Updated July 24, 2006

Heart Attack
Fast Action Needed

by Wayne L. Clark

In an emergency
When a heart attack strikes, the most important response is speed. The faster treatment is started, the better. It’s natural to wait to see if the symptoms go away, but in its National Heart Attack Alert Program, the NHLBI recommends that people wait no longer than 15 minutes before calling for help. Even if the symptoms do go away, the program recommends calling your doctor immediately.

“When you look at all the data from all the studies,” Dr. Lambrew says, “you can calculate that there are 10 lives lost per 1,000 heart attacks, for each hour of delay. The ‘60 Minutes to Treatment’ working group that I served on paid particular attention to reducing the delay once the patient arrives at the Emergency Room. We can’t control the time delay before arrival, except by educating people and encouraging them to move quickly.”

In most areas of the United States, 911 is the emergency response number. However, some areas do not have 911 service yet, so it is important to have the right local number handy. Calling a physician or the hospital before calling 911 creates unnecessary delays.

The NHLBI also recommends that the safest and fastest way to the hospital is by ambulance. Many people try to drive themselves or have a relative or friend drive them. A seriously ill person can endanger themselves and others by trying to drive, and a relative or friend may not be able to render lifesaving care—and certainly could not do it while driving. Emergency medical services teams, by contrast, can both drive and treat at the same time, and can prepare the hospital for your arrival.

Physicians may advise their patients to chew an aspirin tablet when they experience symptoms of a heart attack, because aspirin has an immediate clot-dissolving effect. Aspirin isn’t for everyone, though, so each person needs to seek advice ahead of time. People who have had previous heart attacks may also be advised to take a nitroglycerin tablet if symptoms appear.

At the hospital, people who are having a heart attack will be met with an array of treatments that could only be imagined a couple of decades ago. They can make heart attack treatment much more successful, especially when started early.

Thrombolytic agents, or “clot-busters,” revolutionized heart attack care when they were introduced in the 1980’s, and they are available in virtually every emergency room in the United States.

A growing trend in heart attack care is primary angioplasty. Angioplasty is the use of a catheter-borne instrument to open up a clogged coronary artery. Most often performed as an elective procedure, it is becoming popular as the initial treatment for heart attack at hospitals where it is available.

An interesting phenomenon that is under investigation is the impact of blood sugar levels during a heart attack. Researchers have found that there may be a benefit to quickly lowering blood sugar levels during a heart attack and keeping them low afterward. The Diabetes Insulin Glucose in Acute Myocardial Infarction (DIGAMI) trial used an insulin–glucose infusion during the first 24 hours of acute treatment, followed by intensive insulin treatment for three months. A year after treatment, 26% of the group receiving standard care had died while 19% of those receiving the insulin–glucose infusion treatment had died. At three years, 44% of the standard-care group had died compared to 33% of the insulin–glucose group.

This and other studies have renewed interest in the use of insulin not only during heart attack but during cardiac surgery. There is no consensus, however, so it is not yet recommended treatment.

An early warning for diabetes?
While people with diabetes need to be concerned about a heart attack, those people without diabetes who have a heart attack should be concerned about diabetes. That is because the first sign of diabetes may be a heart attack. A 2002 research study from Norway followed 181 consecutive people who came to the hospital with heart attacks but did not have a diagnosis of Type 2 diabetes. Of those people, it turned out that 31% had previously undiagnosed diabetes and 35% had glucose intolerance, or prediabetes.

Wayne Clark is a freelance medical and science writer who has written extensively on diabetes. He lives in Maine.

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