Recognizing and Preventing a Heart Attack

Every 30 seconds, someone has a heart attack. Half of the people who have a heart attack die?often within the first hour of having symptoms and before reaching a hospital. Yet, most people wait 2 hours before seeking help.

Heart disease is the leading cause of death in the United States. Prevention is your best defense. If you have a heart attack, recognizing symptoms and seeking immediate help are crucial for survival.

A normal heart pumps blood with a strong, steady beat. Coronary artery disease causes most heart attacks. Narrowing or hardening of coronary arteries from the buildup of fatty deposits (or plaque) blocks the normal supply of blood and oxygen to the heart. This blockage often causes irregular heartbeats, and it can affect the heart's pumping action. The blockage may kill heart muscle, in turn damaging the heart or causing death.

Symptoms of a Heart Attack

In the movies, heart attack victims typically clutch their chest, make choking sounds, collapse, and die. In reality, typical symptoms of a heart attack include the following:

• Pressure, squeezing, fullness, or pain in the center of the chest that may seem like severe indigestion or heartburn. This discomfort may last a few minutes, or it may come and go.
• Discomfort in the upper body. It may include pain or numbness in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath occurring just before or along with chest pains
• Nausea, vomiting, dizziness, or breaking out in a cold sweat

Symptoms vary. Even if a person has survived a heart attack, symptoms of later heart attacks may be different. Some people have "silent" heart attacks, without symptoms.

Preventing a Heart Attack

Your likelihood of having a heart attack increases if you have any known risk factors. The key to preventing a heart attack is either to eliminate or to receive treatment for these risk factors.

Table 1 lists 4 lifestyle changes that are your strongest defense. These lifestyle changes are endorsed by leading heart specialists.

Table 2 lists medical conditions that increase your risk of a heart attack. Because many of these conditions may not have symptoms, you should see your doctor for periodic screenings.

3 Risk Factors You Cannot Change

• Age?men over the age of 45 and women over the age of 55 are more likely to suffer a heart attack.
• Family history?having a father or brother who suffered from heart disease before age 55, or a mother or sister before age 65, increases your risk.
• Previous heart attack?having 1 heart attack increases your risk for another one. You should follow your doctor's treatment recommendations exactly, including getting cardiac rehabilitation.

You must collaborate with your doctor to avoid a heart attack. Your doctor may prescribe medication, but only you can improve your lifestyle.

The first step is to know your risk for suffering a heart attack. Your doctor will rate your risk as either low, intermediate, or high. For example, among women rated as high-risk, 20% will suffer a heart attack in the next 10 years.

In addition to prescribed medications, your doctor may prescribe aspirin. Although aspirin has been shown to have a positive effect on high-risk patients, taking aspirin for a long time may have serious side effects. Do not begin taking aspirin before talking to your doctor.

What to Do If You Think You Are Having a Heart Attack

Even people at low risk have heart attacks. If you have symptoms, you should seek treatment immediately.

It is normal not to be sure whether you are having a heart attack. You should call 911 right away, however, and report what is happening. Some people hesitate. They feel embarrassed or do not want to cause a commotion. Remember that delaying more than 1 hour may result in death.

Emergency Action Plan

Do you have an action plan in case you think you are having a heart attack? Your doctor can help you develop one. You should share it with family members.

• Recognize the signs and symptoms of a heart attack
• Follow your doctor's instructions for taking emergency medication or chewing and swallowing an aspirin
• Decide who will care for any dependents you have
• Know how to get emergency medical services, especially if it involves something other than calling 911
• Have a list of contact names and numbers for medical emergencies
• Know the location of the nearest 24-hour emergency heart care hospital
• Carry a list of your current medications

Ms. Wick is a senior clinical research pharmacist at the National Cancer Institute, National Institutes of Health. The views expressed are those of the author and not those of any governmental agency.