Heart attack

Also called Myocardial infarction, MI, Coronary thrombosis

A blocked coronary artery killing heart muscle. Every minute of delay costs muscle, and women delay longer.

What it is

Around 100,000 hospital admissions a year in the UK are for heart attack. Survival has improved enormously: more than seven in ten people now survive, compared with around three in ten in the 1960s.

Almost all of that improvement is about speed. A blocked artery starves heart muscle of oxygen, and muscle that dies does not come back. Opening the artery, usually with an emergency angioplasty, within a couple of hours transforms the outcome.

Which makes the delay before the ambulance is called the most important variable in this entry, and it averages far too long.

Women delay longer than men, are more likely to present atypically, and are more likely to have their symptoms attributed to something else. That gap costs lives and it is well documented.

Signs you might notice

Chest pain or pressure: heavy, tight, or squeezing, often described as a band or a weight rather than a sharp pain.

Pain spreading to the arm, jaw, neck, back or stomach.

Breathlessness, sweating, nausea, and a feeling of impending doom.

In women, older people and people with diabetes: breathlessness, fatigue, indigestion-like discomfort, nausea, or jaw and back pain, often without dramatic chest pain.

Symptoms lasting more than 15 minutes, or not relieved by GTN, mean call 999 now.

How it can affect day-to-day life

The common reasons people wait are: not wanting to make a fuss, assuming it is indigestion, not fitting the film-version picture, and being alone.

After a heart attack, cardiac rehabilitation reduces death and readmission and is attended by fewer than half of eligible people. That is one of the largest missed opportunities in UK cardiology.

Depression and anxiety after a heart attack are common, and untreated they worsen outcomes.

Supporting someone well

Call 999, do not drive to hospital, and do not wait to see if it passes. Say the words heart attack.

Give 300mg aspirin to chew if it is available and there is no allergy or contraindication.

Learn CPR and where the nearest defibrillator is. Out-of-hospital cardiac arrest survival in the UK is around 1 in 10, and bystander CPR roughly doubles it.

Afterwards, attend cardiac rehabilitation. Ask for a referral if you are not offered one.

Take secondary prevention medication daily, every one of them.

Ask about mood, because depression after a heart attack is common and affects survival.

Where to get help

999, immediately, for suspected heart attack.

British Heart Foundation helpline: 0808 802 1234, and they have free CPR training.

Ask your cardiac team about rehabilitation before discharge, not after.