If you were to suffer a heart attack while in the company of people, calling out for help is probably the first instinctive thing you’d do. But what if a heart attack happens when you’re alone, can you survive it? Here's what to do.

What to do when a heart attack occurs?

1. (First thing to do) Call for emergency help

Should you experience a heart attack – regardless of whether you’re alone or in the presence of others – the very first thing to do is to call for emergency medical help (call 995 if in Singapore). You need specialised treatment to be delivered to you as quickly as possible in order to save your heart muscle.

“Should you be alone when a heart attack occurs, stop whatever you’re doing, proceed to a safe place to rest and call for medical help. For example, if you’re driving, first pull to the side of the road and call for aid,” advises Clinical Associate Professor Chin Chee Tang, Senior Consultant, Department of Cardiology, National Heart Centre Singapore (NHCS), a member of the SingHealth group.

What to do while waiting for medical help to arrive

2. Take an aspirin (if you are not allergic to it)

Aspirin is the most commonly taken blood thinning medication in the world, which will improve your chances of survival when taken during a heart attack.

Most cases of heart attack are caused by a blood clot forming in one of the blood vessels responsible for supplying blood to the heart. The resulting blockage deprives the heart of oxygen-rich blood, causing damage to the heart muscle, which progressively dies. Taking an aspirin during a heart attack may help as it prevents the clot from getting bigger, giving the body a chance to break down the blood clot.

If you have aspirin at home, and you know that you are not allergic to it, then you could consider taking it while waiting for the emergency medical services to arrive.

3. Lie down and stay calm

Don't panic! Stay calm, lie down and rest while waiting for help.

What not to do during a heart attack

1. Do not rely on just taking nitroglycerin

Taking a prescribed medication such as nitroglycerin that temporarily widens blood vessels to improve blood supply to the heart is unlikely to stop a heart attack. You still need to call for help.

Assoc Prof Chin says, “Nitroglycerin has not been shown to prevent heart attacks or improve survival substantially during an attack. It is more useful for patients with angina, an altogether different condition where patients experience chest pain or discomfort when exerting themselves.”

Angina results from an imbalance in the supply and demand for blood to the heart, but it is due to a narrowed blood vessel and not to a clot that needs to be broken down. Taking nitroglycerin during such a situation may temporarily expand the narrowed blood vessel and relieve discomfort.

2. Do not cough repeatedly 

For self-administered “treatments” such as coughing repeatedly, Assoc Prof Chin cautions that these are probably just urban legends.

He explains, “In rare cases where the heart beat is very slow from an abnormal reflex mechanism, coughing may help restore normal heart rhythm – but this is not what happens in a heart attack.”

3. Do not apply pressure on the chest

Similar to coughing repeatedly will not help during a heart attack, applying pressure on the chest area during a heart attack is unlikely to help too, unless the person’s heart has stopped beating (also known as a cardiac arrest).

When a cardiac arrest happens, CPR (cardiopulmonary resuscitation) should be administered – ideally by someone who is trained to do so.

“Even if a person is qualified to give CPR, he or she should call for help and notify the emergency medical services before administering aid,” says Assoc Prof Chin.

Symptoms of a heart attack

To know for sure if you’re suffering from a heart attack, you first need to be able to identify its symptoms. Classical symptoms of a heart attack include:

  • Severe chest pain (like squeezing, or a heaviness, or pressing) at the central or left part of the chest, lasting usually for at least 20 min.
  • Pain that radiates to the left upper arm, neck or jaw.
  • Profuse sweating and a feeling of impending doom.

“About 90 per cent of heart attack sufferers experience the classical symptoms," says Assoc Prof Chin.

However, the elderly, females and those suffering from diabetes may develop non-classical heart attack symptoms. These include:

  • Shortness of breath
  • Mild chest pain
  • Nausea, vomiting
  • Pain in the epigastric region (upper central portion of the abdomen)

FAQs about what to do during a heart attack

1. During a heart attack, would it make a difference to lie down, sit upright or stand up?

It is unlikely to make a big difference. Assoc Prof Chin says," Most people will be feeling very uncomfortable and will tend to want to lie down. In some people, they may be feeling very breathless and hence want to sit upright. I would suggest to allow the person to get into the position that he/she is most comfortable in."

2. Will drinking water or eating something during a heart attack help?

It will not help the sufferer. Most people who are having a heart attack will not be hungry or want to eat food. Eating and drinking during a heart attack is discouraged as far as possible because heart attack sufferers have a high chance of vomiting and hence may choke or aspirate on their vomit.

3. Will using an AED during a heart attack help? In what scenarios should CPR and an AED be used?

An AED (automated external defibrillator), as with CPR, must only be used when a person has a cardiac arrest (refer to point 3 above on "Do not apply pressure on the chest").

An AED must never be used If the patient's heart is still pumping during a heart attack as delivering an electric shock to the heart in this situation may actually cause the heart to stop pumping.

4. What is the survival rate for heart attacks in Singapore?

In the latest report from the Singapore Myocardial Infarction Registry, about 92% of patients in 2018 survived for more than 30 days after their heart attack. This is a significant improvement as compared to the survival rate in 2009.

Ref: K21

Check out other articles on heart health:

Tips for a Healthy Heart

Sudden Chest Pains You Shouldn't Ignore

Heart Palpitations: When Are They Serious?

How a Viral Infection Can Affect the Heart

How Plaque Buildup Can Lead to a Heart Attack