Call 911 Immediately
You need to call 911 right now—do not wait, do not drive yourself, and do not have someone else drive you to the hospital. Your symptoms of severe shortness of breath with minimal exertion, heart pounding, and extreme leg fatigue are concerning for acute coronary syndrome (ACS), which includes heart attack, and require immediate emergency medical evaluation regardless of whether you took nitroglycerin. 1
Why You Must Call 911 Now
The ACC/AHA guidelines are crystal clear: if your chest discomfort or shortness of breath is unimproved or worsening 5 minutes after taking one nitroglycerin dose, you must call 911 immediately. 1 Even if your symptoms improved somewhat with the nitroglycerin, the severity of your exertional symptoms (unable to walk without severe shortness of breath, pounding heart, and extreme leg fatigue) indicates you are at high risk and need emergency evaluation. 1
Critical Safety Points About Ambulance Transport
Approximately 1 in every 300 patients with chest pain transported by private vehicle goes into cardiac arrest en route, which is why ambulance transport is mandatory—paramedics can provide life-saving CPR and defibrillation if needed. 1
Emergency medical technicians can perform a 12-lead ECG in the ambulance and transmit it to the hospital, allowing the emergency department to prepare for your arrival and potentially saving critical time if you're having a heart attack. 1
Patients transported by ambulance receive faster treatment including earlier reperfusion therapy if needed for heart attack. 1
What Your Symptoms Mean
Your constellation of symptoms is highly concerning for possible ACS:
Shortness of breath is a recognized symptom of ACS, particularly in certain populations, and can occur with or without chest discomfort. 1
The sensation of your heart "jumping out" (palpitations) combined with severe exertional dyspnea suggests significant cardiac stress or ischemia. 1
Extreme leg fatigue with minimal exertion indicates severely limited functional capacity, which is a high-risk feature. 1
While Waiting for the Ambulance
If you tolerate nitroglycerin and still have symptoms, you can take additional nitroglycerin every 5 minutes for a maximum of 3 doses total while waiting for the ambulance. 1, 2 However, you must sit down when taking nitroglycerin to avoid falling from lightheadedness or dizziness. 2
Important Nitroglycerin Safety Rules
Do not take more nitroglycerin if you feel dizzy, lightheaded, or if your blood pressure is low. 2
Sit down immediately when taking nitroglycerin and use caution when standing up to eliminate the possibility of falling. 2
If you have taken medications for erectile dysfunction (Viagra, Cialis, Levitra) within the past 24-48 hours, tell the paramedics immediately—this is a critical contraindication to nitroglycerin. 2
What Happens Next
When the ambulance arrives, paramedics will:
Place you on a cardiac monitor immediately with emergency resuscitation equipment available. 1
Perform a 12-lead ECG to evaluate for heart attack. 1
Likely administer 162-325 mg of aspirin (chewed, not swallowed) unless you have an aspirin allergy or already took it. 1
Transport you rapidly to an emergency department where a physician will evaluate your ECG within 10 minutes of arrival. 1
Common Pitfalls to Avoid
Do not assume you're fine just because nitroglycerin helped somewhat—response to nitroglycerin is not a reliable way to rule out a heart attack, as it can relieve both cardiac and non-cardiac chest pain. 3
Do not delay calling 911 because you're uncertain or embarrassed—the ACC/AHA guidelines specifically address this, stating you should call despite "feelings of uncertainty about the symptoms and fear of potential embarrassment." 1
Do not try to get someone else's nitroglycerin if you don't have your own—guidelines specifically discourage this practice. 1
Call 911 now. Time is critical in treating heart attacks, and every minute of delay increases risk of permanent heart damage or death. 1