ASK A TOP DOC: How Do I Survive a Heart Attack?

Heart disease is the number one killer of both men and women, but a little insight into what’s happening to your ticker if and when it runs into trouble can go a long way to helping you survive a heart attack. “It’s amazing to learn how rarely patients have sat down with their physician and have been educated as to what coronary heart disease is, what symptoms result from it, how to recognize symptoms of a heart attack, and what to do if those symptoms occur,” says Irving Herling, a 2009 Top Doctor and clinical cardiologist at the Hospital of the University of Pennsylvania. Lucky for you, Dr. Herling gave us five surprising rules that could save your life—and the ones you love.

Understand what’s happening. Though a heart attack may seem sudden, it’s a long time in the making. “The body reacts to fat build up in the arteries throughout the body, including the coronary arteries, by dispatching scavenger cells that engulf the fat in an attempt to get rid of it,” says Dr. Herling. Overtime, this causes the fat to blister and stick to arteries. A heart attack occurs when one of those fat blisters erupts or cracks and a scab forms—much like a scab would form on your finger if you cut it—and closes off the blood vessel, depriving whatever is beyond that point of blood supply. “Heart muscle cells begin to die 20 minutes after the artery supplying that part of the heart becomes blocked with a clot. Death of the heart muscle is what we call a heart attack,” says Dr. Herling.

It can be more than just chest pain. The most common symptoms are feelings of pressure, heaviness, fullness, tightness, pain or squeezing in the chest, but the pain may pop up elsewhere. “The brain doesn’t localize heart pain accurately because the nerves carrying pain impulses from the heart to the brain are intermingled with pain fibers returning to the brain from other nearby areas of the body,” says Dr. Herling, who notes both men and women may feel aching in their jaw, teeth, base of the neck, across the back, or in one or both arms. “Older patients, especially women, are more likey to experience “atypical heart attack symptoms including shortness of breath, and sudden, extreme fatigue or weakness. In some, their heart attack will cause them to break out into a cold sweat, experience nausea or become lightheaded.”

Get help ASAP: “You have a short time to make the decision to call for help, ” says Dr. Herling. “Yes, those symptoms might not be due to a heart attack and you may have cried wolf, but if the wolf is there, you might pay the price with your death or substantial, irreversible heart damage.” That’s because the sudden blockage may cause ventricular fibrillation—which means the heart’s rhythm fails or changes suddenly. “The most dangerous period for developing ventricular fibrillation begins when the artery becomes blocked and for three hours thereafter. If you’re in the hospital or in an ambulance where your heart rhythm can be monitored, ventricular fibrillation can be recognized and treated with an electrical shock, which will restore the heart back to a normal rhythm. If ventricular fibrillation occurs elsewhere — your home or in your car for example — you are not likely to survive. When you hear that someone has had a ‘massive heart attack,’ it often means that they never made it to the hospital and they developed ventricular fibrillation before they could receive medical treatment.”

Time is muscle. After the artery closes you usually have six hours before the damage is permanent. ““If you get to the hospital quickly enough, cardiologists can perform a catheterization and unplug the blocked artery very quickly and successfully,” says Dr. Herling. “Often, a stent will be placed at the site of the obstruction in the artery to keep it open, which restores the blood supply and aborts the heart attack, preventing further death of heart muscle cells.”

Be aware of warnings. “Many people will have heart attack symptoms that come and go before they become unrelenting,” says Dr. Herling. “This occurs because the clot is trying to form but it dissolves spontaneously and re-forms. Eventually, if untreated, the artery may become completely obstructed and the heart attack will begin. If you get to the hospital before the obstruction is complete, you could avoid the heart attack completely.”