Listen to your heart

By Steven Reinhart, M.D., cardiologist, medical director of quality for Providence Heart and Vascular Institute, and medical director of the Coronary Care Unit at Providence Portland Medical Center

When your heart tells you that something’s wrong, listen.

We’ve all felt a pain in the chest at one time or another – a quick flash that came and went, or another episode of heartburn. But if you experience chest pain that is unusual and unrelenting – pain that is different from anything you’ve felt before, and that persists – don’t ignore it. It might not be a heart attack, but the possibility that it might be means you need to call 911 right away.

If it is a heart attack, your quick action could save your life, or spare you from a lifetime of disability from reduced heart function. If it’s not a heart attack – well, what a wonderful problem it is to have it turn out to be a false alarm. Emergency medical technicians (EMTs) and cardiologists expect some false alarms, because we don’t expect people to be able to diagnose themselves accurately without the benefit of EKG machines and blood tests. The best we can hope for is that you recognize that it could be a heart attack, and make that call right away – because when you are having a heart attack, every second counts.

Why timing is everything

A heart attack begins when a blood clot blocks the flow of blood through an artery, preventing blood from reaching part of the heart. From that first moment of blockage, the heart muscle starts to sustain damage. The more quickly the vessel can be reopened and blood flow restored, the more heart muscle can be saved. As each minute goes by without treatment, more of the heart muscle dies. After three hours or more, about 90 to 95 percent of the heart muscle is dead – and that is irreversible.

The advantage of acting fast is obvious: you have the opportunity to preserve your heart muscle, which affects how well you will feel, how well you will function, and how long you will live after a heart attack. The longer help is delayed, the more potential for significant physical impairment or death.

Throughout Providence Health & Services, we have shaped and refined our heart-emergency protocols to shave precious minutes off the time it takes to reopen a patient’s blocked artery. From the minute a paramedic or EMT reaches the patient to the minute we inflate a tiny balloon to reopen the blocked blood vessel, every person and every step is carefully choreographed to restore blood flow as quickly as possible. National guidelines call for “door-to-balloon” times (beginning with the patient’s arrival at the hospital) to be less than 90 minutes. Providence’s median time is 73 minutes, and we’re continually working to reduce that time, and the time between first medical contact and arrival at the hospital, even further.

The one piece of the time equation that is out of our hands is how long it takes the patient to recognize a heart attack and call 911. I hope that the following information will help you minimize that time, should a heart attack ever strike you or someone you love.

Recognize the signs 

Right now, while you’re feeling good, take a moment to learn the signs of a heart attack so you’ll recognize one if it happens to you or someone near you.

A typical heart attack hits the center of the chest with gripping pain, pressure or a pressing sensation. The pain may radiate to the neck, jaw or arms, and may be accompanied by sweating, nausea or shortness of breath. Although there are exceptions, men’s symptoms usually follow this classic pattern.

In women, there is no pattern – one woman’s symptoms may vary from another’s. Some do experience the classic signs, but many don’t. Women may experience atypical symptoms such as pain or discomfort in the jaw, the teeth or an elbow; sudden weakness or deep fatigue; or a vague feeling of dread or a sense that something isn’t right. If a woman feels a chest pain she’s never experienced before, and doesn’t feel very good, I don’t care how odd the pain may seem, she should seek medical attention. If the pain is unrelenting, she should not drive herself to the hospital – she should call 911.

If someone you’re with is experiencing chest pain or pressure that’s not letting up, consider that he or she may be having a heart attack. If the pain persists for several minutes and the person is getting a little sweaty or seems to be breathless, don’t hesitate – call 911 to get medics on the way.

React quickly

If you suspect a heart attack is happening, do not wait it out to see if it will go away. The first thing to do is to call 911. Period.

After calling 911, make sure your door is unlocked so medics can get in. If you have aspirin, take one. If you take nitroglycerin for heart issues, take that, too. Then lie down and wait for the medics. Do not try to drive yourself to the hospital. The Oregon medic community is spectacularly well trained. These medical professionals are part of our team, and they know exactly what to do to begin your treatment with the least delay.

If you are with someone who may be having a heart attack, call 911 first. Then help the person lie down and get comfortable. Administer an aspirin and nitroglycerine, if available. Gather up all medications that the person takes and put them in a bag for the EMTs – this is extremely helpful in delivering the best treatment.

If you are with someone who suddenly loses consciousness, call 911, make sure the person’s airway is open, and start doing chest compressions following the CPR guidelines. (View in Spanish.)

Do your community a favor – learn CPR

We’ve all heard stories about the bystander on the street who delivers CPR until the medics arrive. That person could be you. Or it could be the person who saves your life, or the life of someone you love. If everyone knew CPR, it would be a huge service to the community. I encourage you to sign up for a class – just look online for a class near you – and sign up your kids, too. It only takes a few minutes out of your life, and it could be life changing.

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Dr. Reinhart sees patients at Providence Heart Clinic at The Oregon Clinic Gateway, located at 1111 NE 99th Ave., Suite 201, Portland. For more information about the clinic’s services, call 503-962-1000.