What to Do If You're Having a Heart Attack

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This survival-medicine website provides general information, not individual advice. Most scenarios assume the victim cannot get expert medical help. Please see the disclaimer.

What to Do If You’re Having a Heart Attack

Automated external defibrillators are now widely available in public places. (This one’s at the September 11 memorial in New York.) If you’re having a heart attack in a mall or school, for example, have someone look for an AED in case you need it. AEDs are also available to buy for home use.

by James Hubbard, MD, MPH

When I first started practicing, in the early 1980s, what we would do for a heart attack was simple. (Of course many more died back then also.)

If you were suspected of having a heart attack you were placed in a cardiac-care unit, put on oxygen, and given pain medicine as needed. We tried to regulate your blood pressure and carefully monitored and treated you for the dangerous irregular heartbeats.

Gradually, you were moved out to a regular room; very gradually, we tried to increase your activities, and after a few weeks, you were sent home. The coronary catheterization and possible bypass came about six weeks after your attack to try to prevent future ones.

Now, we still do all those things—the CCU, oxygen, pain meds—but also much more. The catheterization comes quickly, and so do methods to try to stop a heart attack in its tracks.

The reason I tell you this is, if you have any suspicion that you or someone else is having a heart attack, call 911. Things can be done in the hospital right away that can’t be done anywhere else. If you’re out on a camping trip and you have a cell phone, call 911 for helicopter transport. The key to increase your chance of survival is getting expert medical care in a hospital as soon as possible.

How Do You Know If You’re Having a Heart Attack?

Classic symptoms are:

  • A crushing feeling in the middle of your chest. It usually lasts for several minutes or comes and goes.
  • Pain radiating down the left arm or into the jaw.
  • Nausea
  • Shortness of breath

Sometimes you have all of these symptoms, sometimes just one. And too often, you have none.

Other symptoms can be:

  • Extreme fatigue
  • Heart palpitations
  • Indigestion feeling
  • Dizziness or lightheadedness

I think you’d agree these last symptoms are pretty general, but if you can’t easily explain them or they linger, get checked out ASAP. I know of at least two friends, one a doctor, who had not specific symptoms at all, but they just didn’t feel right. An EKG showed they were having a heart attack.

Although you can be young and healthy and have a heart attack, be extra precautious if you have risk factors such as being overweight, being a smoker, having high blood pressure or high cholesterol, not exercising, or having someone in your immediate family with heart disease.

For more information visit the American Heart Association’s website.

But, if getting to a hospital or health-care provider is impossible, here are some tips on what to do if you’re having a heart attack.

First Steps

The tips in this section are pertinent to anyone—whether an ambulance is coming or not.

  1. Chew up and swallow an aspirin. It could help keep the clot in your artery from getting worse. A baby aspirin is enough, but any size works.
  2. Lie down and try your best to relax. I know the relaxing part is asking a lot, but you want to put as little physical and mental stress on your heart as you can.
  3. If you’re in a public place, many have AEDs (automated external defibrillators.) In case you end up needing it (see the box at the end of the article), someone should try to find an AED and then open it and read the instructions. You’ll be surprised how simple it is to operate for nonmedical and medical people alike. You don’t even have to know how to read. Turn it on, and you’ll receive audible instructions.
If You Can’t Get Medical Help

If you can’t get expert help:

  1. Get in as much oxygen as you can. If you have a canister, use it. If not, have someone open window (if it’s not to cold). And, oh please, don’t smoke or have it in the air you’re breathing.
  2. Speaking of the cold, try to stay warm. Use a blanket if necessary. The body doesn’t function as well and has to use more energy if you’re cold.
  3. Use whatever medicine you have available for pain.

After a heart attack, if you can’t get medical help:

  1. Bed rest is very important to put less stress on the heart. This should go on for weeks, to give the heart time to heal, but that’s obviously pretty impractical, so I’d rest completely for three days if possible or at least for 24 hours after the pain goes away. After that, start sitting up for meals and going to the bathroom.
  2. No strenuous exercise for at least six weeks.
  3. Continue an aspirin a day indefinitely unless you have a blood disorder or ulcers or are on Coumadin (warfarin).
  4. See a doctor when you can.

Have any of you ever had a heart attack or other heart pain, such as angina? What did it feel like? What did you do?
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What to Do If Someone Else Is Having the Heart Attack

If someone you’re with is having a heart attack and is conscious, follow the steps in the main article.

If the person is unresponsive (not groaning, not responsive to pain, not breathing):

  • If there is an AED, put the pads and paddles on his/her bare chest, turn the AED on, and follow the audible instructions. (Someone should also be ready for CPR.)
  • If there’s not an AED and you can’t find a pulse: I’d start with a sharp precordial thump (a sharp rap down on the middle of the chest with a fist). Rarely, this can shock the heart back into a more efficient beat. After that, check for a pulse again. If you get one, continue the steps in “If You Can’t Get Medical Help” (above). If you don’t and the person is still unresponsive, start CPR.

When do you stop CPR? If medical personnel are on the way, don’t stop until they take over. If you’re sure no medical personnel are coming, it’s kind of a guessing game on when to stop. I’d probably continue for about 20 minutes or until I gave out. I’d go longer if someone had been electrocuted (including by lightning) or had drowned in cold water because in both, there have been instances of recoveries even an hour or more later. A lot depends on your stamina and if you have someone to help you. Don’t risk your own health.

 

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  • Dave

    What did I do and what did it feel like? Here is my story. My family history includes both my father and paternal grandfather dying of massive heart attacks at age 47. So I’ve been aware of heart issues since I was 15 though it didn’t stop me from smoking until too late. I’ve had 3 heart attacks, beginning with one at 35 years old (09/1993). The symptoms of that one were classic, nausea, feeling like someone was sitting on my chest, pain in the center of my chest and finally pain radiating down my left arm. However, by the time I got to the hospital in the ambulance the pain and other symptoms had subsided to the point they weren’t sure I’d had a heart attack until the blood tests confirmed the event. A couple days later, while undergoing angioplasty, I suffered a dissection and had to have emergency triple bypass. I recovered, quit smoking for good and went 13 years without any real problems.

    In 2006, I had another heart attack but the only real symptom was pain, like someone trying to shove a pencil through the center of my chest. I wasn’t completely sure what was happening but once I decided it was heart related I immediately chewed a full strength aspirin while my brother drove me to the hospital (we were close enough it was faster than waiting for EMTs). A couple stents and a few days later I was feeling better than I had in months. Looking back it was easy to see how I had been declining but only in hindsight was I able to identify the indications I had dismissed.

    In 2009 I suffered a third heart attack while working on my car. I felt the same intense, centralized pain in my chest, accompanied by nausea, sweating and dizziness. I told my wife to give me a full strength aspirin and again we drove to the hospital. this time the pain in my chest was much worse. They flew me to a heart center located a half hour from my home and gave me another couple stents. During this procedure I woke up on the table, an experience I’d rather not have again. Literally in less than 24 hours from the time I arrived at the first hospital I walked out of the hospital feeling amazingly well.

    Since then they have tried to stent the originally bypassed artery twice with no success due to the way the bypass changed my anatomy. So for now, until someone creates a much more flexible stent that will go around corners my treatment is medicinal. The care I have been given over the years has been nothing short of phenomenal and my hat is off to all the men and women who have worked so hard to keep me alive. The bottom line of all this is that each of my heart attacks had similarities and some extreme differences. My advice to everyone is to err on the side of caution especially if you have risk factors like family history and smoking. My Dad apparently had a small heart attack that he did not recognize and the second one killed him. I might have gone the same way if not for being more aware. And even knowing what to expect there were times I didn’t see what was happening until nearly too late.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks for sharing that, Dave.

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  • A Scribe

    It’s a bit early to recommend it, but some of the research in Remote Ischemic Postconditioning makes it look promising for heart attack and stroke in the wilderness. We’ll need to see some of the results of ambulance field tests, but it seems like rather than a blood pressure cuff the same treatment could be done with any tourniquet.

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      Thanks.

  • prayer walker

    I’m new here, so apologies if this has been covered. After I had heart attacks/surgery (3 MIs, stents, CABGx3 since 11/2011) a friend emailed me with suggestion on what to do in the event of a heart attack. the advice was to take deep breaths and force yourself to cough repeatedly and rapidly, at the same time squeezing the chest. This was supposed to at least buy you time to call 911 and wait for help. Could you please comment on this?

    • http://thesurvivaldoctor.com/ James Hubbard, MD, MPH

      To my knowledge the things you mentioned would not help or buy you time until 911 gets there. It’s just one of those things that gets started on the internet and spreads as fact. Some internet sites claim this would increase blood flow to the heart but there’s no proof to those claims. Sometimes a cough or gag (valsalva maneuver) (more on that here– http://www.thesurvivaldoctor.com/2012/10/25/fast-heart-rate/ –can cause the heart to slow in certain situations when it’s beating too fast, but continued coughing would not do anything. The following is a link to the American Heart Association take on this http://www.heart.org/HEARTORG/Conditions/More/CardiacArrest/Cough-CPR_UCM_432380_Article.jsp

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