Most people—women included—are in deep denial about heart attack symptoms until a heart attack strikes. Would you know what to do if you were having a heart attack?

This year, 920,000 million Americans will suffer the big one, and 40% of them will be women. Sadly, one-fourth of all heart attack victims will die from the event – women more so than men because they often delay getting care.

Prompt treatment increases your chance of survival, and treating a heart attack in progress can save heart muscle. The extent of damaged heart muscle ultimately determines whether you’ll be able to survive and return to a normal life. These four survival strategies save time and lives. Here’s what to do if you begin to have symptoms (see “Common Heart Attack Symptoms” below).

#1 Overcome Denial
The most common mistake people make is denying their symptoms, hoping that the pressure around their chest is just indigestion and the symptoms will go away. Denial is the most common and very normal human response to heart attack, but waiting is the wrong thing to do.

#2 Call 911
Don’t hesitate: If you or someone you are with experiences chest discomfort, heaviness, burning or pressure that lasts for five minutes or more, call 911. Don’t waste valuable time calling your own healthcare provider or driving yourself to the hospital. Get into an ambulance, where treatment can begin immediately and en route to a hospital.

#3 Chew an Aspirin
If you’re not allergic to aspirin, chew one regular tablet that can potentially begin dissolving the blood clot that may be the culprit causing the attack Do this only after you’ve called 911.

#4 Prepare for the Paramedics
If you’re alone when symptoms strike, open the door the emergency responders will most likely approach and sit or lay down right there. This way, they will be able to locate you in case you lose consciousness.

Upon arrival, emergency personnel will attach a heart monitor, administer oxygen and open an IV line to administer medicines if needed. They may also put nitroglycerin under your tongue to relax your arteries, allowing more blood to flow to the heart, and to help relieve pain.

At the emergency room, a heart attack is diagnosed based on your symptoms and three additional factors: a physical exam; an electrocardiogram (EKG), which shows any injury to the heart muscle; and blood tests that measure biomarkers, which can indicate heart muscle damage.

If you’re experiencing a heart attack (and not too much time has passed since symptoms began), the medical team will begin what’s called reperfusion therapy to re-open the blocked artery. You may be given clot-busting medications, or you may undergo cardiac catheterization to open the arteries with a tiny hollow catheter that balloons open the affected artery. A stent is then placed to hold the artery open.

Once you are stabilized, your heart’s overall function will be evaluated to help with treatment decisions. Your medical team will evaluate whether there’s significant hardening (atherosclerosis) in any of the other coronary arteries that may require heart bypass surgery or balloon angioplasty and stent placement. Most important, you will be started on an aggressive program to reduce your risk of future heart problems.


Heart attacks happen because atherosclerosis, which occurs when cholesterol and debris build up in the walls of the arteries serving your heart, narrow the arteries so the heart muscle doesn’t receive adequate blood supply. When this happens, you may feel chest discomfort or pain (angina pectoris) as a warning that a heart attack is imminent.

These buildups are called plaques. When one of these plaques ruptures, a clot forms over it. If this clot closes off the artery completely, a heart attack occurs.

In the hospital, you’ll learn how to prevent a second heart attack by slowing the progression of atherosclerosis. You’ll likely begin taking aspirin (unless you’re allergic to it) and perhaps blood-thinning and cholesterol-lowering medicines (such as statins) and others.

If you have high blood pressure or diabetes, your healthcare provider will want to begin aggressive treatment immediately. If you smoke, you’ll be advised to stop. Learning how to deal with stress will become important, as will regular aerobic exercise. Ideally, you will be enrolled in a cardiac rehab exercise program.


You can’t survive a heart attack unless you can recognize when it’s happening. When asked, most people describe a chest-clenching, dramatic “Hollywood heart attack” as the typical myocardial infarction, the medical term for acute coronary syndrome. But experts know there’s no such thing as a sudden heart attack—they’re years in the making, and they may give signs and clues along the way that you’re at risk for one.

Chest discomfort is the most common symptom; it’s often described as pressure, fullness, burning or heaviness. Patients often say, “It wasn’t really pain. It was just something that I knew shouldn’t be there.”

Other symptoms include shortness of breath, vomiting, sweating, weakness, pain in the shoulders, neck, arms, or jaw, or a feeling of impending doom—and these symptoms can occur without any chest symptoms. You know your body. If you sense that something is wrong, seek help immediately.

Most heart attacks are preventable; hopefully, you’ll never need to spring into action. But thinking about and having this action plan can help in the event of an attack.

Q: Can coughing deeply stop a heart attack in progress?
A: As a cardiac nurse, I get asked this question all the time: Can repeated forceful coughing stop what seems like a heart attack in progress?
The answer is no, coughing forcefully won’t stop a heart attack. Patients with abnormal heart rhythms are sometimes asked by providers to cough forcefully to see if it affects heart rhythms. This myth probably gets its origins there. If you’re having a heart attack and CPR is required (meaning your heart has stopped or is quivering ineffectively), you’d quickly lose consciousness. Coughing forcefully would not be possible.


Age: 83% of fatal heart attacks occur in people age 65 and older.

Family history: Your parents can pass on the risk for heart disease.

Smoking: This is the deadliest and most controllable factor, increasing your risk four times that of non-smokers.

Blood pressure: Ideal levels are less than 120/80.

High cholesterol: Keep your total below 200 (HDL ideally above 50 for women and LDL less than 100).

Inactivity: Even mild regular exercise helps reduce risk.

Obesity: Losing just 10 pounds lowers your risk.

Diabetes: Of people with diabetes, 75% die of heart disease.


Women and men don’t always experience heart attack symptoms in the same way or with the same severity. Everyone is different. Along with chest pressure or burning, women are more likely to have the other associated symptoms—like shortness of breath, nausea or a sense that something is very wrong. Sometimes these symptoms occur without chest pain. Symptoms may even go away for a while and then return. When in doubt, check it out.

• Chest pain or discomfort
• Discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Breaking out in a cold sweat, nausea or lightheadedness.

Source: American Heart Association

About the Author: Suzanne Hughes, MSN, RN, is the director of patient and community education and research at Robinson Memorial Hospital in Ravenna, OH, and associate editor of Cardiosource, the online journal of the American College of Cardiology.