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 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 -- and over the long term.

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, an MI 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. An MI 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 an MI depends on how much heart muscle dies, which, in turn, is related to which coronary artery is blocked, and where in the artery the blockage occurs. A blockage near the origin of an artery will affect more heart muscle than a blockage farther down the artery.

If the 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 an MI, or aggressively treating heart failure should it develop acutely, is an extremely important aspect to treating an MI.

An MI 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 both during an acute MI and after full recovery from an MI.

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

For anyone having an MI, getting rapid medical attention is absolutely critical for two reasons:

  • Most of the cardiac arrests seen with acute MIs 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 an MI 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.

    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. Second, it requires that the medical personnel who are caring for you do the right things, and do them quickly. The following articles will help you do what you need to do, and to get the care you need to get.

    Help Yourself Survive A Heart Attack:

    Sources:

    Cannon, CP, Hand, MH, Bahr, R, et al. Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program. Am Heart J 2002; 143:777.

    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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