What to Do During a Heart Attack with Jacqueline Tamis-Holland, MD

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Every 40 seconds, someone in the United States has a heart attack. How you respond to that situation can mean life or death. Acting quickly can limit damage to the heart and improve the chance for survival and a full recovery. Every second counts. That can't be emphasized enough. So today, we're going to learn how to maximize every tick-tock of the clock from cardiologist Jacqueline Tamis-Holland. She's one of the many experts at Cleveland Clinic who visit our weekly podcast to talk health.

Now, let's get moving on learning what to do if someone is having a heart attack. After all, we don't have time to waste.

Welcome back to the podcast, Dr. Tamis-Holland. Thanks for joining us again for a little ticker talk.

Dr. Jacqueline Tamis-Holland:

Thanks, John. I'm really happy to be here today. Thanks.

John Horton:

So let's start with just, I guess, a basic truth, and that heart attacks are terrifying to even think about for most folks. It just has such a “this game is over” feel when it comes to life. I'm guessing you field a lot of worried questions from people on the topic.

Dr. Jacqueline Tamis-Holland:

For sure. Yeah. We see a lot of concerns and a great spectrum of the concerns that people have regarding it.

John Horton:

Yeah. You worry that that's it. You're going to have a heart attack and just drop and that's it. Is it that bad or do we fear it maybe more than what we should?

Dr. Jacqueline Tamis-Holland:

Yeah. So yeah, I think a heart attack is extremely serious compared to what it was maybe 50 years ago when we had less therapies for it and we were less aware of what was going on. I think it's a little less serious than it was 50 years ago, but it is still an extremely serious problem. I would say the range of how serious it is will depend on the severity of the heart attack. It can range from a very small leakage of heart enzymes — because of a very small damage that's not even noticeable on an echo — to a severely blocked major artery that leads to severe heart muscle weakness. And so the seriousness of it will depend on this type of heart attack you have. But it's certainly not the type of thing where people feel like, oh, you won't survive the hospitalization. Most people do perfectly well and survival is well over 95% at one year or so forth. Yeah.

John Horton:

Oh. 95% is a good number. So that's something that should make people feel a little better about your chances of walking away from it, which I think is what we all worry about. And this is going to sound stupid, but can you just define what a heart attack is? Because I think sometimes, people get confused with that, cardiac arrest, and they just know it's bad. So what exactly is happening if you have a heart attack?

Dr. Jacqueline Tamis-Holland:

For sure, I would like to tell you that, because I think that is a major misunderstanding among patients.

So a heart attack is a situation in which there's a blockage in the artery or there's temporarily poor supply to the heart muscle because of poor blood flow to the heart muscle. Most often, it's due to either a temporary blockage in an artery that has a severe blockage and it's temporarily totally closed or a total closure of the artery that lasts for a long period of time. And so when the artery closes up, oftentimes, it's due to a clot. There's no blood flow to that part of the heart muscle. And if it's a large artery, you will not have blood flow to that heart muscle, and over time, if you wait too long, that heart muscle can die.

On the other hand, a cardiac arrest is when the heart stops. So “arrest” means “stop.” “Cardiac arrest” means the heart stops. The heart stops for any number of different reasons. Sometimes, it stops because of a fatal arrhythmia because of a heart attack. But other times, you can have a serious arrhythmia for other reasons and the heart will stop for that reason. So a cardiac arrest is different. That is much more serious, and if you have a cardiac arrest, that's what probably people fear so much because unless you get to the hospital and immediately get resuscitated, the survival is very poor.

John Horton:

So with a heart attack, your heart is still doing the thump, thump, thump, thump. It's just there's a clog just somewhere in the pipes there.

Dr. Jacqueline Tamis-Holland:

Exactly. So that's exactly it. So your heart's still pumping, you're still breathing, you're awake, you're still doing all the functions of your body. It's just that that part of the heart is not getting good blood flow. And with a cardiac arrest, the heart just completely stops functioning. You need something to either make it start again or at least CPR to pump on the heart to supply blood to your brain until your heart rhythms function.

John Horton:

Now, taking action when someone has a heart attack, it begins with knowing that they're actually having it. And I know Hollywood has put this image in our heads that people just fall over and it's like this big dramatic scene. Is it that dramatic, or is it a lot less than that?

Dr. Jacqueline Tamis-Holland:

Yeah. So let's talk about heart attacks because we talked about cardiac arrest.

That is a big dramatic scene. You do collapse. But with heart attacks, usually, it's actually much less dramatic than they show in Hollywood and I think that that is the problem because people come to the hospital — because perhaps the patient doesn't want to go and their wife tells them to go or their husband tells them to go and they oftentimes say, well, we'll use the word “pain,” and we'll ask you, "When did the pain start?" And they'll always tell us, "I'm not having pain," because it's not pain in their mind. It's discomfort or pressure or a burning. So because it's not pain, they don't realize they're having a heart attack. So it's not usually dramatic. You can usually have a pressure-like sensation, maybe burning or squeezing or aching. It could be in the upper belly area. It could be in the throat area. You could have signs that go down the arm. But it's not usually as dramatic as they see on TV, and it's severe and very uncomfortable, but it's not that intense stabbing pain that you see on TV when they'll have those types of scenes where somebody's having a heart attack.

John Horton:

Yeah. And I think that's where we get to exactly what you were saying before. The difference between a heart attack and cardiac arrest, and I think what Hollywood shows us is the cardiac arrest and then they call it a heart attack later, and then we have to correct everything on podcasts like this.

Dr. Jacqueline Tamis-Holland:

Exactly. But they're both not good, so go to the hospital.

John Horton:

They all need attention, so yeah.

Dr. Jacqueline Tamis-Holland:

[inaudible 00:07:15].

John Horton:

And when we're talking about heart attacks, too, we often hear that men and women have some different symptoms. So I want to make sure we touch on that a little bit, so that way, people know that there might be some different feelings going on.

Dr. Jacqueline Tamis-Holland:

Yeah. So the most common symptom in women is chest discomfort and chest pain, just like men. The most common symptom in both women and men are equally chest pain.

But women are more likely than men to have some atypical features as well or alone and that can include just shortness of breath or just nausea, sometimes just epigastric pain — so pain in the upper part of your belly — so they don't recognize it as the heart because it's in the belly area or in the stomach area. They might have some back pain or some jaw pain. So women are more likely to have atypical symptoms, but in truth, women and men equally have chest pain as well.

John Horton:

Yeah. And I always have a hard time wrapping my head around this idea that people have a heart attack and don't really know it. They talk about silent heart attacks or people have one and they don't go seek care for hours or even days. Can they really be that mild where you barely notice you just had a heart attack?

Dr. Jacqueline Tamis-Holland:

For sure. Sometimes, it's so mild you've had that heart attack and they find out months later by just doing an EKG and seeing an abnormality and you didn't even realize it. And sometimes, in retrospect, you remember, "Oh, maybe I had a symptom of indigestion." Maybe that was it and you didn't realize it, but sometimes, people can't even recall an episode. We have lots of patients who come in — and I hate to use the word “silent” because it's not silent — they're having some symptom, but they come in, because especially our patients with diabetes, they come in with intractable nausea and vomiting and it won't go away — and I've seen a couple of patients with a big heart attack, that their only sign was that they had terrible nausea and vomiting and very high sugars. But it is a symptom. It's not silent. And then sometimes, people just have diffuse sweating and again, nausea, and sometimes, people just have shortness of breath. So it's not silent because there is a symptom, but it's not the symptom you'd expect.

John Horton:

Maybe we need to try to get the term whispering heart attack out there because it sounds like it's saying something, but you have to listen to it.

Dr. Jacqueline Tamis-Holland:

Exactly.

John Horton:

All right. So if you're in a situation and you start, either yourself or someone you're with, starts showing some of these symptoms, that pressure in the chest, sweating, nausea, just that feeling that means something is not right, what are the first things you should do? What should happen right away?

Dr. Jacqueline Tamis-Holland:

So if you're feeling something's not right and you know something's not right, you really should be calling 911. We always say that if it's more than 10 minutes, but even if it's less than 10 minutes, and you think something's not right, you should call 911. Certainly, first call 911, but then if you have a neighbor or a friend or a family member that's nearby, then you should also let them know, so that they can immediately be with you if you are alone, so that somebody's with you. But don't take the time, because we see this all the time, to call your family member first, so they can come over and then call 911. You should always call 911.

John Horton:

Yeah. Get the medical care first. Call the kids or parents or everybody else later.

Dr. Jacqueline Tamis-Holland:

Yeah. And then just sit down in the chair or in the bed. Try to lie down. Try to relax. You can certainly take an aspirin of 325 milligrams or 481 milligrams or whatever, but the ambulance, if they arrive or you go to the hospital and you see somebody in the hospital, they'll give you the aspirin, but you can certainly take it. It's probably not going to abort a heart attack, but you can take it because that's going to be your treatment anyway.

John Horton:

Let's talk about some of those things you can do after you call 911 and you're waiting for those sirens to get there. You had mentioned taking an aspirin and I want to make sure we emphasize there: You mean aspirin. We're not talking ibuprofen, Advil®, something like that.

Dr. Jacqueline Tamis-Holland:

Yeah. So you're taking the aspirin not to take the pain away. You're taking the aspirin because it's an antiplatelet and it can block the platelet activity, and part of the way the heart causes clotting in the arteries is through the activation of the platelets. So by inactivating the platelets, it can help treat the heart attack. It really doesn't abort it, but it can be helpful and just typically, that's a standard treatment we give. Motrin®, Tylenol®, Advil, they don't have the same antiplatelet effects. They might help with pain, but that's not why you're taking the aspirin.

John Horton:

Now, what about, you had mentioned maybe lying down. Does it matter what kind of position you're in or should you just get in any position where you're more comfortable?

Dr. Jacqueline Tamis-Holland:

Yeah. Actually, that's a great point. Just stay comfortable and stay still. If you're walking around, you're saying, "Let me try to walk this off," or getting up and “Let me clean my house before the ambulance comes,” [inaudible 00:12:27].

John Horton:

My wife would be doing that, so we got to pick up a little bit before they get here.

Dr. Jacqueline Tamis-Holland:

Exactly. That happens to many people, so just sit down and relax. And you're right. Maybe sitting down is more comfortable than lying down because if you have a big heart attack, you might not even want to lie down because you'll be too short of breath. So certainly, whatever you're comfortable with, you should be doing, but try not to do too much movement and running around.

John Horton:

Is there even things, where I've read where you should loosen up tight clothing or you take a belt off, things like that? Does that help or is that just more feeling comfortable?

Dr. Jacqueline Tamis-Holland:

I think you feel more comfortable. I don't really know if it makes that much of a difference, but certainly, if you've got a million pieces of clothing on, they're going to need to take that off to do an EKG and to take care of you and put an IV in, so perhaps starting to take off your three sweaters you have on will help. That way, when the ambulance comes, you're ready and they can easily take your shirt off and do an EKG and put an IV in and so forth. But I think loosening of the belt and the opening of the shirt, really, it would just maybe make you feel better.

John Horton:

Now, we talked about CPR. Is that something that usually gets done with a heart attack, or is that more of a cardiac arrest thing?

Dr. Jacqueline Tamis-Holland:

Yeah. No. That's cardiac arrest. So if you're having a heart attack and you're a loved one, you're with them, you're waiting for the ambulance to come and then all of a sudden, somebody's having chest pain and all of a sudden, they become unconscious and unresponsive, then you are going to want to check for a pulse. Obviously, 911 should be on the way. If they're not, you should be calling them and then you will start CPR. And most of the time, 911 can give you information. So if you call them, they will be able to explain to you how to do CPR. They will literally take you through it step-by-step. They're trained to instruct you on how to give CPR to your loved one. So if somebody's unconscious and doesn't have a pulse, that would be the treatment, CPR. That's for a cardiac arrest.

John Horton:

OK, all right. And I want to make sure: CPR is not something you automatically trot out where you tell somebody, "Hey, listen, lie down now — I'm going to start giving you CPR."

Dr. Jacqueline Tamis-Holland:

[inaudible 00:14:40].

John Horton:

If they can talk, they're good.

Dr. Jacqueline Tamis-Holland:

Do not do CPR on an awake person who's talking to you and saying they're having chest pain. You will make it worse. Do not do CPR unless somebody is unconscious and doesn't have a pulse. You check for a pulse and you don't go.

John Horton:

All right. And if they're asking for it, then you got to start questioning what's really going on, I guess.

So what about, you always see two AEDs, and those are for cardiac arrest also, right?

Dr. Jacqueline Tamis-Holland:

For sure. And I'm so glad we're talking about it as just to distinguish.

If it's just a heart attack, you do not want to apply an AED and you do not want to do CPR if it's just a heart attack.

So for a cardiac arrest, if somebody is unconscious and they don't have a pulse and if there's an AED around, because in a restaurant or a public place, then what you would do is you would follow the instructions on the AED. You usually put the paddles or whatever, the pads up to the chest, and the AED will tell you do nothing or deliver a shock. It will tell you you're not going to deliver a shock. I don't even think the AED can deliver a shock unless it sees a rhythm that should be shocked. So it'll give you the instructions and you follow the instructions.

John Horton:

Well, that's a good point of emphasis, though, because you don't want people just breaking out that tool because they think there might be a heart attack going on and a person's fine. In case of emergency, somebody's out, they have no pulse, that's when you start breaking that out.

Dr. Jacqueline Tamis-Holland:

Exactly. Two totally different things that sometimes a heart attack can lead to a cardiac arrest, but two totally different things and people just confuse it all the time.

John Horton:

Well, and that's where it's important. Like you said, a heart attack can lead to cardiac arrest. That's why you do need to call 911 and get people in there in case it starts to escalate and you want to make sure you have the right people there to take care of the situation.

Dr. Jacqueline Tamis-Holland:

Exactly.

John Horton:

So how important is it to have a heart attack action plan? You hear people talk about this. Is this something you should do only if you're maybe a higher-risk person, or is it something maybe everybody should have a little idea in their head?

Dr. Jacqueline Tamis-Holland:

I think it's not so much an action plan, but I think that everybody should recognize that they're not immune to a heart attack. And if they feel symptoms that don't feel right, they should pay attention to those symptoms and recognize that this could be serious.

So I don't know, like, you have to have an action plan, like what happens if there's a nuclear bombing in New York City and what do we do and what's our action plan? What you really want to do is just be aware that if you're not feeling well, that I'm going to call 911 or my family member is going to stay with me or whatnot, but I think it's more important that you should recognize that you are at risk and everybody is potentially at risk.

I'm going to emphasize to you that everybody is at risk. I saw a 23-year-old woman who had nothing. No family history, no diabetes, no high blood pressure, no high cholesterol, nothing, who had a heart attack, did have a cardiac arrest from the heart attack, collapsed and her roommate gave CPR and she had severe, severe blockages in all of her arteries. So anybody is at risk and you cannot just say, "Oh, I don't have diabetes," or "Oh, I don't have high blood pressure," or "Oh, there's nobody in my family with a heart attack, therefore, this pain I'm having, this discomfort is not my heart.” I think everybody needs to recognize that it can happen to you and so to recognize that if you're not feeling well, if it's not right, you should call 911.

John Horton:

Yeah. Listen to your body. I can't tell you how many times we've said that on this podcast, but we keep saying it because it's true.

Dr. Jacqueline Tamis-Holland:

Yes. For sure. You have to let your body tell you this isn't right. [inaudible 00:18:23].

John Horton:

So what would be your top tips for improving heart attack survival odds? Because in the end, that's what we all want to do. We want to be able to talk about it afterward because we want to still be around. So how can we make sure that we can tell that story?

Dr. Jacqueline Tamis-Holland:

Yeah. So I'm going to sound like … I say this again and again, but it's basically seeking immediate medical care. About 30% or a third of heart attacks are from a complete blockage to the artery that's called a STEMI and that requires opening of the artery. That's the only treatment for it. And generally, we open the artery with a balloon and a stent, doing an invasive procedure called a cardiac cath and placing a stent. And the sooner you get that artery open, the sooner you restore blood flow to that heart. But with each passing minute, the heart muscle gets damaged because it doesn't get good blood flow and over time, that part of the heart can die. It gets some damage. It can die. And so the trick to taking care of yourself and surviving this heart attack is to get immediate care, so we can open that artery.

John Horton:

And when you say part of the heart can die, is that just, you're talking then, forever more, you're going to be at maybe 80% heart capacity or something like that? It's just always going to be there and you're going to be a little limited?

Dr. Jacqueline Tamis-Holland:

Yeah. So it depends on the heart attack and it depends on how long it's been closed for and how big the artery is, but generally speaking, if your heart muscle is or if your artery is 100% blocked and it's supplying a heart muscle, generally speaking, after about 20, 30 minutes, you start to see damage and that damage could be permanent, but it depends. Sometimes, it's just transient because the body has other channels to supply blood to that area. Those are called collaterals, and so it may not be permanent damage. It could be stunning. You don't know that until you've given it time to get medications to see if the heart recovers. So sometimes, it's permanently damaged. It's done. That part of the heart will never function again.

John Horton:

Wow. Well, and this seems then a perfect time to emphasize, too, that we can all help prevent our own heart attacks by just adopting a heart-healthy lifestyle. So what are your top tips there? If we want to make sure we don't have to come see you for medical care, how can we best avoid that?

Dr. Jacqueline Tamis-Holland:

Yeah. So I would say that for sure, everybody — and everybody, whether you're at risk for heart disease or not — should follow a healthy lifestyle and that includes regular exercise. It should be moderate intensity aerobic activity about five days a week for 30 minutes at a time or about 150 minutes. And that's what the American Heart Association recommends. In addition, you should eat a heart-healthy lifestyle, heart-healthy diet, and for me personally, I think the best example is the Mediterranean diet. I don't mean that if you're 30 years old, you can never have a piece of a chocolate brownie or no matter how old you are, you can never have a chocolate cake or whatnot. Of course, you can have with moderation once a week, once every two weeks or whatever, but in general, you should be following a heart-healthy diet and that I think the Mediterranean diet is great because it emphasizes fruits and vegetables and whole grains and avoidance of fried and fatty foods and things like bacon and animal fats.

John Horton:

Anybody who listens to this podcast has heard that a lot because we spend a lot of time ... we have our resident dietitian. Julia Zumpano's on here all the time and we break that down and exactly what it means to eat healthy and you need to eat with nutrition in mind.

Dr. Jacqueline Tamis-Holland:

For sure. And then, importantly, you should maintain a healthy weight and you should also make sure that you don't smoke because smoking really can increase your risk for heart disease and heart attacks. That's for everybody, no matter who you are.

But then on top of that, you also should go to your doctor and find out, "Do I have high blood pressure, do I have diabetes or do I have high cholesterol?" Because these things are silent. You might not know you have high cholesterol or high blood pressure because you're not going to feel differently for the most part, even if your blood pressure is high or your sugar is high or your cholesterol is high. And so you want to make sure that you have those things checked with your doctor, and if they are abnormal and you do have high blood pressure or diabetes or high cholesterol, you want to address them and make sure that you follow a diet or you get medications to treat that, so it's under control.

John Horton:

Yeah. It sounds like there's a lot we can do to really minimize our risk, but you've got to focus on it and pay attention.

Dr. Jacqueline Tamis-Holland:

Yeah. For sure. That's what it is. You just need to be aware.

John Horton:

So you with everything you've said, heart attacks, they still seem scary to me. I'm going to be honest. But I do feel better after hearing everything that you said as far as what your chances of survival are and things you can do ahead of time and while it's happening to make sure that you do live through it. There's just a power that comes with feeling prepared and I guess, that's the whole point of this chat.

Dr. Jacqueline Tamis-Holland:

For sure. And I think that you say the words “you need to be prepared,” so you need just be aware. I don't want you to constantly be thinking about it 24 hours a day, but you need to be aware that there is a potential and so if something's not right, you want to recognize that this could be a heart attack and maybe you should look into it.

John Horton:

Yeah. Don't ignore your heart telling you something.

Dr. Jacqueline Tamis-Holland:

Yes. Exactly.

John Horton:

All right. Well, that seems like a fabulous point to end this on, and Dr. Tamis-Holland, thank you so much for making some time in your day to come in and talk with us. I know how busy you guys are there, so we appreciate it.

Dr. Jacqueline Tamis-Holland:

Oh, yes. I'm thrilled to be able to tell you, especially on the difference between heart attacks and cardiac arrest, because they are distinctly different. So happy to be here. Thank you for having me.

John Horton:

Thanks so much for coming in. If you or someone with you shows signs of a heart attack, dial 911 and get help immediately. Time is muscle and the longer you wait to get care, the more damage can be done to your heart.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Till next time, be well.

Speaker 3:

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