Lown Cardiovascular Research Foundation

Harvard Heart Letter | October 2008

Dial 911 when a heart attack has your number
Calling for help is the best way to start treating a heart attack.

When a heart attack strikes, two steps can help you protect your heart, and your life. First, recognize you are having a heart attack. Second, call 911 or your local emergency number.

The first one isnt as easy as you might think. Heart attacks dont necessarily feel the way theyre “supposed to” — crushing chest pain that overflows to the shoulder or left arm. Instead, some heart attacks sneak up on you, gradually announcing their presence through dizziness, shortness of breath, nausea or vomiting, a cold sweat, or a feverish feeling.

Calling 911 right away is a lot easier. Yet only about half of people having a heart attack do it. Why many people refrain from calling for help has been the subject of dozens of studies.

In the latest of these, Swedish researchers found that people who called the emergency medical service number and arrived at the hospital by ambulance were more likely to have known the importance of getting help fast or experienced unmistakable signs of a heart attack, like chest pain that came on quickly or breaking out in a cold sweat. Those who came by car didnt believe they were sick enough to warrant calling for an ambulance or thought they could get to the hospital faster by car (American Heart Journal, July 2008).

Theres no question that private transport can sometimes get you to the hospital faster than an ambulance. But whats really important is how quickly treatment begins. For that, calling an ambulance is far and away the better choice. Paramedics can take your vital signs, do an electrocardiogram, give you oxygen, start medications, and alert the emergency department. A study published in 2007 showed that heart attack victims brought in by ambulance received heart-saving therapy earlier and had better short-term and long-term survival than those who came by other modes of transportation.

Equally important, ambulances are equipped with lifesaving defibrillators. When a blood clot blocks a blood vessel in the heart, depriving a section of heart muscle of oxygen-rich blood, the heart can lapse into ventricular fibrillation, a fast, erratic, and deadly rhythm. A defibrillator can jolt the heart back into a steady rhythm. It is possible that earlier use of a defibrillator could have saved the life of journalist Tim Russert, who died in June 2008 of a heart attack that apparently veered into ventricular fibrillation.

Sound the alarm

Its tough to be sure if you are having a heart attack. Knowing the warning signs, including the “unusual” ones, can help. Weve put a comprehensive list suitable for posting near the phone at health.harvard.edu/129.

When in doubt, ask a family member or friend. He or she might help you decide or give you the push you need to take action. That action should be dialing 911 or your local emergency number.

Paramedics will start treatments to save your heart, and possibly your life, even before you get to the hospital. To paraphrase the old Greyhound jingle, leave the driving to them.