Being treated fast - within 90 minutes of the attack - could be the key to survival, writes Kathryn Holmquist
You're doing the washing up after dinner when you feel slight nausea and a crushing pain in the centre of your chest which you think at first might be indigestion. Sure, that's what you get for stuffing yourself. You soldier on for an hour or two, then start looking for the antacid tablets. You wait for them to kick in.
Two hours later, with your feet up in front of the television, you don't feel any better. You're cursing yourself for having eaten too much and worked too hard in the kitchen. You feel tired, but what's new?
As you get ready for an early night, the pain is worse, but you wouldn't bother a doctor at night about indigestion, would you? You'll feel better in the morning, you tell yourself. You can't sleep. The crushing sensation in your chest is worse. You can hardly breathe - something is very wrong.
Four hours after you started feeling ill, you finally call the doctor. Next thing you know, you're in an ambulance, being rushed to the nearest casualty department. It's four hours too late. An electrocardiogram shows it wasn't your hearty appetite that caused the pain - it was your heart.
You'll survive, but not as well or as long as you would have if you'd got to hospital within 90 minutes of the attack.
A heart attack doesn't always feel like a heart attack, especially for women. Half of those who die of heart attacks are women, yet even doctors tend to associate the condition with men. Even when women suspect they are having a heart attack, they may have trouble convincing their doctors. Many doctors wait for hard evidence of heart disease before they'll recognise a heart attack in a woman, says Dr Vincent Maher, a cardiologist and the medical director of the Irish Heart Foundation.
Men get more classic symptoms: a crushing chest discomfort and, sometimes, pains up the neck and down the arm. Men may find themselves sweating profusely. Yet men, too, may dismiss their pains as unimportant. They, too, arrive at hospital too late.
The average Irish person arrives in hospital four hours after the first sign of a heart attack. The reason: lack of information. A heart attack is supposed to be dramatic, isn't it? You're supposed to collapse on the floor and pass out, aren't you? Actually, no.
About half of those who have heart attacks drop dead on the spot. The rest stay alive while their heart muscles are slowly starved of oxygen.
"You shouldn't be waiting at home for more than five or 10 minutes," says Dr Joe Galvin, a cardiologist at the Mater Misericordiae Hospital, in Dublin, and James Connolly Memorial Hospital, in Blanchardstown. If you can get to hospital fast, no more than an hour after the attack, you should be treated within 20-30 minutes.
Heart attacks - which cause one in five Irish deaths - are caused by blood clots that block arteries, depriving the heart muscle of oxygen. Without oxygen, muscle dies. The longer you wait for treatment, the more damage is done to the muscle. This reduces your chances of recovery and increases those of long-term problems and a vastly shortened life.
Thrombolytic drugs, used intravenously, can break down the clots and prevent further damage to the heart muscle by restoring blood flow to the heart muscle. These clot-busters are essential to saving lives - but only if the heart-attack victim gets to hospital quickly.
"From door to needle" is the way accident-and-emergency staff measure the efficiency of treating heart attacks. The quicker patients get the medication, the better their chances. But the real predictor of survival is from chest pain to needle - and that's the patient's responsibility.
Once you're in the door of A&E, you need a clot-busting drug fast. Metalyse, a new bio-engineered clot-busting drug, can be given in one injection. The treatment takes just two minutes and is slightly more effective than some of the older drugs, but the main advantage is that it is given in a single dose, so staff don't need to put up a drip. This makes it easier and faster to administer.
Older, nearly as effective drugs are less expensive, but they must be given intravenously over 90 minutes. This can be a problem in some busy A&E departments, where someone has to be found to put up a drip. In some hospitals the patient may have to be taken from A&E to a cardiac ward, where a bed must be found.
Metalyse can also be a lifesaver for people who live in rural areas, hours from the nearest A&E department. In the country, no matter how well-informed you are, geography holds you up. This is why GPs in Donegal, Waterford, Galway and Sligo are carrying clot-busters in their black bags.
If the time from first symptom to hospital is going to exceed 90 minutes, GPs can make a judgment call and give the drug before the patient gets to hospital for a clear diagnosis from an electrocardiogram. There's no need for a drip, so the GP can give the drug in the home or ambulance. In some countries, paramedics can do an electrocardiogram in the ambulance and administer the drug - a big advantage.
Your survival is up to you. If you feel central, crushing chest pain - or intense, painful indigestion and nausea - don't feel silly about "worrying" GPs and A&E staff, says Dr Maher. It's better to do something about nothing than to take the risk of doing nothing - and dying.