If you or someone near you is having a heart attack, call 911 immediately. Every minute without blood flow causes permanent damage to heart muscle, and research shows that outcomes worsen significantly after roughly two hours from the start of symptoms. The steps you take in those first minutes can determine how much heart tissue survives.
Recognize the Symptoms
The classic sign is chest pain or a feeling of pressure, tightness, or fullness in the center of the chest. But many heart attacks don’t look like what you see in movies. Other warning signs include nausea, unusual fatigue, shortness of breath with little exertion, lightheadedness, sweating without physical activity, and clammy hands.
Women, older adults, and people with diabetes are more likely to experience atypical symptoms. Pain in the jaw, neck, or left arm is especially common in women. Indigestion that won’t go away can also be a heart attack in disguise. People with diabetes sometimes have what’s called a “silent” heart attack, where nerve damage dulls chest pain, making these other symptoms the only clues. If something feels seriously wrong and you can’t explain it, treat it as an emergency.
Call 911 First
This is the single most important step. Paramedics can begin treatment on the way to the hospital, transmit heart rhythm data ahead, and alert the cardiac team so they’re ready when you arrive. Current guidelines set a goal of reopening the blocked artery within 90 minutes of first medical contact. That clock starts when paramedics reach you, so calling early gives the hospital its best chance of hitting that window.
Do not drive yourself. During a heart attack, your heart’s electrical system can become unstable at any moment, potentially causing a dangerous rhythm that leads to sudden loss of consciousness. If that happens behind the wheel, you put yourself and others at risk. Have someone else drive you only if an ambulance truly cannot reach you in time.
While waiting for help, unlock the front door so paramedics can get in without delay. If you’re alone, stay near the door and sit or lie down in a comfortable position.
Take Aspirin (the Right Way)
Heart attacks happen when a blood clot blocks an artery feeding the heart. Aspirin interferes with clotting, which can slow the blockage from getting worse. If the 911 operator or your doctor advises it, chew a single 325 mg regular aspirin rather than swallowing it whole. Chewing gets the drug into your bloodstream roughly twice as fast. In one study, chewing a tablet cut the time to reach meaningful clot-fighting activity from about 12 minutes down to 5.
Don’t take aspirin on your own without guidance, especially if you have an allergy to it or a history of bleeding problems.
If You Have Nitroglycerin
Some people with known heart disease carry prescribed nitroglycerin tablets. If you have them, place one under your tongue at the first sign of symptoms. You should feel some relief within five minutes. If you don’t feel better, or if you feel worse after one dose, call 911 right away. You can take up to three doses, spaced five minutes apart, but never more than three in a 15-minute window. Nitroglycerin is only for people who already have a prescription for it.
If Someone Collapses
A heart attack can trigger cardiac arrest, where the heart stops pumping effectively and the person loses consciousness. If someone collapses and isn’t responsive, the situation has escalated beyond a heart attack into a life-threatening emergency that requires immediate action.
First, tap their shoulder and shout to check for a response. If they don’t react, have one person call 911 while another begins CPR. Push hard and fast in the center of the chest at a rate of about 100 to 120 compressions per minute. If you’re not trained in rescue breathing, hands-only CPR (compressions without mouth-to-mouth) is still effective and far better than doing nothing.
If an automated external defibrillator (AED) is nearby, grab it. These devices are designed for untrained users. Turn it on and it will talk you through each step, including where to place the adhesive pads on bare skin. If it tells you to deliver a shock, press the button, then immediately resume chest compressions. Continue CPR until paramedics arrive or the person starts breathing normally.
Skip “Cough CPR”
You may have seen social media posts claiming that forceful, repeated coughing can keep your heart going during a heart attack. The American Heart Association does not endorse this. The technique has a very narrow use in hospital settings under direct medical supervision, and it doesn’t apply to the kind of emergency you’d face at home or in public. Someone who is truly in cardiac arrest is unconscious and physically unable to cough. Following this advice could waste precious seconds you should spend calling 911 or starting chest compressions.
What to Tell Paramedics
When emergency responders arrive, they’ll move fast. Having key information ready helps them make better decisions. Try to provide:
- When symptoms started. The exact time, or your best estimate, directly affects treatment decisions at the hospital.
- Current medications. Include prescriptions, supplements, and over-the-counter drugs. Blood thinners and erectile dysfunction medications are especially important to mention because they interact with emergency cardiac treatments.
- Allergies. Particularly to aspirin, contrast dye, or any medications.
- Medical history. Prior heart attacks, high blood pressure, diabetes, high cholesterol, or any history of heart disease.
- Family history. Heart disease or sudden cardiac death in close relatives.
If you’re the bystander and don’t know this information, check the person’s wallet or phone for a medical ID card or app. Even partial information helps.
Why Minutes Matter
When a coronary artery is completely blocked, the heart muscle it feeds begins to die. A study using cardiac MRI found that when the artery stayed blocked longer than about two hours from symptom onset, patients had significantly larger areas of dead tissue and much less muscle that could be saved. Patients treated before that threshold kept more functioning heart muscle and had better outcomes.
This is why the entire chain of events, from recognizing symptoms to calling 911 to arriving at a hospital equipped to reopen the artery, needs to happen as quickly as possible. The current treatment goal is to have the blocked artery reopened within 90 minutes of first medical contact for patients brought in by ambulance, or within 120 minutes for those transferred from a smaller hospital. Every delay chips away at the amount of heart muscle that can be rescued, and lost heart muscle doesn’t grow back.