Would You Know If You Were Having a Heart Attack?

Know the Symptoms

If you think you're too young for a heart attack, you need to confront the scary truth: Every year about 40,000 American women under age 55 are hospitalized for heart disease, and 16,000 of them die. What's more, younger women's heart attacks are fatal twice as often as men's. In fact, women who are 35 to 44 are the only Americans whose coronary heart disease mortality is rising (by 1.3 percent a year), according to a new study in the Journal of the American College of Cardiology.

Yet heart disease just isn't on most women's radar, even women who have risk factors that make this kind of health crisis much more likely. Our symptoms can also be so different from what we expect a heart attack to feel like that it's easy to miss what's really going on and delay getting medical care, which might be a deadly mistake. To have the best chance of survival and full recovery, treatment needs to start within 90 minutes of the onset of the attack. Taking the following steps before the ambulance arrives could save your life.

Know the Symptoms A heart attack isn't always excruciatingly painful. A majority of male and female heart attack survivors told University of Rochester researchers in a 2007 study that there was less discomfort than they would have expected. Women often don't have the classic symptoms, says Jennifer H. Mieres, MD, director of nuclear cardiology and associate professor of medicine at New York University Medical Center. "Instead of chest pain, you may feel pressure, as if somebody were pushing on the inside of your chest, or you may have pain or unusual sensations somewhere other than your chest, such as your upper abdomen, the left side of your back, your shoulder, even your jaw," Dr. Mieres says. "One woman's teeth hurt and she had numbness in her mouth along with fullness in her chest. Some women also get a cold, clammy feeling or a sense that something's badly wrong. Or your only symptom may be unusual shortness of breath, so you're huffing and puffing during mild exertion that doesn't usually bother you, or feel that you can't get enough air."

Most younger women (55 or under) who have heart attacks don't recognize any of the warning signs, Yale University researchers reported in May. Many had so-called atypical symptoms, such as sudden onset of fatigue, nausea, and weakness, which are more likely to strike women than men. But even though 88 percent also had some chest pain, a leading heart attack symptom in both sexes, only 42 percent thought it was their heart. Others blamed heartburn or indigestion, which feel similar. Recognizing symptoms that might be a heart attack -- and realizing you could be vulnerable -- is key to survival.

Call 911 Immediately

Say forcefully that you think you're having a heart attack. Don't worry about being wrong. There's a limited window of time to get the full benefit of such potentially lifesaving therapies as clot-busting drugs and balloon angioplasty (threading a balloon-tipped catheter through a vessel in your arm or leg to the blockage, then inflating the balloon to widen the clogged area). Sometimes a wire scaffold called a stent is also used to prop the vessel open. "If balloon angioplasty gets the artery open in the first hour after the heart attack, it can almost always prevent permanent heart damage," says Timothy D. Henry, MD, director of research at the Minneapolis Heart Institute. "And if we can do it within 90 minutes of the onset of symptoms, that's usually fast enough to limit the severity of most heart attacks." Yet many women wait two or more hours. Bad move. "You risk your life by delaying," says Michael Cuffe, MD, chief medical officer of the Duke University Health System. "Not only do your chances of sudden death go up, but even if you survive the attack, you could be left with such severe heart damage that it leads to death over the next six to 12 months."

Consider Aspirin (Maybe)

Taking aspirin soon after a heart attack can significantly improve survival -- but not always. Conditions that make even one aspirin risky? Stomach ulcers, being on blood-thinning drugs or, of course, an aspirin allergy. The 911 operator should ask about these and also try to determine whether your symptoms might signal a stroke. Aspirin can worsen the form of stroke triggered by a ruptured blood vessel. Otherwise, an aspirin can help slow further buildup of the clot that's causing the attack. Chew one standard-strength 325mg aspirin tablet or an equivalent dose of Alka-Seltzer in water. Don't take coated aspirin, which acts more slowly, even when you chew it.

Wait for the Ambulance (Always!)

"About 5 percent of heart attack patients die before they get to the hospital because they develop abnormal heart rhythms, followed by cardiac arrest," Dr. Cuffe points out. "All too often we see spouses drive a loved one to the hospital only to have that happen in the car. After even a minute or two, the chances of reviving someone in cardiac arrest drop very rapidly, and after five to 10 minutes, survival rates are near zero." If your heart stops in an ambulance, however, paramedics can immediately use a defibrillator, which can shock it back into a healthy rhythm. You'll also likely get faster treatment. A May 2007 study coauthored by Dr. Henry shows that arriving by ambulance can speed up "door-to-balloon angioplasty time" by up to 18 minutes, on average. Paramedics can do an EKG en route and alert ER doctors if you're having a heart attack, so they're ready to start artery-opening treatment immediately. On the way the crew can give you emergency medications, start an IV, and monitor your heart rhythms. "The ambulance crew can already diagnose your condition before you get to the hospital," says Dr. Henry. "But this would not be true if you arrived by car."

Don't Go Alone

Should symptoms hit when you're by yourself, 911 should always be your first call. After that, if possible, contact the family member, friend, or neighbor who can get to your location fastest. Tell your helper immediately that you think you're having a heart attack and what your symptoms are. Also say where your insurance card and contact list are (see "Your Heart Attack Emergency Kit") and that you've called an ambulance, and give the name of the hospital you expect you'll go to. That way, if you later become too incapacitated to provide information to emergency responders, she or he can speak for you. Tell her to meet you at the hospital if the ambulance gets to you before she does. Then write down what you feel you have, get out your insurance cards, and unlock your front door in case you lose consciousness. Loosen any tight clothing and sit or lie down in a comfortable position.

Know Your Hospitals

An ambulance will normally take you to the closest hospital. But if there are several close by, the crew may agree to take you to the hospital of your choice if you offer a reason that makes medical sense -- for example, your doctor practices there or has recommended it. The crew may be unable to comply if they are urgently needed for other calls. Or they may deem another center more appropriate, perhaps because it has a better emergency coronary program or because your condition is unstable and the safest option is to rush you to the nearest ER. If you end up at a hospital that's not in your insurance plan, it's unlikely an insurer would refuse to cover ER care for a possible heart attack or other urgent symptoms. If the hospital is out of network, however, you may have a higher co-payment. Does it ever make sense to call the hospital of your choice for an ambulance? The answer is no, to avoid a potentially dangerous delay. Since hospitals don't dispatch ambulances, you'll just be told to contact 911, always your first call in an emergency. Don't call a private ambulance service -- it may be slower and less well equipped and may not be well coordinated with the ER's cardiac team, Dr. Cuffe says.

Your Heart Attack Emergency Kit

• Keep a bottle of uncoated aspirin in your medicine cabinet at all times.
• Prepare a written contact list of family, friends, and physicians. Post near home and office phones and keep a copy with your insurance card.
• Program the numbers of your contact list on the speed dial of your home, office, and cell phones.
• Keep a pad and pen handy to write down your symptoms in case you become unable to speak.
• Ask your doctor which hospital to use for emergencies and research the best cardio units near you.
• If you're allergic to any drugs or have a chronic health issue, consider wearing a medical alert bracelet.
• Know your insurance plan's rules for ER treatment, including those for using out-of-network hospitals.