How to Survive a Heart Attack

The First Few Minutes and Hours Are Critical to Surviving a Heart Attack

There are two good reasons you should know the basic information about how to survive a heart attack. First, odds are very high that either you or someone you love will suffer from a heart attack during your lifetime. And second, whether you (or your loved one) survive that heart attack may depend on what you and your doctors do about it during the first few hours -- and over the long term.

What Is a Heart Attack?

A heart attack, also called a myocardial infarction (MI), is the most severe form of acute coronary syndrome (ACS). MIs, like all forms of ACS, are usually triggered by the rupture of a plaque within a coronary artery. This plaque rupture causes a blood clot to form, leading to blockage of the artery. The portion of the heart muscle being supplied by the blocked artery then begins to die. It's the death of heart muscle that defines an MI.

• How the blood clots, and how clotting contributes to heart attacks.

What Are the Consequences of a Heart Attack?

To a large degree, the outcome of an MI depends on how much of your heart muscle dies, which, in turn, is related to which of your coronary artery is blocked, and where in the artery the blockage occurs. (A blockage near the origin of an artery will affect more heart muscle than a blockage farther down the artery.)

• A Look at the Coronary Arteries

If the heart muscle damage is severe, it is possible to develop acute heart failure during the MI itself, which is a very dangerous condition. If the amount of heart muscle damage is less severe but still significant, you can develop heart failure later on. So, taking steps to prevent heart failure after an MI, or aggressively treating heart failure should it develop, is an extremely important aspect to treating an MI.

An MI can also produce dangerous heart arrhythmias. During the acute MI itself, electrical instability occurs that may cause ventricular tachycardia (VT) and ventricular fibrillation (VF). Later, the scar tissue that results from the healing process can cause a permanent electrical instability. So, unfortunately, cardiac arrest and sudden death are risks both during an acute MI and after full recovery from an MI.

Why Are the First Few Hours of a Heart Attack Critical?

For anyone having an MI, getting rapid medical attention is absolutely critical for two reasons:

• Most of the cardiac arrests seen with acute MIs occur within the first few hours. If the cardiac arrest happens after you have come under medical care, there is an excellent chance it can be successfully treated; otherwise the odds of surviving a cardiac arrest are very low.
• Both the short-term and the long-term consequences of an MI are largely determined by how much of your heart muscle dies. With rapid and aggressive medical treatment, the blocked artery can usually be opened quickly, thus preserving most of the heart muscle that is at risk of dying. If treatment is given within three or four hours, much of the permanent muscle damage can be avoided. But if treatment is delayed beyond five or six hours, the amount of heart muscle that can be saved drops off significantly. After about 12 hours, the damage is usually irreversible.

Getting rapid and appropriate medical care requires that two things happen. First, it requires that you know the signs of a heart attack, and seek medical help the moment you think you might be having one. Second, it requires that the medical personnel who are caring for you do the right things, and do them quickly. The following articles will help you do what you need to do, and to get the care you need to get.

Help Yourself Survive A Heart Attack:

• How to Recognize a Heart Attack...and What to Do About It
• What Is the Critical Early Treatment for a Heart Attack?
• What Should Happen After the First Critical 24 Hours?

_Sources:

_{Antman, EM, Hand, M, Armstrong, PW, et al. 2007 focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction). J Am Coll Cardiol 2008; 51:XXX.}

_{Cannon, CP, Hand, MH, Bahr, R, et al. Critical pathways for management of patients with acute coronary syndromes: an assessment by the National Heart Attack Alert Program. Am Heart J 2002; 143:777.}