Around 1990, use of clot-dissolving drugs to dissolve the clot in the coronary artery that caused the heart attack became the standard of care. The earlier they were given, the better they worked, and the mantra became “time is muscle.” The drugs worked best when given within 6 hours of symptom onset.
In the early 2000’s, an even better treatment became standard: angioplasty - opening the blocked coronary artery by putting a catheter in the artery and opening the artery with a small inflatable balloon. Current best practice is to then put in a stent to keep the artery open.
What has happened in the past 35 years with these advances is that the early (30 day) death rate from an acute heart attack has fallen from over 20% to under 5%. To achieve these results, the earlier the better. Hospitals strive to get a patient from arrival at the emergency room to the cath lab in under 90 minutes. Most hospitals that provide emergency angioplasty have systems in place to achieve this goal.
The weakest link? The patient calling 911! To get the best contemporary care and to have the best odds of surviving a heart attack, it is key that someone experiencing a heart attack gets care ASAP.
How do you suspect you may be suffering a heart attack? The textbook description is crushing pain felt under the sternum (breastbone). The pain is often felt in the jaw and/or left arm as well. You may get sweaty, and you may feel nausea. The pain is not always excruciating – heart attacks are not as painful as childbirth or kidney stones – but there is something about it that tells you “this is serious.”
Unfortunately, your body has not always read the textbook.
Some people experience sudden shortness of breath rather than pain. Some become profoundly weak. Some feel abdominal rather than chest pain. In most situations, this is a new symptom, one you have not had before.
Women, particularly young women, much more than men, are likely to have non-textbook symptoms, and as such are more likely to delay seeking care and/or be treated less urgently than men who show up complaining of “something sitting on my chest.” Some 40% of younger (under 50) women with heart attacks do not complain of chest pain. (By the time women pass 65, they have similar symptoms as men.)
If you experience symptoms that may be a heart attack, call 911 and get an emergency ambulance. Do not drive yourself to the emergency room. In some communities, the advanced Emergency Medical Technicians who arrive may be able to initiate treatment even before you get to the hospital.
In virtually every situation, arriving by ambulance will get you seen and treated faster than presenting at the front desk.
If it is not a heart attack? Great – you will be allowed to go home and follow up with your doctor for any more testing needed. Never be “embarrassed” by a false alarm. Every emergency physician will tell you it is better to come in when you are not having a heart attack than to stay home and suffer the consequences when it is one.
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Ed: As a one-time embarrassed false alarm heart attack patient, I appreciated everything you said here. In my situation, the EW staff were happy to rule out heart attack and said nothing to make me sorry for the visit. My fear of wasting everyone's time was something I brought to the hospital with me. The only thing I would add to what you said is that as a patient who has had heart attack ruled out, you have to be satisfied with ambiguity about alternate explanations for your chest pain. In my case I had a choice of: general stress from a recent cancer diagnosis, a predisposition to amplify chest pain concerns due to a recent heart attack in the immediate family, bone pain at tumor sites from recently initiated cancer treatment, or... shrug. More than a year later, I just think: if the EW docs can rule out heart attack, you take the win and try not to work to hard at the alternative explanations.
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