductive adhesive pads placed directly on his or her chest. The device also analyzes the person's heart rhythm. Increasing numbers of public facilities, such as airports, shopping malls, hotels, and workplaces, have portable defibrillators available for use in an emergency. These devices come with easy-to-understand instructions, so even people who have not been trained can use them effectively.

Even if you are not at high risk, chances are you know someone who is. The American Medical Association suggests that you encourage him or her to learn what to do in the event of a heart attack. Give copies of this article to your loved ones, friends, and coworkers. Take the initiative to learn CPR and encourage other people to learn it. Being prepared to take immediate action in response to a heart attack is an act of generosity and caring. Most important of all, you could save a life.


Excerpted from American Medical Association Family Medical Guide , 4th Edition by staff, American Medical Association. Copyright © 2004 by American Medical Association . All rights reserved. Excerpted by arrangement with Rocks-DeHart Public Relations . $45. Available in local bookstores or call 800.225.5945 or click here.

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