What to Do in the First Minutes of a Heart Attack

The commonest sign of a heart attack is pressure, heaviness or tightness in the middle of the chest that lasts more than a few minutes and may spread to the arm, jaw or back. If a cold sweat, nausea or breathlessness comes with it, call 1122 or reach DHQ Hospital Abbottabad Emergency.

What are the main symptoms of a heart attack?

The core symptom is a feeling of pressure, tightness or heaviness in the centre of the chest, as though a weight has been set down on it. It lasts more than a few minutes, or it fades and returns. The feeling often travels into the left arm, both arms, the jaw, the neck, the back or the upper stomach.

With or without that chest pain, these can also be signs of a heart attack:

• A cold sweat, even when the weather is not hot
• Nausea or vomiting
• Breathlessness, including at rest
• Severe weakness or dizziness
• An unusual sense of dread, hard to explain to anyone else

The American Heart Association makes a point that patients often miss: heart attack pain is not always severe. Many people feel only an uncomfortable pressure and talk themselves out of it. For recognising a heart attack, what matters is not how dramatic the pain is but how long it stays. Our heart attack page explains what is happening in the artery and how the condition is treated.

Who gets different or silent symptoms?

Women, elderly patients and people with diabetes often have a heart attack that looks nothing like the television version. Instead of clear chest pain there may be only breathlessness, exhausting fatigue, nausea, or pain in the jaw and back. This is precisely why those three groups reach hospital latest.

In women the picture regularly steps outside the male pattern: a tiredness so heavy that ordinary housework becomes impossible, breathlessness on small tasks, or a burning in the upper stomach that no antacid touches. Families tend to file this under weakness or a bad stomach, and hours disappear while they do.

Diabetes makes it harder still. Raised sugar over years dulls the nerves that carry pain, so some patients feel very little during a heart attack, or nothing at all. Adopt a simple household rule: in an older person, a woman, or anyone with diabetes, a sudden new symptom with no obvious explanation, even if it is only breathlessness, may be the heart asking for help. Get it checked immediately.

What should you do in the first minutes?

Call 1122, or get the patient to DHQ Hospital Abbottabad Emergency without stopping to think about it. Sit the patient down, stop them walking about, loosen tight clothing, and stay with them. Medicines, remedies and waiting are not the first step. The call is.

Step by step:

1. Call 1122, or have someone else in the house do it while you stay with the patient. Rescue 1122 ambulances cover Abbottabad and the surrounding area.
2. Sit or half-recline the patient. No stairs, no walking out to the car unaided, no packing a bag. Every bit of exertion adds load to a heart that has none to spare.
3. Loosen tight clothing and open a window so the room is not stuffy.
4. Do not leave the patient alone. The situation can change in a moment.
5. Do not give aspirin on your own judgement. It belongs to the emergency staff or the patient's own doctor.
6. Pick up the patient's medicines and old reports if they are within arm's reach, but do not go hunting for them. They are not worth a lost minute.

One thing worth repeating: the patient must not drive. Consciousness can go at any moment during a heart attack, and in a moving car that gamble is taken with other lives too.

Which common mistakes put lives at risk?

The deadliest mistake is calling it gas and waiting. In our households, chest pressure gets waved away with a comment about gas, even though gas pain almost never arrives with a cold sweat and breathlessness. That one sentence kills people every year in this country.

The others are worth naming plainly:

Home remedies. Kahwa, ajwain, a family recipe. None of them opens a blocked artery, and every minute spent on them is heart muscle handed over.

Waiting for morning. When symptoms start at night, families reason that the doctor can be seen after fajr. Hospital Emergencys are open all night, and night-time delay is one of the commonest reasons patients arrive too late.

Waiting for the pain to stop by itself. Pain can ease and come back. Easing is not safety.

Going to a clinic or a hakeem first. An active heart attack needs an Emergency, not an appointment. Clinics are for the follow-up afterwards.

The rule is simple: when in doubt, treat it as the heart. If you reach the Emergency and it turns out to be acidity, that is a good day. The bad trade is the one where the pain everyone called gas turns out to be dil ka daura.

What should you do if the patient collapses?

If the patient loses consciousness and is not breathing, or is only gasping, call 1122 and start CPR straight away. Lay them flat on a hard surface, put both hands in the centre of the chest, and push hard and fast without stopping.

CPR is not a specialist skill locked away with doctors. Chest compressions are something every adult in a household should know how to do. The American Heart Association teaches ordinary people exactly this: call for help, then start hands-only CPR, because those compressions do the stopped heart's job and keep blood reaching the brain until the ambulance arrives.

Do not pause the compressions. When you tire, swap with someone else in the room and keep the rhythm going until the ambulance crew takes over or the patient starts moving. Do not try to give an unconscious person water, put anything in their mouth, or shake them awake. Those things waste time and can do harm.

How is a heart attack treated in hospital?

The moment a patient reaches the Emergency, an ECG is done, and within minutes it shows whether a heart attack is under way. After that the goal is single-minded: open the blocked artery as fast as possible, either with clot-dissolving medicine or with angioplasty.

A heart attack is the sudden closure of an artery supplying the heart, usually because a clot has formed on a fatty deposit. The muscle downstream dies minute by minute, which is why European Society of Cardiology guidelines build heart attack treatment around time above everything else. The earlier the artery opens, the more muscle survives.

In hospital the patient is given blood-thinning medicines, and where needed an angiography is done to locate the blockage. In many patients an angioplasty follows in the same sitting, with a balloon and a stent opening the artery. None of this is cause for panic. These are routine, well-tested procedures, and the biggest single factor in their success is how quickly the patient arrived.

What happens after a heart attack?

Surviving a heart attack is the start of a new chapter, not the end of the story. Taking medicines regularly, coming to follow-up, and changing daily habits are what stop the next one. Never stop a prescribed medicine on your own judgement, however well you feel.

At follow-up the doctor reviews the medicines, checks blood pressure and sugar, and decides which tests are needed to assess the heart's strength. Giving up cigarettes and naswar for good, cutting salt and fried food, and walking a little every day work alongside the tablets rather than instead of them.

Dr. Muhammad Ali Khan is a Consultant Cardiologist based in Abbottabad, with FCPS (Cardiology) training and more than ten years spent treating heart patients. Patients from Abbottabad and the surrounding districts see him for post-heart-attack follow-up, heart failure treatment and full cardiac assessment. Our dil ka doctor Abbottabad page has the details. A clinic consultation costs Rs. 2,000 and an online video consultation costs Rs. 2,500, and you can book through the appointments page.

The last word is the same as the first. If there is chest pressure, a cold sweat or breathlessness right now, stop reading this page and call 1122, or go to DHQ Hospital Abbottabad Emergency. Appointments are for problems that can wait. A heart attack never can.