Call 911 immediately. Do not drive yourself to the hospital. Every minute of delay increases the damage to your heart, and the steps you take in the first few minutes can be the difference between a full recovery and lasting harm. Here is exactly what to do, in order.
Step 1: Call 911
Pick up the phone before you do anything else. Calling 911 does more than send an ambulance. It alerts hospital staff so the right specialists are ready when you arrive. In the ambulance, paramedics can run an electrocardiogram, transmit the results to a cardiologist, start medications, and perform CPR or defibrillation if your heart stops. A well-trained paramedic crew can do nearly everything a hospital emergency room can do for cardiac arrest, and they can do it while you’re still on the road.
Tell the 911 operator you think you’re having a heart attack. They can instruct you on whether to take aspirin while you wait. Stay on the line as long as they need you.
Step 2: Chew an Aspirin
If the 911 operator recommends it and you’re not allergic, chew (don’t swallow whole) one regular-strength aspirin, which is 325 mg. Chewing gets the drug into your bloodstream faster. Aspirin helps prevent blood clots from growing larger, and in clinical trials, chewing a 162 mg dose during a heart attack reduced the death rate by 23% and cut the risk of a second heart attack or stroke by nearly half. Chew the tablet thoroughly, then swallow it.
If you only have low-dose (81 mg) aspirin on hand, chew four of them to reach the recommended range of 162 to 325 mg.
Step 3: Take Nitroglycerin If Prescribed
If you have a prescription for nitroglycerin for a known heart condition, take it as directed while you wait. For the spray form, open your mouth and spray once or twice onto or under your tongue. You can use up to three sprays within 15 minutes. If your chest pain hasn’t improved after three doses, that’s another signal to get to the hospital as fast as possible, which the ambulance should already be handling.
Do not take someone else’s nitroglycerin. It lowers blood pressure, and in some situations that can make things worse.
Step 4: Prepare for the Paramedics
While you wait, do what you can to help the ambulance crew reach you quickly. Unlock your front door. Turn on a porch light if it’s dark. If someone is with you, have them stand outside to flag down the ambulance. Sit or lie down in a comfortable position, and try to stay as calm as possible, since physical exertion forces your heart to work harder.
If you take any medications, have someone gather the bottles so paramedics can see what you’re on. This saves time at the hospital.
Why You Should Never Drive Yourself
It might feel faster to jump in the car, especially if you live near a hospital. It’s not. Even if the hospital is a block away, you still have to park, walk to the emergency department, and potentially wait in line to check in. During a heart attack, mild symptoms can worsen suddenly. Your heart can slip into a dangerous rhythm or stop entirely, and if that happens while you’re behind the wheel, you’re a danger to yourself and everyone on the road.
Emergency physicians have described people arriving at the ER with an unconscious, pulseless passenger in the front seat because they thought driving would be quicker. Fifteen minutes without a pulse in a car, with no one trained to help, is often fifteen minutes too many. The ambulance brings the hospital to your home.
How to Recognize a Heart Attack
The classic symptom is chest pain or pressure, often described as heavy, tight, or crushing. But heart attacks don’t always look like they do in movies. Symptoms frequently start slowly and build over hours or even days before the full event. You might feel discomfort in your arms, jaw, neck, upper back, or stomach. Shortness of breath, cold sweats, nausea, and lightheadedness are all common.
Symptoms in Women
Both men and women most commonly report chest pain or tightness, but men report chest pain as their primary complaint about 13 to 15% more often than women. Women are more likely to experience nausea, vomiting, dizziness, and jaw or neck pain. Some women describe upper back pain, left shoulder pain, or abdominal discomfort as their main symptom. These less obvious presentations are a major reason women are more likely to delay seeking help.
Silent Heart Attacks
Some heart attacks produce symptoms so mild they get dismissed as something else entirely. You might feel like you have the flu, a pulled muscle in your chest, indigestion, or just unusual fatigue. The key difference between heart-related chest discomfort and other causes is that heart attack pain typically doesn’t go away with rest. If you have vague but persistent symptoms, especially combined with risk factors like high blood pressure, diabetes, or a family history of heart disease, call 911. It’s far better to be checked and sent home than to ignore a heart attack.
Why Minutes Matter at the Hospital
The most dangerous type of heart attack, called a STEMI, happens when a major artery supplying the heart is completely blocked. Treatment involves threading a thin catheter to the blockage and reopening the artery. Current guidelines set a target of 90 minutes or less from the moment you first contact emergency services to the moment that artery is reopened. For every 30 minutes of delay beyond that window, the risk of dying within a year rises by 7.5%.
Calling 911 instead of driving shaves critical time off this clock. Paramedics can identify a STEMI in the field using a portable electrocardiogram and radio ahead so the catheterization lab is prepped and staffed before you roll through the hospital doors.
If Someone Near You Is Having a Heart Attack
Call 911 first. Then help the person sit or lie down comfortably. Ask if they take nitroglycerin and help them use it. Ask the 911 operator about aspirin.
Watch the person closely. A heart attack can trigger cardiac arrest, which is when the heart stops pumping blood entirely. You’ll know this has happened if the person becomes unresponsive, stops breathing, or is only making occasional gasping breaths. If that happens, start CPR immediately. Push hard and fast on the center of the chest at a rate of 100 to 120 compressions per minute. If you haven’t been trained in CPR, skip the rescue breaths and just keep pushing. If an automated external defibrillator (AED) is nearby, use it. AEDs are designed for untrained bystanders and provide voice instructions that walk you through each step. Cardiac arrest is survivable if CPR and defibrillation happen within the first few minutes.