In the United States, someone has a heart attack every 40 seconds, according to the Centers for Disease Control and Prevention. And while far fewer people die of heart attacks than they once did, as the temperatures drop, cold weather can put extra strain on the heart and circulatory system. Blood vessels can constrict to prevent heat loss, which can increase blood pressure; cold can increase blood viscosity (thickness), making it more prone to clotting; and once snow gets underway, the exertion of shoveling can place increased demand on the cardiovascular system.
Overall, numerous studies have shown that heart attacks are more common in the cold months.
But doctors and medical experts say the right response to a heart attack can make a world of difference in outcomes. Here are a few top pieces of advice from two medical specialists who frequently treat heart attacks.
Know the signs of a heart attack, especially the less-expected ones
According to the American Heart Association, heart attack symptoms can include chest discomfort that lasts more than a few minutes or comes and goes, often described as pressure, squeezing, fullness or pain. But it can feel quite different to different people.
“Most patients have some level of chest discomfort or chest symptoms at some point, but that’s not always how it begins, and that’s not always what they feel is the most prominent symptom,” said Bryn E. Mumma, an emergency medicine physician at the University of California at Davis.
“I’ve had a lot of patients tell me, ‘Well, I don’t have chest pain.’ Stop calling it chest pain,” she said. “It’s usually more of a vague, diffuse pressure.”
Other signs can include pain radiating up to the neck, jaw, one arm or both arms, sometimes accompanied by a feeling of heaviness, Mumma said. She described this as “referred pain.” Though the pain originates elsewhere, the brain perceives it in those areas because of how nerve pathways transmit pain signals.
“It doesn’t necessarily hurt when you push on the shoulder or when you touch the jaw,” she said. Patients often describe it as an intense, deep pain.
Other symptoms can include unusual fatigue, shortness of breath or difficulty catching one’s breath, as well as nausea, vomiting, lightheadedness or dizziness. Breaking out in a cold sweat and experiencing upper-abdominal or stomach discomfort — a feeling of heartburn or indigestion, particularly though not exclusively in women — can also be signs.
Always call 911 first
Mila Polyak is a cardiothoracic charge nurse who oversees 32 operating rooms at NewYork-Presbyterian/Columbia University Irving Medical Center.
“Treatment always starts before the patient reaches the hospital, and it can be the difference between life and death,” Polyak said.
Mumma, who specializes in emergency cardiovascular care, stresses the importance of calling 911 immediately. Generally, it is not advisable to drive yourself to the hospital, and allowing EMS to get to you first can streamline the process, among other advantages.
Emergency medical personnel are often equipped to perform a 12-lead electrocardiogram (ECG), then transmit the results to the hospital before the patient arrives, she said. This gives the hospital time to assemble the cardiac team and prepare for potential interventions while the ambulance is en route.
While exertion should be avoided, make sure that first responders are able to enter your home. Unlock the door if possible.
Relax and take medicine if appropriate
Mumma recommended avoiding climbing stairs, walking around or other exertion. Sit or lie down — whichever position is most comfortable. The more active a person is, the harder the heart has to work to pump oxygen-rich blood to the body’s muscles, she explained. This increases the heart muscle’s own oxygen needs, which can be particularly problematic during a heart attack, when a blocked coronary artery could be restricting oxygen delivery to the heart muscle.
She recommended that people who think they’re having a heart attack chew four baby aspirin or one full-strength adult aspirin. Chewing helps the body absorb it more quickly. While aspirin will not clear an existing blockage, it inhibits platelets from clumping together to form clots and can help prevent a clot from growing.
Aspirin may not be appropriate for someone with an allergy, active bleeding or other contraindications. Consult with the 911 dispatcher if possible.
If you are already prescribed nitroglycerin, take it, Mumma said. It’s generally okay to take aspirin along with prescribed nitroglycerin, she added, as the medications work in very different ways.
If someone collapses: CPR and AEDs
A heart attack is not the same as cardiac arrest.
“Most people who have a heart attack never experience a cardiac arrest, and a cardiac arrest can be due to a heart attack but can be due to any number of other conditions,” Mumma said.
Cardiac arrest occurs when the heart stops beating effectively, preventing it from pumping sufficient oxygen-rich blood to the brain and other organs, she explained.
If someone becomes unresponsive and is not breathing normally — including if they’re only gasping — call 911 and begin CPR, following dispatcher instructions, she said.
Bystanders shouldn’t delay CPR by trying to find a pulse, Mumma advised. “If you’re not sure, err on the side of doing compressions,” she said. “If you do a couple chest compressions and the patient doesn’t need it, they’ll let you know real fast.”
If someone is experiencing cardiac arrest, ask another bystander to retrieve an automated external defibrillator, or AED, if available, while you perform chest compressions, advised Polyak.
AEDs, available in many public places, analyze the heart’s rhythm and determine whether a shock is needed. The devices provide step-by-step instructions, allowing people without medical training to operate them, Polyak explained.
Don’t ignore symptoms
All too often, Polyak encounters patients who have dismissed their symptoms and failed to seek medical attention.
The nurse recalled one patient, a 60-year-old former triathlete, who experienced chest discomfort and pain in his right shoulder and arm but went about his day, apparently assuming he had pulled a muscle.
“He was a very stubborn individual, and I heard even postoperatively that he was getting out of bed prematurely, and everyone was worried,” Polyak said. “All the other nurses were telling him: ‘You need to stay in bed. You have three chest tubes in you.’”
While it’s not possible to know whether earlier intervention might have prevented the need for the emergency bypass he ultimately had, Polyak emphasized the importance of seeking medical assistance promptly.
“The goal is to protect the heart muscle and restore adequate blood flow,” Polyak said. “Time is muscle essentially. The longer the heart muscle is depleted of oxygen, the greater the potential for permanent damage.”
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