En español | Every 34 seconds, someone in the U.S. has a heart attack. Every 60 seconds, someone dies of one. What sufferers do — or don't do — in the critical first moments can be the difference between life and death.
Over the past decade, hospitals across the country have shortened the time between arrival at the ER and treatment to an hour or less, contributing to a 38 percent decline in deaths from coronary artery disease.
Now cardiologists are turning to the next big challenge: helping the nearly 40 percent of heart attack victims who never make it to the hospital. Many of them — 120,000 a year — will die, largely because they didn't seek help in time.
"It's a huge problem and a major unrealized opportunity," says Steven E. Nissen, M.D., chairman of cardiovascular medicine at the Cleveland Clinic. "People will still sit at home and take antacids because they think it's indigestion, or say, 'This can't happen to me because I'm a woman.' "
Here's what you can do to increase your odds of surviving a heart attack.
Recognize the (less typical) symptoms
Men and women with a type of heart disease called atherosclerosis have a buildup of fat and cholesterol, or plaque, in the arteries. A heart attack occurs when a piece of that plaque breaks off and forms a clot that blocks blood flow to the heart muscle. The classic signs are chest pain; pain or discomfort in one or both arms, the back, the shoulders, the neck or the stomach (above the belly button — pain here is sometimes mistaken for indigestion); and shortness of breath. Sweating, nausea and vomiting are also common.
Yet studies find that as many as a third of heart attack patients have no chest pain. These patients are more likely to be older, female or diabetic. In fact, "the older you are, the more likely you are to have atypical symptoms," Nissen says. Research shows that as people age, they don't always experience chest or arm pain, sweating, nausea and vomiting. Instead, they're more apt to experience confusion and labored breathing, and to faint.
That's because as the coronary artery closes, the heart starts pumping less blood through the body. "With the stiffer blood vessels that older people typically have, they don't get enough blood flow to the brain, and pass out," Nissen says. "They wake up on the floor with vague chest pressure."
In general, symptoms may come on gradually, be hard to pin down, and stop and then start again. It's not uncommon to feel unwell days or weeks earlier. According to new data from Linköping University in Sweden, published in the Journal of Cardiovascular Nursing, people ages 32 to 74 who had had a heart attack were more likely to have visited the doctor in the week prior to the event than those who hadn't.
That's why Harlan M. Krumholz, M.D., a cardiologist and health care researcher at the Yale University School of Medicine, says to stay alert even when you're simply not feeling yourself: "If something feels really different from what you've experienced in the past, don't ignore it."
Get off the Internet and call 911
You need to get to the hospital within an hour to ensure the best outcome. "Time is muscle," Nissen says. "The earlier we intervene, the less damage to the heart, the better the chance for survival and the better the quality of life. The people who develop heart failure are the ones who get there too late."
Yet studies show that people often deny what their bodies are telling them and delay making the call. Some people waste precious minutes looking up their symptoms online; others decide to call their primary care doctor for guidance.
Patients with chronic conditions such as diabetes or chronic obstructive pulmonary disease may assume that these other health problems are to blame for their discomfort. "They wait for their medications to take effect to see if it makes a difference," says Angelo Alonzo, a research scientist at the Yale University School of Nursing who has studied heart attacks for 40 years.
The way to get past these self-imposed roadblocks: Tell your spouse, your children or a neighbor what's going on. "Others will give you the encouragement to call for help or take over for you," Krumholz says. If you are alone, ask yourself: If someone else had your symptoms, would you urge that person to call for help? If the answer is yes, call.
What to do while you're waiting
Before the emergency medical technicians (EMTs) arrive, chew and swallow a regular, uncoated 325-milligram aspirin (not a baby aspirin), which thins the blood and interferes with blood clotting. It probably won't stop a heart attack, but it may limit the damage.
If you are able, unlock the doors, then rest. "Call someone to come over and wait with you," Krumholz says, "or talk with someone on the phone until help arrives."
Don't drive yourself to the hospital or have someone drive you. Ambulances have defibrillators in case your heart stops, as well as clot-busting medications, so EMTs may be able to start treatment before you get to the hospital. "If something goes south, they can deal with it," Krumholz says. "Equally important, they smooth the path for you. If you come in the front door, [hospital personnel] haven't had time to prepare for your arrival and you may have to wait for the cath lab team to assemble."
EMTs will also know the best cardiac center to take you to, says Sharonne N. Hayes, M.D., founder of the Women's Heart Clinic at the Mayo Clinic in Rochester, Minn. "The nearest hospital may be five minutes away," she says, "but the one best equipped to open up your arteries may be 15 minutes away."
Say the right things
When EMTs arrive, focus on describing your symptoms and any risk factors. Be prepared to tell people what medications you're on, or bring a list with you. "If someone is taking Viagra, we need to know," Krumholz says. Viagra and some other medications for erectile dysfunction cannot be taken with nitroglycerin, which is typically given during a heart attack, as the combination can trigger a potentially life-threatening reaction.
Some studies suggest that it's harder for EMTs to recognize heart attack symptoms in women because they are less likely to have classic symptoms such as chest pain. If EMTs don't zero in on your heart right away and you're concerned, it's OK to say, "I think I'm having a heart attack."
Some people believe that if you say you're having chest pain, you'll get faster attention. It's more important to be honest, Krumholz says. Still, if you're having chest pain, mention that symptom upfront.
Studies suggest that how you are perceived can make a difference in how you're treated. In research from the McGill University Health Centre in Montreal, men and women who were shy or reticent waited longer for treatment, says study author Roxanne Pelletier. Try to be assertive, and don't play down your symptoms. If you say, "Oh, it's probably just heartburn," your condition may not be taken as seriously.
There is no shame if your symptoms turn out to be a false alarm. "Don't worry about looking foolish or bothering people," Krumholz says. "To catch all heart attacks, we're going to have some people come in when there's nothing wrong."
New Heart Tests
Better tests for detecting a heart attack in progress or for screening for future risk are in the pipeline.
A test with higher sensitivity
Scottish researchers have come up with a blood test that can detect far lower levels of troponin — a protein released when heart muscle is damaged — than those currently available. In a study published in the Lancet, the test identified low troponin levels in about two-thirds of people who were hospitalized with symptoms, indicating they were at such low risk for a heart attack that they were eligible for an earlier hospital discharge.
An improved troponin testing device
Currently, detection of troponin requires bulky instruments available only in a well-equipped hospital. But a South Korean team has recently developed a thermometer-like device that could make determining heart damage almost as easy as taking someone's temperature. It tests a drop of a person's blood using nanoparticles sensitized to troponin antibodies. Years of testing lie ahead, however, before this will be available.
A screening tool
Cleveland Clinic researchers have found that a by-product of intestinal bacteria can increase a person's chances of having a heart attack. The chemical by-product, called trimethylamine N-oxide (TMAO), can be detected in blood and accurately predicts a person's risk for future cardiac events such as a heart attack or stroke. More testing is needed before screening for TMAO becomes a routine part of care.
What to expect in the hospital
When a heart attack is confirmed, patients usually undergo balloon angioplasty to open up the blocked artery and restore blood flow to the heart. The doctor threads a catheter, with a small inflatable balloon on the tip, through an artery near your groin or wrist and then to the site of the blockage. Next, the balloon is inflated, compressing the plaque against the artery wall to allow blood to flow. Typically, a tube of stainless steel mesh, called a stent, is then inserted into the artery to prop it open.
After the procedure and a day or more to recuperate, you'll leave the hospital with follow-up instructions and prescriptions to help reduce the chances of a second heart attack. You should also be referred for cardiac rehabilitation, a supervised program that includes physical activity, social support and education to encourage healthful behaviors. —B.H.
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