How to Survive a Heart Attack

Why the First Hours Count

There are two very good reasons you should know how to survive a heart attack. First, odds are very high that either you or someone you love will suffer from a heart attack during your lifetime. And second, whether you survive that heart attack may depend on what you and your doctors do about it during the first few hours.

Recognizing the Signs of a Heart Attack
Verywell / Brianna Gilmartin

About Heart Attacks

A heart attack, also called a myocardial infarction (MI), is the most severe form of acute coronary syndrome (ACS).

Like all forms of ACS, a heart attack is usually triggered by the rupture of an atherosclerotic plaque within a coronary artery (the arteries that supply oxygen to the heart muscle). This plaque rupture causes a blood clot to form, leading to blockage of the artery. The heart muscle being supplied by the blocked artery then begins to die.

A heart attack is diagnosed when there is death of a portion of the heart muscle.

Consequences and Dangers

To a large degree, the outcome of a heart attack depends on how much the heart muscle dies. This is largely determined by which coronary artery is blocked, where in the artery the blockage occurs, and how much time passes before the artery can be re-opened.

A blockage near the origin of an artery will affect more of the heart muscle than a blockage farther down the artery. A blockage that persists for five or six hours will cause substantially more heart muscle death than a blockage that is reversed within two or three hours.

If the extent of heart damage is severe, acute heart failure can occur in tandem with the heart attack, a dangerous combination. Even if the extent of the damage is minimal to moderate, heart failure is more likely to occur later on due to the underlying injury sustained by the heart muscle.

A heart attack can also produce dangerous heart rhythm problems known as arrhythmias, including tachycardia (rapid heartbeat) and fibrillation (irregular rapid heartbeat). After the heart attack, scarred cardiac tissue can lead to permanent electrical instability and recurrent arrhythmia.

Cardiac arrest and sudden death are risks that are present both during an acute heart attack and, to a lesser extent after the recovery.

According to the Centers for Disease Control and Prevention, around 790,000 Americans have a heart attack each year. Of these, only 27% are aware of the major symptoms and know to call 911.

Why the First Hours Are Critical

For anyone having a heart attack, getting rapid medical attention is absolutely critical. Both the short-term and the long-term consequences of a heart attack are largely determined by how much of the heart muscle dies. With rapid and aggressive medical treatment, the blocked artery can usually be opened quickly, thus preserving most of the heart muscle.

If treatment is delivered within three or four hours, much of the permanent muscle damage can be avoided. But if treatment is delayed beyond five or six hours, the amount of heart muscle that can be saved drops off significantly. After about 12 hours, the damage is usually irreversible.

Most cardiac arrests occur within the first few hours of a heart attack. If a cardiac arrest occurs in the hospital, there is an excellent chance it can be treated. Unfortunately, 47% of sudden cardiac deaths occur before a hospital is reached, according to statistics compiled by the Centers for Disease Control and Prevention (CDC)

Recognizing the Signs

Getting rapid and appropriate medical care requires you to recognize the signs of a heart attack, and seek medical help the moment you think you might be having one.

While chest pain is the classic symptom of a heart attack, other kinds of symptoms can occur in addition to (or instead of) chest discomfort. These may include:

  • Profuse sweating
  • Shortness of breath
  • Radiating pain in the jaw, neck, shoulders, or arms
  • Heartburn-like symptoms
  • A sense of impending doom

Anyone who has risk factors for coronary artery disease ought to be alert to these symptoms. Even so, there are times when the symptoms may be uncertain or less overt, and people will not act immediately because the signs aren't "as severe" as they as they assume.

According to the American Heart Association, one in five heart attacks is "silent" and will have few, if any, symptoms. Even if the underlying obstruction is less profound, the risk of death may be higher simply because treatment is delayed.

If you think there’s any chance you may be having a heart attack, you need to get medical help as quickly as possible. Even if it turns out to be something else, it is better to act quickly than risk putting your life on the line.

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  1. Centers for Disease Control and Prevention. Heart Attacks. Atlanta, Georgia; updated August 18, 2017.

  2. O'gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-425.

  3. About Heart Attacks. American Heart Association. Jul 31, 2016