Emergency Care For You

Emergencies A-Z

Heart Attack

Dr. Greg Henry, emergency physician and clinical professor at the University of Michigan Medical Center in Ann Arbor, Michigan

Heart attack (myocardial infarction) remains the leading killer of both men and women in the United States. More than 400,000 Americans die from heart attacks each year. Getting emergency medical help immediately can dramatically increase your chances of survival and recovery.

A heart attack is not always a sudden, deadly event. Often it is an evolving process during which a clot forms in an artery of the heart, depriving the heart of blood and oxygen. The longer the heart attack process continues, the more permanent damage is done to otherwise healthy heart muscle.

Many people ignore the warning signs of a heart attack or wait until their symptoms become unbearable before seeking medical help. Others wait until they are absolutely sure it's a heart attack because they worry they will look foolish if it is a false alarm. These reactions can result in dangerous delays.

Only skilled medical professionals can determine if someone is having a heart attack. Your responsibility is to recognize the warning signs and act quickly. If you are having a heart attack, you may be moved from the emergency department to a catheterization lab to receive angioplasty or a stent, or possibly heart bypass surgery. In addition, hospitals have lifesaving medications that are designed to stop a heart attack by dissolving the clot and restoring blood flow to the heart, although these medications work best when given within the first one or two hours after the onset of heart attack symptoms, when the damage is still limited.  

People often will experience some, but not all, of the following symptoms, which may come and go:

  • Uncomfortable pressure, fullness, squeezing sensation or pain in the center of the chest, lasting more than a few minutes, or it goes away and comes back.
  • Pain that spreads to the shoulders, neck, jaw, arms or back.
  • Chest discomfort accompanied by lightheadedness, fainting, sweating, nausea or shortness of breath.

Some less common warning signs of heart attack that should be taken seriously - especially if they accompany any of the above symptoms - include:

  • Shortness of breath and difficulty breathing.
  • Abnormal chest pain (angina), stomach, or abdominal pain. (Symptoms may feel like indigestion or heartburn.)
  • Nausea or dizziness.
  • Unexplained anxiety, weakness, or fatigue.
  • Palpitations, cold sweat or paleness.

As with men, women's most common heart attack symptom is chest pain or discomfort. Women are more likely than men to experience shortness of breath, nausea/vomiting and back or jaw pain.
If you suspect someone is having a heart attack:

  • Call 911 or your emergency services number immediately. Stay with the person until the ambulance arrives. Do not attempt to drive the person to the hospital; if his or her condition should worsen, there is nothing you can do to help while driving.
  • After 911 is called, the EMS dispatcher will likely give pre-arrival instructions (when appropriate) for the administration of aspirin (not acetaminophen, ibuprofen or naproxen) and nitroglycerin (if prescribed) while emergency-response units are enroute to the scene The ideal aspirin dose in such instances is two to four baby aspirin or one full or extra strength tablet (325 or 500mg), and chewing helps get the aspirin into the bloodstream faster than swallowing it whole. (The patient should not be given aspirin if his or her physician has advised otherwise, e.g., because of allergies or possible harmful interactions with other medications or known disease complications).
  • If the person is conscious, keep the person calm and help him or her into a comfortable position. The victim should stop all physical activity, lie down, loosen clothing around the chest area, and remain calm until the ambulance arrives.
  • If the person becomes unconscious, make sure the person is lying on his or her back. Clear the airway and loosen clothing at the neck, chest and waist. Check for breathing and pulse; if absent, and if trained to do so, begin cardiopulmonary resuscitation (CPR).

If you think you may be having a heart attack:

  • If you are with someone, tell that person you may be having a heart attack and want to get to the hospital immediately. Have the person call 911 or the emergency services number.
  • If you are alone, call 911 or the emergency services number immediately. Do not drive yourself to the hospital.
  • Once you have called 911, you likely will be instructed to chew and swallow an aspirin unless your physician has advised you otherwise (e.g., because of allergies or contraindications, including possible harmful interactions with other medications or known disease complications). Keep in mind that chewing helps get the aspirin into the bloodstream faster than swallowing it whole.

Here you will find information about automated external defibrillators (AEDs) and heart attack prevention.

Automated External Defibrillators (AEDs)

Lay rescuers can be trained to operate portable, computerized, automated external defibrillators (AEDs) used to apply electric shock to restart a heart that has developed a chaotic rhythm called ventricular fibrillation, the most common cause of sudden cardiac arrest. Survival is directly linked to the amount of time between the onset of sudden cardiac arrest and the treatment with an electric shock to stop the abnormal heart rhythm. If an AED is available where you work or live, ACEP recommends taking a training course to learn to use it. In September 2004, the U.S. Food and Drug Administration approved over-the-counter sales of AEDs, available for use in the home and without a prescription.

Heart Attack Prevention

The major risk factors for coronary heart disease are:

  • Increasing age. About four out of five people who die of coronary heart disease are ages 65 or older.
  • Gender. Men have a greater risk of heart attack than women, and they have attacks earlier in life. At older ages, women who have heart attacks are twice as likely as men to die from them within a few weeks.
  • Heredity (including race). Children of parents with heart disease are more likely to develop it themselves. African Americans have more severe hypertension than whites and consequently, are at greater risk.
  • Smoking. A smoker's risk of heart attack is more than twice that of non-smokers.
  • High cholesterol. The risk of coronary heart disease rises as blood cholesterol levels rise.
  • Physical inactivity. Regular, moderate-to-vigorous exercise plays a significant role in preventing heart and blood vessel disease.
  • Body weight. People with excess body fat are more likely to develop heart disease and stroke, even if they have no other risk factors.
  • Diabetes. This condition seriously increases the risk of developing cardiovascular disease.

You can reduce your chances of having a heart attack by quitting smoking, and nonsmokers should not start. People can also lose excess weight, exercise regularly, eat a low cholesterol diet, and take medications to reduce cholesterol if prescribed. It's also important to maintain a healthy blood pressure, control diabetes, and avoid excessive alcohol consumption. Talk to your physician about taking aspirin if you have major risk factors for heart disease. Get regular checkups, and if you have a family history of heart disease, it's especially important that you maintain a healthy lifestyle. More information can be found on the American Heart Association's website www.americanheart.org.