Call 911 immediately. Do not drive yourself to the hospital. Every minute matters: heart muscle begins to die within hours of a blocked artery, and half of all heart attack deaths happen in the first three to four hours after symptoms start. The single most important thing you can do is get emergency medical services on the way.
Step by Step: What to Do Right Now
If you think you or someone near you is having a heart attack, follow these steps in order:
- Call 911. Tell the dispatcher you think you’re having a heart attack. They can talk you through the next steps and dispatch paramedics immediately.
- Chew an aspirin. If you’re not allergic to aspirin and the 911 operator confirms it’s safe, chew one regular aspirin (325 mg) or up to four low-dose aspirin. Chewing gets it into your bloodstream faster than swallowing whole. Uncoated aspirin works quickest, but coated aspirin is fine if that’s all you have.
- Sit or lie down. Stay as calm as possible and avoid any physical exertion. Sit upright if breathing is difficult.
- Unlock your door. If you’re alone, unlock the front door so paramedics can get in if you lose consciousness.
- If you have prescribed nitroglycerin, take one dose under your tongue while sitting down. If symptoms don’t improve after five minutes, take a second dose. A third dose can follow five minutes later. If chest pain hasn’t gone away completely five minutes after the third dose, that confirms you need the emergency care already on its way.
Why You Should Never Drive Yourself
A heart attack can worsen rapidly. Your heart rhythm can become dangerously unstable at any moment, which could cause you to lose consciousness behind the wheel. That puts you, your passengers, and everyone else on the road at risk.
Beyond safety, calling 911 actually gets you treated faster. Paramedics can start lifesaving treatment in the ambulance, monitor your heart rhythm for cardiac arrest, and radio ahead to the emergency department so the team is ready the moment you arrive. Hospitals aim to open a blocked artery within 90 minutes of your arrival. Driving yourself eats into that window and delays everything that follows. Even having someone else drive you is less safe, because the driver may be distracted, speed dangerously, and neither of you has the equipment to treat a sudden cardiac arrest.
Recognizing the Symptoms
The classic sign is chest pain or pressure, often described as squeezing, fullness, or a heavy weight on the chest. But heart attacks don’t always look like they do in movies. Pain can spread to your arms, back, neck, jaw, or stomach. You may also feel short of breath, nausea, a cold sweat, lightheadedness, or a rapid or irregular heartbeat.
Women are more likely to experience symptoms without obvious chest pain. Fatigue, upper back pain, dizziness, palpitations, weakness, anxiety, jaw pain, and vomiting are all more commonly reported by women during a heart attack. In one study, women were significantly more likely to have a “painless” heart attack, with shortness of breath as the primary symptom in 72% of those cases.
People with diabetes face a similar challenge. Nerve damage from diabetes can dull the sensation of chest pain, meaning the typical warning signal never fires. Diabetic patients are more likely to present with shortness of breath, weakness, or hyperventilation instead of recognizable chest pain. If you have diabetes, treat any unexplained combination of these symptoms seriously, even without pain.
If Someone Collapses
A heart attack and cardiac arrest are different things, but a heart attack can trigger cardiac arrest, where the heart stops beating effectively and the person collapses, becomes unresponsive, and stops breathing normally. If this happens:
- Call 911 (or have someone else call while you act).
- Start chest compressions immediately. Place the heel of one hand in the center of the chest, put your other hand on top, and push hard and fast. Aim for 100 to 120 compressions per minute. That’s roughly the beat of “Stayin’ Alive” by the Bee Gees. Push at least two inches deep on an adult.
- Don’t stop. Keep compressing with minimal interruptions until paramedics arrive or the person starts moving, breathing normally, or speaking.
- Use an AED if one is nearby. Automated external defibrillators are found in many public buildings. Turn it on and follow the voice prompts. It will only deliver a shock if one is needed.
You don’t need formal training to do Hands-Only CPR. Skipping mouth-to-mouth and focusing entirely on chest compressions is effective for adults who collapse suddenly, and it’s what the American Heart Association recommends for untrained bystanders.
Why Minutes Matter
During a heart attack, a clot blocks blood flow to part of the heart muscle. The longer that muscle goes without oxygen, the more of it dies permanently. After about six hours, most of the damage is irreversible. Clot-dissolving medications must be given intravenously within six hours to be effective, and the sooner they’re administered, the more heart muscle is saved.
For the most severe type of heart attack (called a STEMI), hospitals aim to open the blocked artery with a catheter procedure within 90 minutes of your arrival. That clock starts the moment you walk through the door. Every delay before that, whether it’s hesitating to call 911, driving yourself across town, or waiting to see if symptoms pass, subtracts from the time available to save heart tissue.
What Happens at the Hospital
The first test is typically an electrocardiogram (EKG), which reads your heart’s electrical activity and can show whether you’re actively having a heart attack. This often happens within minutes of arrival. Blood tests follow, measuring a protein called troponin that leaks from dying heart cells. Troponin levels are checked more than once over several hours to track changes, since levels rise as damage progresses.
Based on these results, the medical team decides on treatment. For a major blockage, that usually means a catheter procedure to open the artery and place a small stent to keep it open. For less severe cases, medications to dissolve the clot or prevent further clotting may be the first approach. What you’ll experience is an IV, monitoring equipment, and a team working quickly. Recovery time and next steps depend on how much muscle was affected and how fast treatment began.
Skip “Cough CPR”
You may have seen posts online claiming that coughing forcefully and repeatedly can keep you alive during a heart attack. The American Heart Association does not endorse this. While forceful coughing has been used in very specific hospital settings, under direct medical supervision, with continuous heart monitoring, it is not a substitute for calling 911. It doesn’t work reliably, it doesn’t treat the underlying blockage, and relying on it wastes the time you need most.
Aspirin Cautions
Aspirin works during a heart attack by preventing the blood clot from growing larger. But it’s not safe for everyone. You should avoid taking aspirin if you’ve ever had an allergic reaction to it, if you have asthma that worsens with aspirin, or if you have a bleeding disorder. People with active stomach ulcers or those currently taking blood thinners like warfarin also face higher bleeding risks. When in doubt, the 911 dispatcher can advise you in real time on whether to take it.