A Heart Attack Cannot and Should Not Be Allowed to "Pass" on Its Own
A heart attack is a medical emergency that requires immediate activation of emergency medical services (EMS) by calling 9-1-1—waiting for symptoms to resolve on their own can result in death or permanent heart damage. 1
Why Waiting is Dangerous
Cardiac arrest occurs in approximately 1.5% of patients with suspected heart attack before reaching the hospital or in the emergency department, making every minute critical. 1 The evidence is unequivocal:
- Most deaths from heart attack occur within the first few hours due to ventricular fibrillation, which happens most frequently in the early stages before hospital arrival. 1
- Thrombolytic treatment given within the first hour saves 65 lives per 1,000 patients treated, compared to only 25 lives per 1,000 when given 4-6 hours after symptom onset. 1
- Morbidity and mortality can be reduced significantly only if patients recognize symptoms early and seek immediate care. 1
The Critical Time Window
The guidelines establish clear time targets that emphasize urgency:
- Patients should wait no more than 5 minutes maximum before calling 9-1-1 if symptoms persist or worsen. 1
- The goal is to achieve treatment within 90 minutes from the time of calling for help (call-to-needle time). 1
- Every minute of delay results in more heart muscle death, as heart tissue begins dying within minutes of coronary artery occlusion. 1
Why Symptoms Are Unreliable Indicators
Symptom severity is a poor predictor of the seriousness of a heart attack—patients commonly make the dangerous mistake of waiting because symptoms seem tolerable or intermittent. 2
- The most common reason patients delay seeking care is believing symptoms will go away on their own. 3
- Patients frequently think symptoms are not severe enough to warrant emergency care, even when having a life-threatening heart attack. 3, 4
- Symptoms can be gradual rather than sudden in onset, leading patients to underestimate their severity. 2
The Immediate Action Plan
Call 9-1-1 immediately for anyone with chest pain or other signs of heart attack, rather than trying to transport the person to a healthcare facility yourself. 1 This is a Class I recommendation (the highest level).
While waiting for EMS to arrive:
- Take aspirin (if no allergy or recent bleeding) as it significantly decreases mortality from heart attack. 1
- Do not drive yourself or have someone drive you to the hospital—approximately 1 in 300 chest pain patients transported by private vehicle goes into cardiac arrest en route. 2
- Remain as calm and still as possible to minimize oxygen demand on the heart. 1
Common Dangerous Misconceptions
Several pitfalls lead patients to delay care:
- Believing that if symptoms are tolerable, the situation is not urgent 2, 3
- Thinking symptoms are caused by another illness (indigestion, anxiety, muscle strain) 3
- Waiting to see if symptoms resolve before "bothering" emergency services 1, 3
- Not recognizing atypical presentations, particularly in women, elderly patients, and those with diabetes 2
Special Considerations for Atypical Presentations
Women may experience different symptoms than men, including back, neck, and jaw pain, along with nausea, vomiting, and shortness of breath more frequently than chest pain. 2 These atypical presentations are just as dangerous and require the same immediate response.
The Bottom Line
There is no safe scenario in which a suspected heart attack should be allowed to "pass" without immediate medical evaluation. 1 The risk of sudden cardiac death, permanent heart damage, and life-threatening complications is too high. Even if symptoms spontaneously resolve, the patient still requires emergency evaluation as this could represent unstable angina or an evolving heart attack. 1
Every patient with suspected heart attack symptoms should be placed on cardiac monitoring immediately upon EMS arrival, with defibrillation equipment readily available. 1 This level of care cannot be provided at home or during private vehicle transport.