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: "Time is muscle"

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.

If angina occurs:

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

Download a Free Guide on Coronary Artery Disease and Treatment Options

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. If chest discomfort or pain is unimproved or is worsening 5 min after one dose, it is recommended that the patient or family member/friend/caregiver call 9-1-1 immediately to access EMS before taking additional NTG. In patients with chronic stable angina, if symptoms are significantly improved by 1 dose of NTG, it is appropriate to instruct the patient or family member/friend/caregiver to repeat NTG every 5 min for a maximum of 3 doses and call 9-1-1 if symptoms have not resolved completely.

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.

Last reviewed by a Cleveland Clinic medical professional on 04/25/2019.

References

  • McSweeney J, Cody M, O'Sullivan P, Elberson K, Moser D, Garvin B. Women's Early Warning Symptoms of Acute Myocardial Infarction. Circulation. 2003; 108(21):2619-2623
  • ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction._ Circulation. _2007;116:e148-e304, June 27, 2017.
  • ACC/AHA 2014 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction._ Circulation. _2014;130:e344-e426., September 23, 2014.

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