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Heart Attack (Myocardial infarction)
 Heart attack (myocardial infarction) remains the leading killer of both
men and women in the United States.
 More than 400,000 Americans die from heart attacks each year.
 Getting emergency medical help immediately can dramatically
increase your chances of survival and recovery.
 A heart attack is not always a sudden, deadly event. Often it is an
evolving process during which a clot forms in an artery of the heart,
depriving the heart of blood and oxygen. The longer the heart attack
process continues the more permanent damage is done to otherwise
healthy heart muscle.
 Many people ignore the warning signs of a heart attack or wait until
their symptoms become unbearable before seeking medical help.
 Others wait until they are absolutely sure it's a heart attack because
they worry they will look foolish if it is a false alarm.
These reactions can result in dangerous delays.
 Only skilled medical professionals can determine if someone is
having a heart attack. Your responsibility is to recognize the warning
signs and act quickly. If you are having a heart attack, you may be
moved from the emergency department to a catheterization lab to
receive angioplasty or a stent, or possibly heart bypass surgery. In
addition, hospitals have lifesaving medications that are designed to
stop a heart attack by dissolving the clot and restoring blood flow to
the heart, although these medications work best when given within
the first one or two hours after the onset of heart attack symptoms,
when the damage is still limited.
Can be caused by several different conditions and have several signs and
People often will experience some, but not all, of the following symptoms,
which may come and go:
 Uncomfortable pressure, fullness, squeezing sensation or pain in the
center of the chest, lasting more than a few minutes, or it goes away
and comes back.
 Discomfort, Pressure or Pain that spreads to the shoulders, neck,
jaw, arms or back.
 Chest discomfort accompanied by lightheadedness, fainting,
sweating, nausea or shortness of breath.
 Rapid or Weak Irregular pulse
Some less common warning signs of heart attack that should be taken
seriously - especially if they accompany any of the above symptoms include:
 Shortness of breath and difficulty breathing.
 Changes in skin appearance (pale or bluish in color)
 Abnormal chest pain (angina), stomach, or abdominal pain.
(Symptoms may feel like indigestion or heartburn.)
 Nausea or dizziness.
 Unexplained anxiety, weakness, or fatigue.
 Palpitations, cold sweat or paleness.
The most common heart attack symptom is chest pain or discomfort.
Women are more likely than men to experience shortness of breath,
nausea/vomiting and back or jaw pain.
If you suspect someone is having a heart attack:
1. Assess the situation. Is the person breathing, is there a pulse, are
they in a safe environment. If you have found them unconscious
touch them and ask "are you OK'?
2. Call 911 or your emergency services number immediately. If there is
an advance directive let them know. If you are not alone instruct
another person to call. Stay with the person until the ambulance
arrives. Do not attempt to drive the person to the hospital; if his or her
condition should worsen, there is nothing you can do to help while
3. After 911 is called, the EMS dispatcher will likely give pre-arrival
instructions (when appropriate) for the administration of aspirin (not
acetaminophen, ibuprofen or naproxen) and nitroglycerin (if
prescribed) while emergency-response units are enroute to the scene
The ideal aspirin dose in such instances is two to four baby aspirin or
one full or extra strength tablet (325 or 500mg), and chewing helps
get the aspirin into the bloodstream faster than swallowing it whole.
(The patient should not be given aspirin if his or her physician has
advised otherwise, e.g., because of allergies or possible harmful
interactions with other medications or known disease complications).
4. If the person is conscious, keep the person calm and help him or her
into a comfortable position. The victim should stop all physical
activity, lie down, loosen clothing around the chest area, and remain
calm until the ambulance arrives.
5. If the person becomes unconscious, make sure the person is lying on
his or her back. Clear the airway and loosen clothing at the neck,
chest and waist. Check for breathing and pulse; if absent, and if
trained to do so, begin cardiopulmonary resuscitation (CPR) and or
the Automated External defibrillators (AEDs).
6. Do not allow them to ingest any food or water and remain calm and
7. Once emergency services arrive inform them of what happened,
when it happened and what you have done to alleviate the situation.
A medication list, any advanced directives and emergency contact
information should accompany the person to the hospital.
If you think you may be having a heart attack:
 If you are with someone, tell that person you may be having a heart
attack and want to get to the hospital immediately. Have the person
call 911 or the emergency services number.
 If you are alone, call 911 or the emergency services number
immediately. Do not drive yourself to the hospital.
 Once you have called 911, you likely will be instructed to chew and
swallow an aspirin unless your physician has advised you otherwise
(e.g., because of allergies or contraindications, including possible
harmful interactions with other medications or known disease
complications). Keep in mind that chewing helps get the aspirin into
the bloodstream faster than swallowing it whole.
Automated External Defibrillators (AEDs)
Lay rescuers can be trained to operate portable, computerized, automated
external defibrillators (AEDs) used to apply electric shock to restart a heart
that has developed a chaotic rhythm called ventricular fibrillation, the most
common cause of sudden cardiac arrest. Survival is directly linked to the
amount of time between the onset of sudden cardiac arrest and the
treatment with an electric shock to stop the abnormal heart rhythm. If an
AED is available where you work or live, ACEP recommends taking a
training course to learn to use it. In September 2004, the U.S. Food and
Drug Administration approved over-the-counter sales of AEDs, available for
use in the home and without a prescription.
Heart Attack Prevention
The major risk factors for coronary heart disease are:
 Increasing age. About four out of five people who die of coronary
heart disease are ages 65 or older.
 Gender. Men have a greater risk of heart attack than women, and
they have attacks earlier in life. At older ages, women who have heart
attacks are twice as likely as men to die from them within a few
 Heredity (including race). Children of parents with heart disease are
more likely to develop it themselves. African Americans have more
severe hypertension than whites and consequently, are at greater
 Smoking. A smoker's risk of heart attack is more than twice that of
 High cholesterol. The risk of coronary heart disease rises as blood
cholesterol levels rise.
 Physical inactivity. Regular, moderate-to-vigorous exercise plays a
significant role in preventing heart and blood vessel disease.
 Body weight. People with excess body fat are more likely to develop
heart disease and stroke, even if they have no other risk factors.
 Diabetes. This condition seriously increases the risk of developing
cardiovascular disease.
You can reduce your chances of having a heart attack by;
 Quitting smoking, and nonsmokers should not start.
People can also lose excess weight, exercise regularly, eat a low
cholesterol diet, and take medications to reduce cholesterol if
 It's also important to maintain a healthy blood pressure, control
diabetes, and avoid excessive alcohol consumption.
 Talk to your physician about taking aspirin if you have major risk
factors for heart disease.
Get regular checkups, and if you have a family history of heart
disease, it's especially important that you maintain a healthy lifestyle.
More information can be found on the American Heart Association's
website or at