What NOT to Do

Answer me this:

When a person is having chest pain, within which timeframe should you call 911?

  1. After one hour
  2. After 90 minutes
  3. After nine hours
  4. Within 15 minutes

The answer may seem obvious to you, but I became an American Heart Association CPR instructor because we did everything WRONG when my husband, Steve, had a heart attack in 2007. Instead of “D,” we answered “C,” and I became an instructor because I wanted to ensure that I had the proper training to respond correctly the “next time.” I want to share our story because we were completely fooled, and it nearly cost my husband his life.

CPR instructor Susan Blake with husband and survivor, Steve

How can you NOT know someone is having a heart attack? It’s actually pretty easy — if you’re not looking for it. Even as an experienced Registered Medical Assistant who had taken CPR classes, I completely missed all the clues when it involved my own husband.

First, my 50-year-old, active, slender, non-smoking husband didn’t look like a heart attack victim to me. You know what I mean? Picture in your mind a guy who looks like he’s going to drop dead from a heart attack any minute. Who did you picture? An older, overweight man puffing cigarettes in the parking lot? Beet red face and cramming in two super-sized hamburgers at lunchtime? ‘Clearly,’ you are thinking to yourself, ‘this guy doesn’t eat right, is probably sedentary, has high blood pressure, and obviously has a lifestyle that’s going to lead to a heart attack!’ My husband, except for being male and having a less-than-stellar diet, wasn’t any of those things, he was thin and active — so we weren’t expecting a heart attack.

Second, his symptoms didn’t scream “HEART ATTACK!” to us. Screaming would have made me call 911, but there was no screaming. What are the symptoms you would expect to see? A person complaining of a crushing chest pain? Radiating pain to the shoulder or jaw? A person saying, “I can’t breathe…I feel like I have an elephant standing on my chest?” My husband began his ordeal by throwing up in the middle of the night. After he vomited, he said he had a burning, acid-like sensation running down the center of his chest — just what one might expect after vomiting. So he took an antacid and sat in his recliner for a while to get that acid sensation to go away. And I went back to bed … for two hours.

Third, there is the natural “denial” response. Even if that little voice in the back of your head is saying, ‘Something isn’t right — you should go to the hospital,’ you want to believe that it’s just indigestion, it’s just a stomach bug. So when I woke up and checked on Steve — still in the recliner at 1 a.m. — and asked whether we should go to the hospital, I believed him when he said, “No, it’s just acid reflux — it’ll go away soon, I’m sure.” I wanted to believe him and so I did. And went back to bed.

Unrelenting chest pain that will not go away within 15 minutes, no matter what you do, requires a trip to the hospital.

When I woke up a few hours later, he was no better. We did not recognize this final clue — that unrelenting chest pain that will not go away no matter what you do — requires a trip to the hospital. In fact, it was at this point I noticed that he was doing something that looked like holding his breath. So I asked him, “Steve, are you short of breath?” “No,” he replied, “it just makes my chest feel better if I expand it a little.” Denial. And I’m embarrassed to say that I believed him, or at least I didn’t want to upset him by pushing him to do something he didn’t want to do, so I went back to bed.

At 8 a.m. — NINE HOURS after his initial vomiting — I convinced him to go with me to our local doctor’s office. They immediately hooked him up to an electrocardiogram (ECG) and called an ambulance: “You’re having a heart attack, Mr. Blake — you should’ve gone to the hospital hours ago!” While we waited for the ambulance, Steve leaned over to me and whispered, “I’m not having a heart attack — it’s just acid reflux.” I followed the ambulance to the hospital and was met by the trauma doctor who said, “Mrs. Blake, your husband is having a heart attack. We’re taking him to the cath lab — the damage could be significant. You really should have come in HOURS ago.” As they wheeled Steve past me to the cardiac cath lab, he whispered, “I’m not having a heart attack — it’s going to be fine.”

Well, it wasn’t fine. His left anterior descending artery was completely occluded and not delivering any blood to his heart muscle. The cardiologist was right — the damage was significant. In the cath lab, they cleared out the obstruction and placed a stent in the artery. After a year of cardiac rehab, he was left with a 30 percent ejection fraction (normal is 55- 70 percent), a daily fistful of pills, a new heart-friendly diet and an implanted defibrillator.

So what have we learned?

TIME IS OF THE ESSENCE! The longer you wait, the more heart muscle dies. Dead heart muscle cannot grow back; it creates permanent scars and lifelong health issues — if the person survives. ANY unrelenting chest pain not relieved within 15 minutes is a trip to the hospital. You may be told that it’s acid reflux, but who cares?

ANY person can have a heart attack — men, women, active people as well as sedentary people, young and old. Don’t become “blind” to a heart attack simply because the person doesn’t fit your idea of what a heart attack victim looks like.

Signs of a heart attack are not always what you think. They can include nausea, vomiting and sweating, along with the more recognizable chest pain, jaw or shoulder pain and shortness of breath.

Denial is a natural response — for both the heart attack victim and family and friends. Even experienced healthcare workers can miss the clues when it comes to their own family members. Don’t climb on board the denial train! INSIST the person go to the hospital to get checked out. He or she may be irritated with you, but who cares? I’d rather have an irritated husband than a dead husband.

Steve’s heart attack — and our embarrassing lack of appropriate action — prompted me to get re-educated. I took the CPR instructor training course through the American Heart Association and have been teaching CPR classes to all kinds of people going on five years now. As a CPR instructor, I can teach my students what to do in the event of cardiac arrest; I can teach them how to give chest compressions and breaths, and how to operate an AED. But I also tell them this story of how we did everything wrong, so that one day they’ll recognize a heart attack in progress and react quickly.

By considering your own biases — your own ideas of WHO might have a heart attack and WHAT a heart attack looks like, even your own tendency toward denial — I hope that you won’t be fooled like we were. Make that call to 911 “Within 15 minutes” … NOT “After nine hours.”

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