Call 911 immediately. That is the single most important thing you can do during a heart attack. Heart muscle begins to die within 30 minutes of losing blood flow, so every minute between the start of symptoms and medical treatment determines how much damage your heart sustains. While you wait for paramedics, there are a few specific steps that can improve your outcome.
Step by Step: What to Do Right Now
If you think you or someone near you is having a heart attack, follow this sequence:
- Call 911 first. Do this before anything else. Paramedics can begin treatment in the ambulance and alert the hospital so a team is ready when you arrive. Hospitals aim to open a blocked artery within 90 minutes of your arrival, and that clock starts ticking the moment you walk through the door.
- Sit or lie down. Stop all physical activity. Your heart needs less oxygen when your body is at rest.
- Take nitroglycerin if you have a prescription. Place the tablet under your tongue or use the spray. You can take one dose every 5 minutes, up to 3 doses in 15 minutes. Do not eat, drink, or smoke while the tablet dissolves. If pain continues after 3 doses, emergency services should already be on the way.
- Chew an aspirin if emergency services advise it. When you call 911, the dispatcher may tell you to take an aspirin. Chewing it gets it into your bloodstream faster than swallowing it whole. Aspirin slows blood clotting, which can limit damage to the heart muscle. Don’t take one on your own without that guidance, especially if you have an aspirin allergy or a bleeding disorder.
- Unlock your front door. If you’re alone, unlock the door so paramedics can reach you if you lose consciousness.
- Do not drive yourself to the hospital. A heart attack can cause sudden loss of consciousness or dangerous changes in heart rhythm. If you pass out behind the wheel, you put yourself and others at serious risk. Have someone else drive only if an ambulance truly cannot reach you.
If Someone Collapses and Stops Breathing
A heart attack and cardiac arrest are not the same thing. During a heart attack, the heart usually keeps beating. Cardiac arrest is when the heart suddenly stops, and the person loses consciousness and has no pulse. A heart attack can trigger cardiac arrest, which is why you need to know what to do if the situation escalates.
If the person is unresponsive and not breathing normally, call 911 (if you haven’t already) and start CPR. 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 do chest compressions. Performing CPR can double or triple a person’s chance of survival. If an automated external defibrillator (AED) is nearby, use it. The device gives voice instructions and is designed for untrained bystanders.
Recognizing the Symptoms
The classic heart attack symptom is chest pain or pressure, often described as dull, heavy, tight, or crushing. Pain frequently spreads to the left arm, jaw, neck, or upper back. But not everyone experiences the textbook version, and hesitating because your symptoms don’t “look right” is one of the most common reasons people delay calling for help.
Women in particular tend to present with less obvious symptoms. Nausea, vomiting, dizziness, shortness of breath, and unusual fatigue are all more common in women during a heart attack. Many women report prodromal symptoms in the days leading up to the event: unusual tiredness, trouble sleeping, anxiety, and mild arm or back pain. Women also tend to wait longer before going to the hospital, which leads to more heart damage. Pain in the jaw, neck, upper back, or abdomen, without any chest pain at all, can still be a heart attack.
Men more commonly feel the classic crushing chest pressure radiating to the left arm, but they can also experience nausea, cold sweats, and lightheadedness. The bottom line: if something feels seriously wrong and you can’t explain it, call 911. A false alarm is always better than a missed heart attack.
What Happens at the Hospital
Once you arrive at the emergency department, the first test is an electrocardiogram (EKG), often performed within minutes. This measures the electrical activity of your heart and can show whether a heart attack is in progress and which part of the heart is affected. The medical team will also draw blood to check for a protein called troponin, which leaks into the bloodstream when heart muscle is damaged. Troponin levels are tested repeatedly over several hours to track changes.
If the EKG shows a major blockage, the goal is to reopen the artery as quickly as possible. The standard procedure involves threading a thin catheter to the blocked artery and inflating a small balloon to restore blood flow. Current guidelines set a target of 90 minutes or less from hospital arrival to reopening the artery. This is why calling 911 matters so much: paramedics relay your EKG results ahead of time, so the hospital team can prepare and shave precious minutes off that timeline.
Recovery After a Heart Attack
Recovery happens in stages. The first phase of cardiac rehabilitation begins while you’re still in the hospital. A care team will help you sit up, stand, and walk short distances to begin rebuilding your activity tolerance. Most people start outpatient cardiac rehab shortly after discharge. This second phase involves supervised exercise sessions, nutrition counseling, and education about managing risk factors like blood pressure and cholesterol. Programs typically meet two or three times a week for several months.
The third phase is long-term maintenance, where you continue the exercise habits and lifestyle changes on your own. People who complete cardiac rehab have significantly better outcomes than those who skip it, yet many patients don’t follow through. Treating rehab as seriously as any medication is one of the most impactful things you can do for your long-term heart health.
Throughout recovery, you’ll have follow-up appointments with your cardiologist and primary care provider. These visits track your heart function, adjust medications, and catch complications early. If anything feels off during rehab, whether it’s chest discomfort, unusual shortness of breath, or difficulty keeping up with the program, bring it up with the supervising provider at your next session rather than pushing through it.