Dear Neighbor:

There's a saying in cardiology that "time is muscle."  Every minute that a heart attack goes unrecognized and untreated means that more heart muscle dies.  The more the heart muscle is compromised, the greater the decrease in the person's quality of life forever after.  Think of it as a clock that is running out on living a normal life - on the ability to walk up stairs, to play with grandchildren, to simply do the things you want to do.    

When someone is having a heart attack, delay in treatment may lead to a bigger heart attack and worse prognosis. That's why we are focusing this issue of our newsletter on recognizing heart attack signs and symptoms. By learning to recognize these signs and symptoms, and by seeking emergency care without delay, you might make an enormous and positive difference in the quality of your life for the rest of your life.  You might save your own life.  Or, you might do that same good thing for someone you love, or for a perfect stranger.  How cool is that?  

When Washington Ambulance Emergency Medical Technicians (EMTs) and Emergency Medical Responders (EMRs) begin our assessment of a 

patient, we are always attuned to cardiac risk factors.  If a patient has any of these risk factors, it heightens our level of suspicion that the call may be cardiac, even if it was not originally dispatched as a cardiac call. The specific risk factors that raise red flags for us are:

1. A patient who is over 65 years old
2. A family or personal history of heart disease
3. Smoking
4. Hypertension
5. Diabetes
6. High cholesterol
7. A sedentary lifestyle

If you have any of these risk factors, then it is especially important for you to know and recognize heart attack symptoms.

Tip #2:  Know the Most Common Heart Attack Symptoms 

The most common symptoms of a heart attack are chest pain (sometimes radiating to the upper arm or jaw), nausea, vomiting, shortness of breath, sudden, heavy sweating, and lightheadedness.  Some people also experience a feeling of anxiety or a sense of impending doom.  

If you have these symptoms, call 911 immediately.  Do NOT try to drive yourself to the hospital!  It could put you or others on the road in danger. When you call 911, the responding ambulance crew will begin assessment and treatment right on scene, will continue that assessment and treatment in the ambulance on the way to the hospital, will take you to the most appropriate hospital, and will fast track you to the right setting within that hospital.   

Tip #3:  Know the Atypical Symptoms of a Heart Attack  

37% of women and 27% of men who are having heart attacks do not have chest pain.  That's why it's important to be attuned to the total constellation of symptoms, which may include:

• Pain or discomfort in other parts of the body, such as the arm, shoulder, middle back or jaw
• Indigestion, heartburn, nausea or vomiting
• Clammy skin or sweating
• Feeling dizzy or light-headed or actually fainting
• Unusual or unexplained fatigue or generalized weakness
• Heart palpitations
• Strokelike symptoms such as numbness or unexplained confusion

Tip #4:  A Special Tip for Women (and those who love them)

Coronary heart disease is the leading cause of death for women in the United States.  Women are 5.5 times more likely to die from heart disease than from breast cancer.  Women, do not ignore heart attack symptoms!

Tip #5:  For Patients Who Have Diagnosed Angina

Patients who have previously been diagnosed with angina should be concerned if their angina is increasing or becoming unstable - that is, if it is happening more often, being triggered by lower levels of exertion, becoming more severe, lasting longer, not responding to nitro, or continuing even after 20 minutes of rest.  A patient with diagnosed angina should have a calm, in-advance conversation with their doctor about when increasing angina should prompt a call to 911.    

Tip #6:  For People Who Are Worried About Crying Wolf

It is true that there are lots of things besides heart attacks that can cause chest pain.  These include coughing, pleurisy, direct trauma to the chest, indigestion and stress.  Our suggestion to you is that you take the time now, in a moment of calm, to read an excellent article from the Mayo Clinic called Heartburn or chest pain: When is it heart attack?     

We would like to say this: Unexplained shortness of breath is a huge red flag that you are experiencing a medical emergency. There are really no benign explanations for unexplained shortness of breath or difficulty breathing.  

Tip #7:  Keep Baby Aspirin in Your Medicine Cabinet

If you call 911 and your symptoms appear to be cardiac, one dispatcher will get the ambulance and paramedic started while the original dispatcher will stay on the phone with you and will very likely direct you to take four 81 mg tabs of baby aspirin.  Why?  Aspirin is a blood thinner that can begin working to dissolve a blood clot, if you have a blood clot obstructing the flow of blood to your heart.  Before directing you to take baby aspirin, the 911 dispatchers will ask you a few questions to see if you are a good candidate for aspirin.