Heart attack? Get to the ER on time

If you suddenly felt faint and developed shoulder discomfort, would you call 911? You should. Those are two of the five most important heart-attack warning signs. And more than half of cardiac deaths may occur within an hour of developing the first symptom.

But according to an article in the February 22, 2008 issue of Morbidity and Mortality Weekly Report, published by the federal Centers for Disease Control and Prevention, less than a third of adults recognize all five warning signs of a heart attack:

1. Pain and discomfort in the jaw, neck or back
2. Feeling weak, lightheaded or faint
3. Chest pain or discomfort
4. Pain or discomfort in the arms or shoulder
5. Shortness of breath

Even more disturbing, the CDC study found that many people who did suspect a heart attack would delay calling 911. That hesitation can be fatal: Your odds of surviving an attack are much higher if you get to the emergency room within an hour of the onset of symptoms. After you call 911, chew and swallow one 325-mg (regular) aspirin or four 81-mg (baby) aspirins, since that can help prevent artery-clogging blood clots from forming.

The CDC data revealed striking variability across the country.  In Washington, D.C., for example, only 34 percent of respondents recognized pain or discomfort in the jaw, neck, or back as a sign.  Joel Rosenberg, M.D., Clinical Director of Cardiology at the George Washington University Hospital, said, “We’ve done a very poor job of educating people on how heart attacks present.” Rosenberg is not surprised by the poor results in D.C. given a financially devastated healthcare infrastructure, substantial numbers of low income residents, and poor access to care. “We have to start investing more time, money and effort into prevention of disease as opposed to just focusing on treatment” said Rosenberg, adding, “This includes teaching the public about the warning signs of heart attacks.”

Minnesota—which ranked number one in residents’ ability to identify chest pain as a heart-attack symptom and in calling for emergency assistance—may provide some clues as to how to accomplish that goal.  Thomas Behrenbeck, M.D., Ph.D., Associate Professor of Cardiology at the Mayo Clinic in Rochester, Minn., attributes these stats to focused public service campaigns and grass roots efforts, such as CardioVision 2020, dedicated to improving heart health. “As a result, Minnesota folks are probably more in tune with the warning signs and get medical attention faster than most,” Behrenbeck said. And efforts to improve the care chest pain patients receive once they get to the ER has improved the heart-attack survival rate at Mayo’s emergency room to between 94 and 97 percent, proving, said Behrenbeck that “time is life.” 

—Orly Avitzur, M.D., medical adviser to Consumers Union

Comments

[marcia]

In the past, I have had sharp pain in back, shoulder,neck & jaw & feel nauseous & dizzy. Whenever I take TUMS,
it eventually goes away, so I figure it was heartburn or indigestion. Am I wrong to assume this? Could these have been
"mini heart attacks"? Should I go to ER next time?

[Robert Steen]

Had heart attack--only sympton was severe pain in middle of chest. Waited about an hour before calling 911. Ended up having a triple bipass--no heart damage.

[Jan]

Can you imagine evertime someone felt faint or had a pain in their shoulder and ambulance would be called? The emergency rooms would be more flooded than they are now, ambulances would be called by the minute! Neck, shoulder pain could be your TMJ acting up, over exercising, even gall bladder symptoms. Feeling faint, can be heat related, emotional related or flu, etc. I think what really should be examined is the true symptoms for women which are different for men, age and past history of a person. I realize that having a heart attack is not (like in the movies where they clutch their chest and pass out) you may not have chest pain. In my experience I have seen a person feel severe nausea, sweating, uneasiness, and denial, sometimes indigestion, sometimes pressure in the chest. From this article it can only cause mass hysteria.

[Denise]

Like Jan, I would like to see more accurate information on women's heart attack symptoms. Enough has come out about these in published health newsletters that I am dismayed to find Consumer Reports omitting them. One such newsletter cited research showing that severe, unexplained fatigue is the most commonly experienced indicator of incipient heart attack in women. Many of us (at least here in Minnesota, as you report!) would head to the ER or at least phone a nurse line with chest pain, but not with fatigue or uneasiness (both of which our culture encourages us to ignore).

[Jim]

I agree completely with Jan's March 27 comment, above. if everyone responded to vague symtoms by calling 911, ERs would be swamped.

[nancy]

I have been a bartender for 25 years and I always have shoulder pain; in fact, I have it right now!