Definition

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.

Alternative Names

First aid - heart attack; First aid - cardiopulmonary arrest; First aid - cardiac arrest

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 pubmed.ncbi.nlm.nih.gov/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 pubmed.ncbi.nlm.nih.gov/34882436/.