How to Survive a Heart Attack

The First Few Minutes and Hours Are Critical to Surviving a Heart Attack

Senior businessman with heart attack helped by wife and doctor
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There are two very good reasons you should know how to survive a heart attack. First, odds are very high that either you or someone you love will suffer from a heart attack during your lifetime. And second, whether you survive that heart attack may depend on what you and your doctors do about it during the first few hours.

What Is a Heart Attack?

A heart attack, also called a myocardial infarction (MI), is the most severe form of acute coronary syndrome (ACS).

Like all forms of ACS, a heart attack is usually triggered by the rupture of an atherosclerotic plaque within a coronary artery (the arteries that supply oxygen to the heart muscle). This plaque rupture causes a blood clot to form, leading to blockage of the artery. The heart muscle being supplied by the blocked artery then begins to die. a heart attack is diagnosed when there is death of a portion of heart muscle.

What Are the Consequences of a Heart Attack?

To a large degree, the outcome of a heart attack depends on how much heart muscle dies. The volume of heart muscle that dies is related to which coronary artery is blocked, where in the artery the blockage occurs, and (possibly most important) how much time passes before the artery can be re-opened with treatment. A blockage near the origin of an artery will affect more heart muscle than a blockage farther down the artery.

A blockage that persists for five or six hours will cause substantially more heart muscle death than a blockage that is reversed within two or three hours.

If the amount of heart muscle damage is severe, it is possible to develop acute heart failure during the MI itself, which is a very dangerous condition.

If the amount of heart muscle damage is less severe but still significant, heart failure can still develop later on. So, taking steps to prevent heart failure after a heart attack, or aggressively treating heart failure should it develop acutely, is an extremely important aspect of treating a heart attack.

A heart attack can also produce dangerous heart arrhythmias. During the acute MI itself, electrical instability occurs that may cause ventricular tachycardia (VT) and ventricular fibrillation (VF). Later, the scar tissue that results from the healing process can cause a permanent electrical instability. So, unfortunately, cardiac arrest and sudden death are risks that are present both during an acute heart attack, and (to some extent) after full recovery.

Why Are the First Few Hours of a Heart Attack Critical?

For anyone having a heart attack, getting rapid medical attention is absolutely critical for two reasons:

  • Most of the cardiac arrests seen with acute heart attacks occur within the first few hours. If a cardiac arrest occurs after a heart attack victim has reached the hospital, there is an excellent chance it can be successfully treated; otherwise the odds of surviving a cardiac arrest are very low.
  • Both the short-term and the long-term consequences of a heart attack are largely determined by how much of the heart muscle dies. With rapid and aggressive medical treatment, the blocked artery can usually be opened quickly, thus preserving most of the heart muscle that is at risk of dying. If treatment is given within three or four hours, much of the permanent muscle damage can be avoided. But if treatment is delayed beyond five or six hours, the amount of heart muscle that can be saved drops off significantly. After about 12 hours, the damage is usually irreversible.

If You Think You Might Be Having a Heart Attack

Getting rapid and appropriate medical care requires that two things happen.

 First, it requires that you know the signs of a heart attack, and seek medical help the moment you think you might be having one. While chest pain is the “classic” symptom of a heart attack, other kinds of symptoms can occur in addition to (or instead of) chest discomfort. These may include an unexplained sudden sense of intense fear, profuse sweating, shortness of breath, discomfort of the jaw, neck, shoulders, or arms, or heartburn-like symptoms. Anyone who has risk factors for coronary artery disease ought to be especially alert to any of these symptoms. Here’s more on how to recognize the symptoms of a heart attack

If you think there’s any chance you may be having a heart attack, you need to get medical help as quickly as possible. Minutes can make the difference between longterm health, or longterm disability or death.

Second, getting the immediate care you need requires that the medical personnel who are caring for you do the right things, and do them quickly. Remember: every minute is critical. Make sure the first doctors you see know you are concerned about a possible heart attack, and that they are taking the possibility seriously. In general, once the medical personnel are keyed in to this diagnosis they will act rapidly to make the diagnosis, and if a heart attack is indeed in progress, to administer therapy. Read about the immediate treatment for acute heart attacks.

Simply saying the words, “I might be having a heart attack,” will do the trick. Too many people with heart attacks will try to minimize their symptoms when they see the doctor, and say something like, “It’s probably just heartburn.” Don’t do that, because minutes matter. Get the doctor started down the path of checking for a heart attack right away. If it does turn out to be just heartburn, they’ll figure that out quickly. 

It’s the people who take their symptoms seriously, and act quickly, who have the best chance of surviving a heart attack in good health.

Sources:

O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA Guideline for the Management of ST-elevation Myocardial Infarction: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.

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