First aid - heart attack; First aid - cardiopulmonary arrest; First aid - cardiac arrest
A heart attack is a medical emergency. Call 911 or the local emergency number if you think you or someone else is having a heart attack.
The average person waits 3 hours before seeking help for symptoms of a heart attack. Many heart attack patients die before they reach a hospital. The sooner the person gets to the emergency room, the better the chance of survival. Prompt medical treatment reduces the amount of heart damage.
This article discusses what to do if you think someone may be having a heart attack.
Symptoms of a heart attack may widely vary, from the classic elephant on the chest feeling of crushing pain, to the nausea and heartburn mistaken for indigestion. In some patients, the symptoms may only be sudden fatigue or an oppressive feeling of impending doom.
Symptoms of a heart attack can vary widely and can mimic other conditions such as indigestion or heartburn. The important fact to know is to take all heart attack related symptoms seriously and seek medical help as soon as possible.
You feel a tight band of pain around your chest. The pain moves from your chest to your arms, shoulder, and neck. What could your pain mean? Could it be a heart attack, could it be the big one? Heart attacks are caused by interruption of blood supply to part of the heart. If the blood flow is blocked, your heart is starved of oxygen and heart cells die. A hard substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack can occur as a result of plaque buildup or the rupture of one of these plaques. We're not sure why heart attacks occur when they do. You may have a heart attack when you are resting or asleep, or after a sudden increase in physical activity, when you are outside in cold weather, or after a sudden, severe emotional or physical stress, including an illness. So, how is a heart attack treated? If you go to the hospital for a suspected heart attack, a doctor or nurse will listen to your chest with a stethoscope. You will have a blood test to look for heart damage. A coronary angiography test can show your doctor how well blood is moving through your heart. If blood moves slowly, or not at all through your coronary arteries, you have either a narrowed, or blocked artery. Other tests can look at the valves and chambers of your heart and check for abnormal heart rhythms. If you've had a heart attack, doctors can do an emergency procedure called angioplasty. This surgery or procedure can open narrowed or blocked blood vessels. Usually they'll place a small, metal mesh tube, called a stent, in your artery to help keep it open. You may also receive drugs to break up the clot in your artery. Sometimes, doctors will do heart bypass surgery to get blood flowing to your heart muscle again. After you are treated in the hospital for a heart attack, you may need to take medicines to thin your blood, to protect your heart, or to improve your cholesterol levels. You may need to take these medicines for the rest of your life. Most people who have had a heart attack also need cardiac rehabilitation. This will help you slowly increase your exercise level and learn how to follow a healthy lifestyle. After you have a heart attack, your chance of another is higher. How well you do after a heart attack depends on the damage to your heart and where the damage is, and what steps you take to prevent another one. If your heart can no longer pump blood to your body as well as it used to, you may have heart failure and will need lifelong treatment. Usually a person who has had a heart attack can slowly go back to normal activities, but you will need to take steps to prevent another heart attack.
Causes
A heart attack occurs when the blood flow that carries oxygen to the heart is blocked. The heart muscle becomes starved for oxygen and begins to die.
Symptoms
Symptoms of a heart attack can vary from person to person. They may be mild or severe. Women, older adults, and people with diabetes are more likely to have subtle or unusual symptoms.
Symptoms in adults may include:
- Changes in mental status, especially in older adults.
- Chest pain that feels like pressure, squeezing, or fullness. The pain is most often in the center of the chest. It may also be felt in the jaw, shoulder, arms, back, and stomach. It can last for more than a few minutes, or come and go.
- Cold sweat.
- Lightheadedness.
- Nausea (more common in women).
- Indigestion.
- Vomiting.
- Numbness, aching, or tingling in the arm (usually the left arm, but the right arm may be affected alone, or along with the left).
- Shortness of breath.
- Weakness or fatigue, especially in older adults and in women.
First Aid
If you think someone is having a heart attack:
- Have the person sit down, rest, and try to keep calm.
- Loosen any tight clothing.
- Ask if the person takes any chest pain medicine, such as nitroglycerin for a known heart condition, and help them take it.
- If the pain does not go away promptly with rest or within 3 minutes of taking nitroglycerin, call for emergency medical help.
- If the person is unconscious and unresponsive, and not breathing or does not have a pulse, call 911 or the local emergency number, then begin CPR.
- If an infant or child is unconscious and unresponsive, and not breathing or does not have a pulse, perform 1 minute of CPR, then call 911 or the local emergency number.
- If the person is unconscious and unresponsive, does not have a pulse, and an automated external defibrillator (AED) is immediately available - follow the instructions on the AED device.
Many experts recommend chewing and swallowing a full dose aspirin (325 mg), after calling 911 or the local emergency number. Only do this if you are not allergic to aspirin and do not have any condition that could make taking aspirin dangerous for you. The 911 operator can help you decide whether or not to take aspirin.
Do Not
- DO NOT leave the person alone except to call for help, if necessary.
- DO NOT allow the person to deny the symptoms and convince you not to call for emergency help.
- DO NOT wait to see if the symptoms go away.
- DO NOT give the person anything by mouth unless a heart medicine (such as nitroglycerin) has been prescribed.
When to Contact a Medical Professional
Call 911 or the local emergency number immediately if the person:
- Does not respond to you
- Is not breathing
- Has sudden chest pain or other symptoms of a heart attack
Prevention
Adults should take steps to control heart disease risk factors whenever possible.
- If you smoke, quit. Smoking more than doubles the chance of developing heart disease.
- Keep blood pressure, cholesterol, and diabetes in good control and follow your health care provider's orders.
- Lose weight if obese or overweight.
- Get regular exercise to improve heart health. (Talk to your provider before starting any new fitness program.)
- Eat a heart-healthy diet. Limit saturated fats, red meat, and sugars. Increase your intake of chicken, fish, fresh fruits and vegetables, and whole grains. Your provider can help you tailor a diet specific to your needs.
- Limit the amount of alcohol you drink. One drink a day is associated with reducing the rate of heart attacks, but two or more drinks a day can damage the heart and cause other medical problems.
References
Amsterdam EA, Wnger NK, Brindis RG, et al. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64(24):e139-e228.PMID: 25260718
Bonaca MP, Sabatine MS. Approach to the patient with chest pain. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 35.
Glass GF, Brady WJ. Acute coronary syndrome. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 64.
Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):e4-e17.PMID: 34882436
Version Info
Last reviewed on: 10/6/2022
Reviewed by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
