Every year we see patients arrive six or eight hours after their symptoms began, having waited for the pain to "settle". By then a large part of the heart muscle cannot be saved. The single most useful thing you can learn about heart attacks is what they actually feel like.
1. Chest discomfort that is pressure, not a sharp stab
Most people describe heaviness, tightness or a squeezing band across the middle of the chest rather than a sharp pain. It typically lasts more than a few minutes and does not change with position or breathing.
2. Pain that travels to the left arm, jaw, neck or back
Referred pain is common and often confusing. Jaw or upper-back pain with sweating deserves an ECG, not a painkiller.
3. Breathlessness out of proportion to the activity
If climbing one flight of stairs suddenly leaves you gasping when it never used to, that is a change worth investigating the same week.
4. Cold sweat with nausea or vomiting
Being drenched in sweat while feeling sick is a classic autonomic response. It is frequently mistaken for acidity or food poisoning.
5. Unexplained exhaustion, especially in women
Women more often present with profound fatigue, mild breathlessness or discomfort between the shoulder blades rather than dramatic chest pain. This is one reason heart attacks in women are diagnosed later.
6. A sense of impending doom
Patients often say they simply knew something was seriously wrong. Take that instinct seriously — it is reported often enough to be clinically meaningful.
7. Silent symptoms in diabetics
Long-standing diabetes damages the nerves that carry pain. A diabetic patient may have a significant heart attack with nothing more than mild breathlessness or unusual tiredness.
What to do in the first ten minutes
- Stop all activity and sit down. Do not drive yourself.
- Call an ambulance rather than arranging a private car — an ambulance can start an ECG and treatment on the way.
- If you are not allergic and have no bleeding disorder, chew a 325 mg aspirin tablet.
- Unlock the front door so paramedics can reach you if you collapse.
Angioplasty within the first hour can salvage almost all of the threatened muscle. At three hours, much less. At twelve hours, the damage is largely permanent. That is the whole argument for not waiting.
