ANN ARBOR, MI -What would you do if you started feeling chest pains right now, or if someone around you suddenly felt short of breath?

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If you’re like most Americans, you might wait it out for an hour or two, just to see if the symptoms go away. Believe it or not, that’s what many people do.

But that’s just about the worst way to react to such symptoms, says a University of Michigan heart expert. They could be caused by a heart attack — and if so, every minute of delay may mean the difference between life and death, or between health and disability. Many treatments work wonders, but only if given soon after an attack.

Instead of waiting, says U-M Cardiovascular Center heart attack specialist Eric R. Bates, M.D., patients at risk for heart attack should call 911 and get emergency help immediately for any symptoms such as chest pain, arm or shoulder pain, shortness of breath, fatigue, abdominal pain or nausea.

In fact, he says, you should wait no longer than five minutes before calling for help. Even if the symptoms turn out to be unrelated to your heart, it’s better to play it safe.

Most of the 1.1 million Americans who suffer a heart attack each year go for hours without getting help, Bates says, because they’re not sure what’s happening to them, or they don’t want to “make a fuss.” Or, they try to get to the hospital on their own, rather than taking an ambulance, which would speed up their arrival and treatment.

As a result, more than 200,000 each year die before they even get to the hospital, and many more doom themselves to permanent serious health problems, says Bates, a member of the national heart attack guidelines committee. If only they had reached the hospital sooner, they might have gotten clot-buster drugs, angioplasty, or other modern, fast-acting treatments that stop the damage to the heart muscle.

“ The speed with which a patient seeks treatment is critically important, because most of the risk of a heart attack occurs within one hour of the start of symptoms,” he explains. “The problem is that most patients wait two hours or more to seek medical attention, so most heart attack deaths occur before the patient gets to the hospital.”

The risk of death from a heart attack is highest in the first hour after symptoms begin — and modern treatments give the best results if they’re given in that same first hour. Some heart attacks can even be stopped entirely if they’re treated quickly.

“ As soon as the ambulance team arrives, you’re relatively safe,” says Bates, a professor of cardiovascular medicine at the U-M Medical School. “But if you’re transporting yourself by car, or waiting two hours before you call an ambulance, you’re at risk for dropping over dead from cardiac arrest. And after three hours, the heart is damaged to the point where there’s not much heart muscle that can be salvaged.”

For some patients who manage to survive their heart attack even after a long delay, the future holds lifelong disability from a failing heart that can’t pump blood with nearly the same force as it once did.

All of this means that the “need for speed” is a key goal for doctors trying to improve heart attack care and survival. That’s why the new national guidelines for heart attack treatment that Bates and his colleagues will release later this year will focus on methods to speed up delivery of care.

But doctors and guidelines can’t do all the work, he says. That’s why he urges people who have a higher-than-normal chance of suffering a heart attack to make a plan for what to do and where to go if they start to feel symptoms.

“ If your family members have had heart attacks in their 50s or 60s, or if you have high cholesterol, high blood pressure or diabetes, or if you smoke, you’re at higher risk of a heart attack and you should have a higher state of alertness and a plan in place,” says Bates. “If you have severe heart disease, or you’ve had heart attacks or heart surgery in the past, it may even be important for your family to be trained in CPR.” Cardiopulmonary resuscitation can save lives if given within minutes.

Everyone, but especially high-risk people, their loved ones and co-workers, should familiarize themselves with the symptoms that commonly come with a heart attack, he continues. And they should also remember that not all heart attacks produce the “classic” symptoms.

“ The severe pain in the middle of the chest that you see portrayed on television occurs in the minority of patients,” he says. “Symptoms are usually more subtle. And women are more likely to have atypical heart attack symptoms, such as fatigue or feeling generally ill.”

The bottom line is that if you’re suddenly feeling different or strange, don’t take a chance — call 911 right away and let an ambulance crew evaluate you.

If they take you to the hospital, the treatment you get first will depend on what kind of hospital it is. In most hospitals, you’ll probably get a dose of a clot-buster drug, which will dissolve the clump of blood cells that’s clogging the “plumbing” of your heart.

About 20 percent of all hospitals, including the U-M, offer emergency angioplasty — a technique that inserts a tiny balloon into the clogged heart artery that’s causing the heart attack, and inflates it to clear the passage for blood to flow. If your ambulance takes you to a hospital that offers angioplasty, you might find yourself being wheeled directly from the ER to the angioplasty area.

“ Balloon treatment has improved greatly and is now considered to be the better heart attack therapy because of the higher rates of opening up blocked arteries,” Bates explains. “The problem with it, however, is that it’s currently limited to hospitals that have heart surgery programs. And it takes time to get the hospital team organized to perform the procedure on an emergency basis.”

That’s another reason it’s important to get to the hospital by ambulance, rather than driving yourself or getting a ride — the ambulance team can radio ahead and advise the hospital to get ready.

But even if the hospital you arrive at first doesn’t offer balloon treatment, the important thing is to get the clot-buster drug fast. Then, you might be eligible to be transferred to another hospital for angioplasty the same day.

But, as Bates and his colleagues recently reported in a research article, if getting to an angioplasty hospital would take more than 60 minutes longer than it would take to get a dose of clot-buster drug at a non-angioplasty hospital, you’re better off just going to the regular hospital.

The bottom line, he says, is to remember the symptoms of heart attack, recognize them when they happen to you or someone near you, and call 911 after the start of symptoms — after 5 minutes if at all possible. Don’t hesitate, don’t worry about making a fuss, don’t try to drive yourself or get someone to drive you in a car — let the emergency medical system do the work.

If everyone did this, Bates says, the result could be a major decrease in the number of people who die or suffer permanent damage from heart attack. “Any progress in getting patients in contact with the emergency medical system, even just 15 minutes sooner, would have a huge impact on the number of patients who could be saved.”

More information on heart attack and the “need for speed”:

• Heart attacks mostly occur when a blood clot occludes one of the blood vessels that feeds the heart, blocking off the blood supply and causing heart muscle to start to die.
• This “plumbing” problem is often followed by an “electrical” problem, in which the electrical signals in the heart muscle erupt in a storm of activity. This can kill a person within minutes.
• In the first few minutes of a heart attack, symptoms such as pain in the chest, arm, head, shoulder or abdomen, or nausea, fatigue and shortness of breath, occur.
• Anyone experiencing such symptoms should call 911 or ask someone to do it for them, within five minutes of when symptoms begin. Delaying, or trying to arrange transportation yourself, can mean the difference between life and death.
• The first hour after a heart attack is important for two reasons: it’s when the risk of dying is highest, and it’s when treatments work the best.
• People who have a higher-than-normal risk of heart attack should know how to recognize symptoms and know what to do if they experience them. This includes people who smoke, have diabetes or have high blood pressure or high cholesterol, as well as people with a history of heart disease or a family history of heart attack.
• Today’s heart attack treatments, including clot-buster drugs and balloon treatment (angioplasty) can open up the clogged blood vessel and stop heart muscle damage. But the longer it takes before these treatments are delivered, the worse the damage to the heart.
• More than 1.1 million Americans have a heart attack each year, and more than 200,000 of them die before they reach the hospital.
• On average, it takes more than two hours for American heart attack patients to reach the hospital, mostly because they delay seeking help, or they try to drive themselves or get a ride to the hospital.
• New national heart attack guidelines due out later this year will set standards for speeding up and improving heart attack treatment, but the power to save lives rests with patients and those around them.

Find more information on the World Wide Web at:

U-M Health System, Health Topics A to Z: Heart attack (myocardial infarction) www.med.umich.edu/1libr/aha/aha_myoinf_car.htm

U-M Health System, Health Topics A to Z: Angioplasty: www.med.umich.edu/1libr/aha/aha_angiopl_car.htm

National Heart, Lung and Blood Institute: Act in Time to Heart Attack Signs
www.nhlbi.nih.gov/actintime/index.htm

Written by Kara Gavin

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