Medical

How to Survive a Heart Attack

For starters, don't do what Carrie Bradshaw did -- instead, call 911 immediately.

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It was the Peloton ride that sent shockwaves through America: On HBO Max's Sex and the City reboot And Just Like That, Mr. Big completes a rigorous bike workout, only to collapse on the floor of his and Carrie's luxurious apartment, clutching his chest. Carrie comes home to find him, still conscious, and proceeds to 1) stare at him, 2) shout his name (the still-disappointing John) and 3) hold him and cry as he dies in her arms -- providing an excellent example of exactly what not to do if you or your loved one is having a heart attack.

Here's how to survive a heart attack, or how to help someone who is having a heart attack so they have a better chance than Mr. Big. 

Is this a heart attack? Common symptoms

a heart surrounded by veins and arteries
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When you think "heart attack," classic symptoms such as chest discomfort might first come to mind. But heart attacks can present differently in men and women, and in people with certain diseases, like diabetes. 

Heart attack symptoms could include: 

  • Chest discomfort, pain or pressure that radiates up to your jaw, your back and/or your left shoulder
  • Bad indigestion or nausea
  • Extreme fatigue
  • Shortness of breath
  • Feeling generally unwell

"Essentially anything from the belly button up," says Dr. Khadijah Breathett, a heart failure transplant cardiologist and tenured associate professor of medicine at Indiana University. "Constant pressure should raise concern that you should see your doctor, and it's OK if it's something else. We'd rather have an individual come see a health care professional and get evaluated rather than toughing it out at home, because that is what contributes to the escalating risk of death." 

Call 911, no matter what

If you feel any of the above symptoms, even if you aren't sure it's a heart attack, you should call 911 immediately, doctors recommend. 

"If you feel unwell, or you're starting to have chest discomfort, seek medical attention quickly, because the sooner you get treated, the better," says Dr. Grant Reed, an interventional cardiologist and director of Cleveland Clinic's STEMI (ST-elevation myocardial infarction) program. "A lot of patients ignore their symptoms, and by the time they come in, their heart muscle has already died." 

an ambulance on the road
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The No. 1 indicator of how well you're going to do after a heart attack is how fast you recognize your symptoms, Reed adds. There's a strong relationship between when you start to have your heart attack (which is generally when symptoms start) and how fast doctors can open up the blocked coronary artery that's causing it -- the shorter the time, the better the outcomes, not just regarding survival but also the likelihood of heart failure or needing to be readmitted to the hospital. 

When you get to the hospital, medical professionals will likely perform an electrocardiogram (EKG or ECG), which will determine the diagnosis of a heart attack. If it is a heart attack, you'll be taken to the cardiac catheterization laboratory, where a coronary angiography will be performed. If you have a blockage in your coronary artery, the doctors will offer treatment with a balloon and a stent to keep the artery open. 

Many people are hesitant to seek emergency medical care due to a lack of insurance or immigration status. But in the US, hospitals are required to treat all people who come in with life-threatening emergencies. 

"It's a lot better to be treated and deal with the financial ramifications after the fact," Grant says. In most cases, costs can be sorted out with the hospital, he adds. 

an EKG line with a stylized heart on it
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Don't drive yourself or your loved one to the hospital 

If you suspect you're having a heart attack, don't drive yourself to the hospital: Call an ambulance. You could lose consciousness and hurt yourself or others on the road, says Dr. Joel Beachey, a cardiologist at Mayo Clinic Health System in Eau Claire, Wisconsin. The same goes for having a loved one drive you -- if your symptoms worsen, they won't be able to help you while they're driving, and may be distracted. 

Paramedics can provide the best and fastest care while you're on the way to the hospital, including giving you an assessment and providing some treatment, Beachey says. 

If you'e with someone who is having heart attack symptoms and becomes unconscious, you should first call 911 and then engage in CPR, Breathett says. (You can find free CPR training at your local American Heart Association branch and many other places.) 

Take aspirin, if you have it

If you're having heart attack symptoms and have access to aspirin, take a full dose of 325 mg after calling the ambulance, Beachey says. (If you have baby aspirin, which comes in an 81 mg dose, take four of those.) He recommends chewing it instead of swallowing, so it gets into your system faster. 

The reason? When you're having a heart attack, a plaque inside your arteries becomes unstable and ruptures, which forms a blood clot that can close off supply to that artery. Taking aspirin can help break down some of that blood clot. 

patient on a stretcher receiving CPR
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Advocate for yourself 

Though in an ideal world, health care providers would take all patient concerns seriously when it comes to heart attack symptoms, studies show women and people of color are less likely to receive adequate treatment for heart attacks and heart disease. For example, older Black women were 50% less likely to be treated when they arrived at a hospital with heart attack or coronary artery disease symptoms than white women, including after accounting for education, income, insurance status and other heart health complications like diabetes and high blood pressure, a 2019 study found. 

"It's been very clear over most of our history in the US that women and people of color are not heard," Breathett says. "Their symptoms get dismissed, and they have worse outcomes. As a health care system, we have a lot more work to do to change that system so that each person can get equitable care irrespective of their demographic."

Until that time comes, patients need to be their own advocate and speak up for themselves, she adds. And if they aren't being heard, they have the right to seek care elsewhere. 

One tip recommended by a resident on TikTok: If you feel a provider isn't taking your symptoms seriously, for heart health or otherwise, you can ask the provider, "What is your differential diagnosis?" 

@dor_the_grayt POCs are more likely to be ignored. Ask questions, take notes, document the events. If you are alone, have a relative/friend on the phone. #patientadvocate#racisminmedicine#maternalmortality#bipoc#blackwomen#learnontiktok♬ original sound - Dorender Dankwa

A differential diagnosis is a term to describe what the different diseases are that could be contributing to your symptoms, basically asking the provider to explain why they've ruled out a heart attack and what else it could be. "That might help a person realize, oh, I haven't effectively tested to make sure this is not cardiac disease," Breathett says. 

You can also bring a family member or friend to help ask questions on your behalf. Write down questions in advance if you can, so you can have them addressed during your short visit. And call back with any questions that were not answered. If you're not satisfied or feel that you're not being heard, seek out another care team. 

Work on prevention

You've heard it a million times, but that's because it's true: The best way to prevent a heart attack is maintaining a healthy diet, doing moderate exercise for 120 to 150 minutes per week, keeping your cholesterol and blood pressure under control and not smoking. 

Woman in exercise gear checking her wrist
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Heart attacks can happen to people of any age, race or gender. You should get regular physical exams with your primary care provider to assess your risk, and make lifestyle changes that can help with prevention. Some people might also benefit from taking a baby aspirin every day as a preventative measure, but you'll need to talk to your care provider about that. 

Exercise is important even if you have a history of heart trouble, Beachey says. 

"Just because Mr. Big was exercising on a Peloton doesn't mean that caused him to have his heart attack," he adds. "That exercise pattern probably helped him to put off the time when his heart attack occurred."

The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.