Every year, about 750,000 Americans have a heart attack. Even though advances in emergency care and cardiology have greatly improved one’s odds of survival, roughly one of every six of these individuals dies.

What determines whether a heart attack sufferer lives or dies? Certainly, the person’s age and overall health play an important role. But there’s another factor that gets far less attention than it should.

Lifesaving strategy: When a person on the scene knows how to recognize that someone is having a heart attack and then respond to the emergency appropriately, it can have a profound effect on whether the victim lives or dies.

Sobering research: When a heart attack occurs, the average sufferer waits two hours or more before calling 911 and going to the hospital. This delay often occurs because victims can’t believe that they are really having a heart attack…or they don’t want to feel embarrassed at the hospital if it turns out that it’s not a heart attack and they’ve “wasted” everyone’s time.

But each minute of delay during a heart attack destroys more heart muscle, putting the victim at greater risk for disability and death.


My advice for quickly and accurately identifying heart attack symptoms…*

  • Chest discomfort. Chest pain is widely believed to be the classic heart attack symptom, but severe chest discomfort usually is a more accurate way to describe it. Pain typically is sharp, but the sensation that usually occurs with a heart attack is not sharp but rather a severe pressure, squeezing or tightness—as if a massive weight had been placed on the chest.

Also: Many women report having no chest discomfort during any part of the heart attack.

How to respond: If a person is having severe chest discomfort, don’t assume that it can’t be a heart attack because he/she isn’t complaining of chest pain. Call 911 immediately. It is important to tell the dispatcher that you believe the person is having a heart attack because saying this increases the likelihood that an ambulance specializing in heart care will be sent.

  • Referred pain. The nerves that supply the heart also serve many other areas of the body between the jaw and the navel—places that can produce referred pain during a heart attack.

Case history: A woman who had tooth pain while exercising was referred to me. Her exercise stress test showed that her tooth pain was referred pain. In actuality, the pain was due to angina, a sign that her arteries were significantly blocked, putting her at high risk for a heart attack. Other areas of referred pain during heart attack can include one or both arms or shoulders…the upper back or abdomen…the neck and lower part of the face, including the jaw.

  • Other common symptoms. A heart attack can produce many other symptoms, including sudden shortness of breath…nausea and vomiting…a cold sweat, or feeling cold and clammy…fatigue…and/or light-headedness. Important: All of these symptoms (except for feeling cold and clammy) tend to be more common in women than in men.

How to respond: If a man has chest discomfort and at least one other symptom…or if a woman has chest, back or jaw pain and at least one other symptom, it’s very likely the individual is having a heart attack. Or if a person’s discomfort or pain is particularly severe—even without another symptom—a heart attack is also likely. In either instance, call 911.

Another red flag: Sometimes, a victim has a feeling of “impending doom” and asks a loved one or friend to take him to the hospital. If someone says to you, “I think I should go to the hospital,” call 911. Never drive a victim to the hospital—lifesaving treatments start when the paramedics show up. The only exception is if you are within a few minutes of emergency care.


Knowing one’s risk for a heart attack also helps prevent delays in treatment.

While some heart attack victims don’t have any of the risk factors described below, people generally are at increased risk due to smoking, age (generally, over age 50 for men and over age 60 for women) and being at least moderately overweight. Diabetes or a chronic inflammatory disease, such as rheumatoid arthritis or lupus, can cause heart disease 10 or 20 years earlier than the norm, increasing risk for heart attack.

Important: Diabetes damages nerves, so a diabetic having a heart attack is less likely to have nerve-generated chest discomfort or referred pain—and more likely to have sudden shortness of breath.

In their cholesterol guidelines released in November 2018, the American College of Cardiology and American Heart Association recommended considering a coronary calcium test before starting cholesterol-lowering therapy. As arteries age, they often accumulate cholesterol in their walls. As this cholesterol “plaque” builds up, it can block the arteries and cause a heart attack. A computed tomography (CT) test can be performed to look for calcium in the arteries of the heart, called the coronary arteries. While often not covered insurance companies, it can typically be obtained for $100 to $200 in most communities.

As calcium is a dense, hard element, it blocks the X-rays of a CT scan, thus showing up as white specs in the coronary arteries on a scan. A score is then assigned based on how much calcium is present. The more calcium, the higher the score and the greater the risk for an eventual heart attack. The greater the risk, the more likely one is to benefit from taking a daily statin medication. In a study recently released from the Walter Reed Army Medical Center in Bethesda, Maryland, researchers found that individuals with no calcium in their arteries experienced no benefit from taking statins. Those with mild calcification—a score of 1 to 100—had mild benefit, while those with a score of more than 100 had more than a 50% decrease in suffering a heart attack, stroke or death from heart disease.


In addition to calling 911, do the following to aid a heart attack victim…

  • Position the person correctly. Contrary to popular opinion, the best position for a conscious heart attack victim is not lying down—this fills the heart with a bit more blood, straining it. The best position is sitting up, which puts the least amount of stress on the heart. An exception is if the person is light-headed, which might indicate low blood pressure. In that case, lay the person down and call 911 immediately.
  • Give aspirin. Give the person uncoated aspirin—either four 81-mg baby aspirin or one full-strength aspirin (325 mg). The pills should be chewed—this releases clot-busting medicine within 15 minutes into the bloodstream versus up to 30 minutes or more when aspirin is swallowed whole. If someone is already taking a daily blood thinner, aspirin may not be needed. If the person has been prescribed nitroglycerin, it should be taken as directed.
  • Reassure. A heart attack is frightening—and fear floods the body with adrenaline, speeding up and further stressing the heart. Reassure the person that help is on the way and that he will get through this.

If the victim is unconscious: If the individual doesn’t appear to be breathing and you cannot feel a pulse or are unable to check for one, start CPR if you know how to do it. If you don’t, simply press down on the victim’s chest at least two inches deep (where the ribs meet at the base of the breastbone) and pump as fast as you can (100 times per minute). Like CPR, this technique pushes air into the lungs—the best action you can take until paramedics arrive.

 *There are some exceptions to the heart attack symptoms described in this article. If you have any question, play it safe and call 911.

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