Heart Attack Warning Signs: What to Do in the First Hour

A heart attack happens when a coronary artery is blocked and part of the heart muscle loses its blood supply. From that moment, muscle begins to die. Treatment that opens the artery within the first hour or two preserves far more heart function than the same treatment given six hours later.

Indians develop coronary artery disease roughly a decade earlier than European populations, and often with fewer classical risk factors, which makes recognition even more important.

What it actually feels like

The Hollywood version, a person clutching their chest and collapsing, is not how most heart attacks begin.

• Pressure, tightness, heaviness or squeezing in the centre of the chest, often described as a weight rather than a sharp pain
• Lasting more than a few minutes, or coming and going
• Spreading to the left arm, both arms, jaw, neck, back or upper abdomen
• Breathlessness, with or without chest discomfort
• Cold sweat
• Nausea or vomiting
• Sudden extreme fatigue or a sense of impending doom
• Lightheadedness

Pain that is sharp and stabbing, lasts a couple of seconds, is reproduced by pressing on the chest, or changes clearly with breathing or position is less likely to be cardiac, though it never rules it out.

Atypical presentations

Women more often present with breathlessness, nausea, back or jaw pain and unusual fatigue rather than classic chest pain. People with diabetes may have blunted pain sensation and present with breathlessness, confusion or simply feeling unwell, sometimes called a silent heart attack. Older adults may present with collapse or confusion.

These are the presentations most often dismissed as gas or acidity, which is why a persistent unexplained discomfort in the chest or upper abdomen deserves an ECG rather than an antacid.

What to do in the first hour

• Call an ambulance. Do not drive yourself. Do not wait to see if it settles.
• Chew 300 mg of aspirin (usually four 75 mg tablets or one 325 mg tablet) unless you are allergic to it or have been told not to take it. Chewing matters; it works faster than swallowing.
• Sit down and rest. Stop all exertion.
• Loosen tight clothing.
• If the person has been prescribed sublingual nitroglycerin, take it as instructed.
• If the person becomes unresponsive and is not breathing normally, start chest compressions immediately: centre of the chest, hard and fast, about 100-120 per minute, and continue until help arrives.

Time is the whole game. Most deaths happen in the first hour, often before reaching hospital, and often because someone waited to see whether it would pass.

At the hospital

An ECG within ten minutes, troponin blood tests, and then either primary angioplasty with a stent, which is preferred, or clot-dissolving medication where angioplasty is not available quickly. Knowing which nearby hospital has a 24-hour cardiac catheterisation lab is worth finding out before you need it.

Reducing the risk

• Stop smoking. This is the single largest modifiable risk, and risk falls measurably within a year.
• Control blood pressure to target
• Control LDL cholesterol according to risk
• Manage diabetes, and consider drugs with proven cardiovascular benefit
• 150 minutes a week of moderate activity
• Reduce central obesity
• Treat obstructive sleep apnoea if present
• Know your family history, especially heart disease before 55 in men or 65 in women

Angina: the warning that comes first

Many heart attacks are preceded for weeks by chest discomfort that appears on exertion and settles with rest. This is angina, and it is an opportunity. New exertional chest discomfort, or a clear worsening of a familiar pattern, should be assessed within days, not months.

This article is general health information and is not a substitute for emergency care. If you suspect a heart attack, call emergency services immediately.