It is the middle of the night, and your partner shakes you awake, saying "I can't breathe, and I am sweating like crazy."  Listen to her symptoms!  Not everyone who is having a heart attack has chest discomfort.  The classic kind of pain in the chest, which is often described as feeling like an elephant  is sitting on one's chest, only occurs about 25% of the time, and more unusual symptoms are the rule.  Women tend to have symptoms that are different than men, more often experiencing shortness of breath, jaw discomfort, discomfort in the arm or sweating.

If you have the slightest suspicion that you or a loved one may be having a heart attack, it is important to call 911 and get help immediately.   Let's describe exactly what is going on inside your heart when a heart attack begins and you will see why time is of the essence.

Picture your coronary arteries, which over the years may have developed blockages (which we call plaque) that have not caused you any symptoms at all.  Any blockage of your coronaries that is less than 75% will probably not cause a symptom such as chest discomfort or shortness of breath.  Even a cardiac stress test can miss a mild blockage such as this.   Things can happen that begin to irritate this blockage- whether it is smoking cigarettes, having diabetes or high blood pressure, or the effects of the stress in your life. The irritated, often ulcerated blockage tries to heal itself, usually by a scab.  This sets off a process that involves blood clotting at the site of the scab. Remember, our coronary arteries are tiny, so it does not take much of a scab to form a tiny blot clot that completely closes off the artery, and prevents any blood from getting past.  If this happens, the heart muscle immediately is deprived of any blood, and this causes a heart attack.

Many heart attacks occur early in the morning.  Due to our Circadian rhythm, our blood tends to be a little bit stickier in the early morning hours, making it more likely that a clot can form, and totally close off the blood vessel.

Once this tiny clot forms, a clock begins to tick.  No blood to the heart means that the heart muscle will quickly begin to die.  The muscle cries out for more blood and oxygen; this cry is the chest discomfort, shortness of breath, sweating, or other symptoms that you may experience.  If the blood supply to the heart is restored within one hour, then no permanent damage may result.

If more time goes by, the heart begins to have damage, which can be permanent.  One of the biggest advances in the field of cardiology in the past 20 years has been to develop methods to quickly restore the blood flow to the heart.  Here are some things that you need to know:

  1. If you think you may be having a heart attack, take an aspirin.  This may help break up the blood clot and open up your artery,  Best to chew it, and not swallow it whole, so it can begin to work quickly
  2. Call 911. Every moment is precious, and that clock is ticking toward damage to your heart.  Do not drive yourself.  During the minutes of no blood supply to the heart muscle in the early stages of a heart attack, the heart muscle is extremely irritable as it is not getting enough oxygen.  A potentially fatal arrhythmia called ventricular fibrillation can occur, and this can only be fixed by a defibrillator or an AED (or automated external defibrillator) which an ambulance will have
  3. There are conditions other than a heart attack that can cause these symptoms.  Only about one in five people who go to the hospital for chest discomfort are actually having a heart attack.  Although other things such as heartburn, gallbladder problems, and panic attacks can mimic a cardiac problem, it is much safer to get yourself checked out in case it is really your heart.
  4. If you are having a heart attack, and damage is ongoing, the best thing that can happen is to have an emergency cardiac catheterization.   A coronary stent can be placed to open up the blockage and restore blood flow.  Hospitals have set up systems to ensure that this happens quickly, as the faster the artery is opened, the less the long term damage.
  5. Do not feel foolish or silly if you are having symptoms and want to get checked out.  Get to the hospital right away.  Waiting out these symptoms could be the worst decision of your life if a heart attack is missed, as preventable damage may occur.  It is better to be a little bit cautious, and be sure nothing is wrong.
  6. Even if it turns out that it is not your heart causing your symptoms, it might mean an overnight stay in the hospital to be fully evaluated.  It often takes a couple of electrocardiograms and a blood test called a troponin (which is a sensitive test of early heart damage) to be sure. When it comes to checking out your heart when you are having discomfort, better safe than sorry

On the 22 day of this program, my doctor said to me:

  1. If you think you might be having a heart attack, call 911, and chew an aspirin
  2. During the early moments of a heart attack, the heart muscle is vulnerable to possibly fatal irregular heartbeats, so it is important not to drive to the hospital, but to call for an ambulance.
  3. Act quickly, as damage can be reversed if not too much time has gone by

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