Heart attack: 4 signs and 4 emergency first aid steps at home

Every year, millions of people worldwide suffer from myocardial infarction (heart attack), and it remains one of the leading causes of death. According to international statistics, in the US, approximately one person has a heart attack every 34 seconds. The alarming fact is that many deaths occur because the patient or those around them fail to recognize the signs of a heart attack early or perform heart attack first aid incorrectly in the first few minutes.

If signs of a heart attack are detected and managed promptly, myocardial damage can be significantly reduced, increasing the patient's chances of survival and recovery. In this article, Tiptory will guide you on how to recognize a heart attack, the correct heart attack first aid steps according to medical recommendations, and what to do immediately before the ambulance arrives, helping you calmly respond in an emergency.

Part 1: Signs of a Heart Attack and How to Provide First Aid

Sign 1: Early Recognition of Heart Attack Symptoms

Not all heart attacks have clear signs

• Heart attacks can occur very suddenly with severe pain, but many cases have almost no warning symptoms.
• Most patients often experience early but vague warning signs, making them prone to complacency or confusing them with common health issues.
• Early recognition of heart attack symptoms helps patients receive timely first aid, reduces myocardial damage, and increases their chances of survival.

Pay attention to warning signs days or weeks in advance

• Before a heart attack occurs, the body may show one or more of the following symptoms:
  • Prolonged or difficult-to-control high blood pressure.
  • Frequent burning sensation in the chest, heartburn.
  • Easy fatigue during activity, reduced exercise capacity compared to before.
  • Feeling tired, unwell, or generally not well without a clear cause.
• These symptoms can appear a few days to a few weeks before severe myocardial damage. If they persist or worsen, you should see a cardiologist for an early evaluation.

Women often have symptoms that are harder to recognize

• Symptoms of a heart attack in women are often not as typical as severe chest pain.
• Instead, the patient may only feel unusual fatigue, shortness of breath, nausea, pain in the back, neck, shoulder, or jaw.
• Because the symptoms are not clear, women are at risk of missing the "golden hour" for treatment. If suspicious signs appear, do not self-diagnose or delay seeking medical attention.

Factors that increase the risk of heart attack

• The risk of coronary artery disease and myocardial infarction will be higher if you have one or more of the following factors:
  • High blood cholesterol.
  • High blood pressure.
  • Diabetes.
  • Overweight or obesity.
  • Smoking or frequent exposure to smoke.
  • Age 65 or older.
• If you are in a high-risk group, you should have regular health check-ups, control blood pressure, blood sugar, and blood lipids to reduce the chance of a heart attack.

Distinguishing between a heart attack and cardiac arrest

• A heart attack occurs when blood flow to the heart muscle is blocked, causing part of the heart muscle to be deprived of oxygen and damaged.
• Cardiac arrest is a condition where the heart stops pumping blood, causing the patient to lose consciousness and stop breathing almost immediately.
• Not all heart attacks lead to cardiac arrest. However, cardiac arrest can be a dangerous complication of a heart attack and requires immediate heart attack first aid and cardiopulmonary resuscitation (CPR) to increase the chances of survival.

Sign 2: Recognizing Heart Attack Symptoms

Don't wait for severe pain to consider a heart attack

• Many people believe that a heart attack occurs suddenly with severe chest pain. In reality, most cases begin with mild symptoms that gradually increase over several hours, or even days.
• Early recognition of heart attack symptoms helps patients receive heart attack first aid and get to the hospital promptly, reducing the risk of dangerous complications.

Chest pain is the most typical sign

• The most common symptom is pain or discomfort in the center of the chest.
• The patient may feel:
  • Pressure or tightness in the chest.
  • A feeling of chest tightness, heaviness, or dull pain.
  • Pain that is continuous or comes and goes.
• If the pain lasts more than a few minutes or recurs multiple times, call emergency services immediately instead of waiting for the symptoms to subside on their own.

Do not overlook accompanying symptoms

• In addition to chest pain, heart attack symptoms can also include:
  • Shortness of breath, gasping for air even at rest.
  • Cold sweats, pale or bluish-gray skin.
  • Dizziness, lightheadedness, or feeling like fainting.
  • Unusual fatigue, exhaustion despite little exertion.
  • Nausea or vomiting.
  • Upper abdominal pain or a feeling of indigestion, bloating, burning sensation similar to stomach problems.
• These symptoms are easily mistaken for digestive illnesses or common fatigue, causing many people to delay treatment.

Symptoms can vary from person to person

• Not everyone who has a heart attack will experience all of the above symptoms.
• Some people only have mild chest pain, while others primarily experience shortness of breath, nausea, or extreme fatigue.
• The severity of pain and clinical manifestations vary depending on age, gender, underlying medical conditions, and the extent of coronary artery blockage.

Some people experience unusual sensations before fainting

• Before a heart attack becomes severe, some people describe intense anxiety, unease, or a premonition that something very bad is about to happen.
• While this is not a specific symptom, if it accompanies chest pain or shortness of breath, it should be considered an urgent warning sign.

Fainting or sudden collapse is a dangerous sign

• When the heart no longer pumps enough blood to the brain and other organs, the patient may suddenly collapse, fall, or need to hold onto surrounding objects for balance.
• This condition is rare in common causes of chest pain but is a warning sign of a heart attack or a serious complication.
• If the patient collapses, loses consciousness, or stops breathing, call emergency services immediately and perform heart attack first aid according to medical guidelines while waiting for paramedics to arrive.

Sign 3: Recognizing Less Common Heart Attack Symptoms

Don't just focus on chest pain

• Although chest pain, shortness of breath, and cold sweats are typical heart attack symptoms, some people only experience less common symptoms.
• Full recognition of these signs helps increase the likelihood of early heart attack detection and performing heart attack first aid at the right time.

Pain can spread to many other areas

• When a heart attack occurs, the pain or discomfort is not always concentrated only in the chest.
• The patient may feel pain or numbness spreading to:
  • The left arm, sometimes both arms.
  • The mid-back area.
  • The front of the neck.
  • The lower jaw or jaw area.
• These pains can appear simultaneously with chest pain or occur before chest pain becomes obvious.

Women often have atypical symptoms

• Heart attack symptoms in women are often harder to recognize than in men.
• Common symptoms include:
  • Mid-back pain.
  • Jaw or neck pain.
  • Nausea or vomiting.
  • Fatigue and shortness of breath without obvious chest pain.
• Because these symptoms are easily mistaken for musculoskeletal problems, digestive disorders, or stress, many cases reach the hospital late, reducing treatment effectiveness.

Many other illnesses also have similar symptoms

• Conditions such as acid reflux, muscle pain, arthritis, lung disease, or anxiety disorders can also cause chest pain, back pain, or shortness of breath.
• However, if multiple heart attack symptoms appear at the same time, especially in individuals with cardiovascular risk factors such as high blood pressure, diabetes, or high cholesterol, the likelihood of a heart-related cause is higher.
• In case of suspicion, do not self-diagnose or wait for symptoms to disappear. Call emergency services and perform heart attack first aid as instructed to limit myocardial damage and increase the chance of survival.

Sign 4: Call for emergency help immediately if a heart attack is suspected

Do not hesitate if a heart attack is suspected

• If you suspect someone is having a heart attack, call your local emergency number immediately. In Vietnam, you can call 115 for urgent medical assistance.
• Do not wait for the patient to show all heart attack symptoms before calling emergency services. If there are any suspicious symptoms such as prolonged chest pain, shortness of breath, cold sweats, or sudden fainting, act immediately.
• Every minute of delay increases the risk of heart muscle damage and reduces the chance of recovery.

Ask for help from those around you if needed

• If you cannot call for emergency services yourself, ask someone nearby to call 115 immediately.
• While waiting for the ambulance, stay in contact to know the estimated arrival time of medical personnel, and have the patient's condition information ready to provide when needed.

Emergency personnel can provide immediate treatment at the scene

• Emergency teams are trained to recognize signs of myocardial infarction, monitor vital signs, and perform first aid for myocardial infarction while en route.
• If the patient experiences cardiac arrest or respiratory arrest, medical personnel can perform cardiopulmonary resuscitation (CPR), use a defibrillator when necessary, and carry out other emergency interventions.

Taking an ambulance shortens treatment time

• Individuals suspected of having a myocardial infarction should be taken to the hospital by ambulance instead of driving themselves or taking a motorcycle.
• When arriving by ambulance, the hospital usually has prior preparations to receive and provide emergency treatment, helping the patient receive examination and intervention faster.
• The sooner treatment is provided, the higher the chance of preserving heart muscle, reducing complications, and increasing survival rates.

Part 2: How to administer first aid for a heart attack at home

Step 1: Place the patient in a safe position

Help the patient sit in a comfortable and stable position

• If a person is suspected of having a heart attack, help them sit in a semi-reclined position, with their upper body elevated about 45–75 degrees and knees slightly bent.
• Lean the patient against a chair, wall, or place pillows behind them if available to reduce pressure on the heart and facilitate breathing.
• Do not let the patient lie flat if they are still conscious, unless instructed by medical personnel.

Loosen clothing to help the patient breathe easily

• Remove or loosen ties, scarves, collar buttons, and any clothing around the neck and chest that feels tight.
• Keep the surrounding area clear to help the patient feel more comfortable while waiting for emergency services.
• This is an important step in heart attack first aid, helping to reduce feelings of shortness of breath and tightness.

Do not allow the patient to walk or exert themselves

• Ask the patient to remain seated and avoid walking, climbing stairs, or attempting to move themselves.
• Any strenuous activity makes the heart work harder, which can worsen the heart attack.
• If movement is necessary for safety, provide gentle support and minimize physical exertion.

Stay calm and reassure the patient

• Speak briefly and gently to let the patient know that the ambulance is on its way and you will be there to help.
• Avoid asking too many questions or asking the patient to talk continuously, as this can tire them out.
• Keep the environment quiet and limit people gathering around to help the patient reduce stress and anxiety.

Keep the body warm while waiting for emergency services

• If the weather is cold or the patient shows signs of shivering, use a blanket, coat, or towel to gently cover their body to keep them warm.
• Continue to monitor signs of myocardial infarction such as increased chest pain, difficulty breathing, sweating, loss of consciousness, or respiratory arrest to promptly perform the next steps of heart attack first aid if the condition worsens.

Step 2: Help with proper nitroglycerin administration

Check if the patient is carrying nitroglycerin

• If a person suspected of having a heart attack has a history of heart disease or angina, ask if they are carrying nitroglycerin prescribed by a doctor.
• Do not use medication belonging to someone else or use nitroglycerin if it has not been prescribed by a doctor specifically for the patient.
• The medication only helps relieve symptoms in some cases and does not replace calling emergency services or providing heart attack first aid.

Help the patient use the medication as directed

• If the patient is conscious and has been previously instructed by a doctor on how to use it, help them take the medication at the prescribed dosage.
• Nitroglycerin typically comes in two forms:
  • Sublingual tablets.
  • Sublingual spray.
• Do not let the patient swallow the tablet, as the medication is best absorbed through the sublingual mucous membrane.

Monitor reactions after medication use

• After taking nitroglycerin, some people may experience reactions such as:
  • Dizziness.
  • Lightheadedness.
  • Feeling faint.
  • Temporary drop in blood pressure.
• Therefore, let the patient continue to sit or semi-recline, avoiding standing up or walking to reduce the risk of falling.

Continue monitoring while waiting for emergency services

• Even if chest pain symptoms decrease after taking nitroglycerin, the patient still needs to be taken to the hospital as soon as possible to determine if it is a heart attack.
• While waiting for medical personnel, continue to monitor signs of myocardial infarction such as prolonged chest pain, difficulty breathing, sweating, decreased consciousness, or respiratory arrest to promptly perform the next steps of heart attack first aid if the condition worsens.

Step 3: Administer aspirin to the patient if appropriate

Only use aspirin if there are no contraindications

• If myocardial infarction is suspected, the patient may be given aspirin while waiting for emergency services if they are not allergic to aspirin and have no contraindications according to medical guidelines.
• Before use, ask the patient about their history of drug allergies, especially to aspirin or non-steroidal anti-inflammatory drugs (NSAIDs). If the patient cannot answer, check for a medical alert bracelet or personal medical information if available.
• Do not give aspirin to children or adolescents under 18, unless directed by a doctor.

Have the patient chew aspirin instead of swallowing the whole pill

• If eligible for use, adults are generally advised to slowly chew 300 mg of aspirin for faster absorption through the digestive tract.
• Chewing the medication helps aspirin take effect sooner than swallowing the whole pill, aiding in heart attack first aid before the patient receives specialized treatment.

Aspirin helps reduce blood clot formation

• Aspirin inhibits platelet aggregation, helping to limit the growth of blood clots that are blocking the coronary arteries.
• The medication also helps reduce inflammatory reactions and can partially alleviate pain from a heart attack.
• However, aspirin cannot dissolve blood clots and does not replace specialized treatments at the hospital.

Can be used with nitroglycerin if prescribed

• If the patient has previously been prescribed nitroglycerin by a doctor, aspirin can usually be used concurrently with this medication while waiting for emergency services.
• However, only help the patient use the specific medication prescribed by a doctor and do not arbitrarily increase the dose or combine with other medications.

The patient still needs to be taken to the hospital immediately

• Even if aspirin has been given and symptoms improve, the patient must be taken to a medical facility as soon as possible.
• At the hospital, doctors will assess the myocardial infarction condition and may prescribe specialized treatments such as antiplatelet drugs, anticoagulants, thrombolytic drugs, or coronary artery intervention, depending on the cause and degree of blockage.
• Throughout the waiting period for emergency services, continue to monitor signs of myocardial infarction and be ready to perform the next steps of heart attack first aid if the patient loses consciousness or stops breathing.

Step 4: Perform timely cardiopulmonary resuscitation

Begin cardiopulmonary resuscitation (CPR) when the patient stops breathing or loses consciousness

• If a person suspected of having a heart attack suddenly loses consciousness and is not breathing normally, call 115 immediately if not already done, and begin cardiopulmonary resuscitation (CPR) as soon as possible.
• CPR helps maintain blood circulation and provides a minimum amount of oxygen to the brain and other vital organs while waiting for medical personnel to arrive.
• This is one of the most important steps in heart attack first aid when the patient experiences cardiac or respiratory arrest.

Prioritize chest compressions if untrained

• If you have not been trained in CPR, you should perform continuous chest compressions instead of attempting mouth-to-mouth resuscitation.
• Place both hands one on top of the other in the center of the patient's chest and press hard and fast at a rate of about 100–120 beats per minute, allowing the chest to fully recoil after each compression.
• Continue chest compressions until medical personnel take over or the patient shows signs of recovery.

Perform full CPR if trained

• If you have been trained in cardiopulmonary resuscitation (CPR), combine chest compressions with rescue breaths according to current professional guidelines.
• Performing the correct technique helps increase the ability to maintain oxygen to the brain and organs while waiting for emergency services.

Time is critical for survival

• The brain begins to sustain damage after only about 4–6 minutes if it does not receive enough oxygen.
• If circulatory arrest is prolonged, the risk of irreversible brain damage and death increases rapidly with each passing minute.
• Therefore, do not wait for medical personnel to arrive before beginning heart attack first aid if the patient has stopped breathing or suffered cardiac arrest.

Continue CPR until emergency medical personnel provide assistance

• Do not stop chest compressions just because the patient hasn't regained consciousness after a few minutes.
• If an automated external defibrillator (AED) is available at the scene and you know how to use it, follow the device's voice prompts while continuing CPR.
• Early emergency calls, proper heart attack first aid, and timely CPR significantly increase the patient's chances of survival and reduce the risk of long-term complications.

Notes on heart attack first aid

Do not leave the patient alone

• After suspecting a heart attack, always stay with the patient until medical personnel arrive.
• Only leave the patient if you absolutely must call for emergency help and no one else is available to assist.
• While waiting, continuously monitor for heart attack symptoms such as consciousness, breathing, and the patient's reactions to promptly intervene if their condition worsens.

Stay calm and delegate support roles

• The person performing heart attack first aid needs to remain calm to make accurate decisions.
• If there are multiple people around, assign specific tasks to each person, such as:
  • One person calls 115.
  • One person helps reassure and monitor the patient.
  • One person prepares the access path or meets the ambulance.
  • One person looks for an automated external defibrillator (AED) if the area is equipped with one.
• Clear delegation helps prevent a situation where everyone waits for others to act, slowing down the emergency response.

Follow the instructions of the emergency dispatcher

• While waiting for the ambulance, stay in contact with the 115 dispatcher if requested.
• Emergency dispatchers will provide step-by-step instructions for heart attack first aid, including how to monitor the patient or perform CPR if necessary.
• Follow the instructions precisely until the emergency team arrives.

Do not drive yourself to the hospital if you suspect a heart attack

• If you yourself experience heart attack symptoms such as chest pain, shortness of breath, cold sweats, or pain radiating to your arm, neck, or jaw, absolutely do not drive yourself to the hospital by car or motorcycle.
• Symptoms can suddenly worsen, causing fainting or loss of vehicle control, increasing the risk of accidents for yourself and others.
• Call 115 or ask someone else to take you to the hospital if an ambulance cannot reach you immediately. Being transported by ambulance allows the patient to be monitored and receive medical treatment en route to the hospital if their condition deteriorates.

References

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7. Panchal, A. R., Bartos, J. A., Cabañas, J. G., Donnino, M. W., Drennan, I. R., Hirsch, K. G., et al. (2020). 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 142(Suppl_2), S366–S468.
8. World Health Organization. (2023). Cardiovascular Diseases (CVDs). World Health Organization.
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Content editor: Rene Lee Nguyen.

Information consulted and verified by expert: Ava Anderson.