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Call 911 - Before It's Too Late

Don’t Be Embarrassed to Death!

The good news about heart attacks:

Advances in technology over the past decade or so have dramatically lowered the death rate from acute heart attacks (myocardial infarction, or MI).

The bad news:

Many people never get to the hospital in time to take advantage of these life-saving advances. In fact, about 40% of the 1.1 million heart attacks that occur annually in the U.S. are fatal. That’s about 460,000 deaths from heart attack. Many more patients who survive their heart attacks do so with chronically damaged hearts.

Why timing is everything

When an acute MI occurs, there is a limited amount of time before significant and long-lasting damage is done to the muscle of your heart. If a large area of the heart is injured during the heart attack, full recovery becomes much more difficult. To obtain the greatest benefits of emergency care, anyone who thinks they are having a heart attack should get to the hospital within one hour of the onset of symptoms. The sooner you get to the emergency room, the sooner the appropriate treatment can begin, meaning the lesser the chances of permanent damage.

Sadly, only one in five patients actually gets to the hospital within this time frame. Therefore, many people who survive the MI are unnecessarily left with large portions of the heart scarred by the heart attack. This decreases the heart’s ability to pump blood effectively. Such patients may experience lifelong problems such as shortness of breath and angina (chest discomfort). Patients are also at an increased risk of developing heart failure, in which the heart weakens progressively over time.

Call 911 – not a friend

Calling 911 is almost always the fastest way to get lifesaving treatment. Emergency medical services (EMS) staff can begin treatment when they reach you. And they are trained to revive someone whose heart has stopped. Also, you’re likelier to get treated faster at the hospital if you arrive by ambulance.

If you are having symptoms of a heart attack, do not drive yourself.

What are the warning signs of a heart attack?

  • Sudden chest pain or pressure (also called angina) that worsens. This may be felt as discomfort, heaviness, or pain. May also be felt in the back, jaw, throat, arm or below the breastbone.
  • Feeling as if a belt is being tightened around your chest
  • Pain that spreads from the center of the chest to your arms, shoulders, neck or jaw
  • Sweating
  • Feeling sick to your stomach, nausea, vomiting
  • Dizziness
  • Shortness of breath
  • A fullness, indigestion or choking feeling (may feel like "heartburn")
  • Rapid or irregular heartbeats
  • Extreme weakness, anxiety

Why do people delay?

Many people don’t recognize the symptoms of a heart attack (see list). The image we get from TV and movies is that a heart attack is a dramatic, chest-clutching event, yet this is rarely the case. Arm pain may signal a heart attack. Or shortness of breath. Or even an awareness of sweating.

Some people mistake heart attack symptoms for heartburn, take an antacid and wait for it to work. Many people will call 911 for someone else, but not for themselves.

Many people feel they will be embarrassed if they call 911 and they are not in fact having a heart attack. But don’t be embarrassed to death – heart attacks are the leading cause of death in both men and women.

What can you do?

Planning what to do ahead of time in case of a heart attack could save your life or someone else’s. We recommend the following steps as part of your plan:

  1. Learn the signs of a heart attack.
  2. Ask your doctor whether you are at risk for a heart attack and what you can do about it. Be sure to ask about aspirin and nitroglycerin.
  3. Talk with your family members, friends and coworkers about the heart attack warning signs and the importance of acting quickly.
  4. Discuss the benefits of calling 911.
If angina occurs:

If you have been prescribed nitroglycerin and experience angina, stop what you are doing and rest. Take one nitroglycerin tablet and let it dissolve under your tongue, or if using the spray form, spray it under your tongue. Wait 5 minutes. If you still have angina after 5 minutes, call 911 to get emergency help.

For patients diagnosed with chronic stable angina: If you experience angina, take one nitroglycerin tablet and let it dissolve under your tongue, repeating every 5 minutes for up to 3 tablets spanning 15 minutes. If you still have angina after taking 3 doses of nitroglycerin, call 911 to get emergency help.

[Reference: ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Journal of the American College of Cardiology, 2007. 50(7):1-157.]

Use of Aspirin with unstable chest pain: After you call 9-1-1, if you do not have a history of aspirin allergy or bleeding, emergency personnel may advise that you chew one full (325 mg) aspirin slowly. It's especially effective if taken within 30 minutes of the onset of symptoms.

Do not drive yourself to the hospital. In many cases, the emergency personnel can begin to give you heart-saving care right away.

To prevent damage to your heart muscle, do not delay seeking medical treatment.

What is Nitroglycerin?

Nitroglycerin is the most common vasodilator used for acute cases of angina. It works to dilate or widen the coronary arteries, increasing blood flow to the heart muscle and to relax the veins, lessening the amount of blood that returns to the heart from the body.

This combination of effects decreases the amount of work for the heart. Nitroglycerin comes in tablet or spray form. If you have angina, it is important that you keep this medication with you at all times.

  • Nitroglycerin must be kept in a dark container.
  • Keep it away from heat or moisture.
  • Check the expiration date on the container.
  • Once the container is opened, it must be replaced every 6 months

Information and Resources:

*a new browser window will open with this link. The inclusion of links to other web sites does not imply any endorsement of the material on the web sites or any association with their operators


If you need more information or would like to make an appointment with a specialist, contact us, chat online with a nurse or call the Miller Family Heart and Vascular Institute Resource & Information Nurse at 216.445.9288 or toll-free at 866.289.6911. We would be happy to help you.

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

© Copyright 2010 Cleveland Clinic. All rights reserved. 01/10

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