1. Don't Ignore Symptoms!
If you have discomfort in the chest, shoulder, neck or jaw that is associated with breathing difficulty and starts suddenly. Don't ignore it. A tip off that this is serious is that any level of exertion may make it dramatically worse. The faster you seek medical attention the better. I can't tell you how many times I have been called in to see a patient at 2 a.m. whose symptoms started at lunch time the day before. They symptoms can be a subtle as vague upper abdominal pain that started after lunch. The phrase I hate to hear is, "I thought it was something I ate, but it wouldn't go away and got worse as I was walking to work and now my breathing is affected." It is well described that many patients arrive to Emergency Department too late to salvage the injured muscle because they expected a more dramatic presentation.
2. Take an Aspirin
If you have any aspirin, take it right away, and chew it. This increases the rate of absorption into the blood stream. This may be enough to open the blocked artery. The cause of the blockage is a clot that has formed because a cholesterol-rich pocket inside the artery split open and leaked its contents inside the vessel and exposed factors to your blood. Then call 911. Don't drive to the ER. Many communities have a rapid triage system that directs heart attack patients to hospitals that can deliver lifesaving rapid around the clock angioplasty. This method is proven to be very effective and safe for the treatment of a heart attack. The sooner you get it, the better your chance of a good result.
3. Take Your Prescribed Medications
Heart attack patients typically are discharged on several medications. They include aspirin, clopidogrel, beta-blockers, angiotensin converting enzyme inhibitors and statins. This powerful combination of drugs all work together to reduce your chance of having a second heart attack, stoke or dying suddenly. If you have major damage to the heart muscle, other medications might be prescribed, such as diuretics or coumadin. If you have a stent implanted, it is critical that you not stop the aspirin or clopidogrel. These to medications work to reduce clots in the stents. If you have a medicated stent this combination of medications should be continued for a total of twelve months.
4. Quit Smoking
When I am doing an emergency angioplasty on a smoker, I can often tell without asking. The clot burden in the arteries is often much worse than nonsmokers and the leg arteries are often calcified and narrowed due to peripheral arterial disease. Patients who continue to smoke after a heart attack not only have yellow fingers and smell bad but they have worse outcomes after an angioplasty and stent. Even if you take all your medications religiously you can negate the effects of aspirin and clopidogrel. This can result in a higher chance of stent clots or thrombosis which is many times fatal. Chemicals in cigarettes increase the propensity for clotting. Nothing makes me more disappointed than seeing a patient in the office who is smoking after I saved their life in the middle of the night. Prior to leaving the hospital all smokers receive counseling for smoking cessation. This can include prescriptions for medications that are specifically tailored to increase the chance of quitting.
