Amelia was an active and healthy 62-year-old accountant in the middle of a busy workday when she experienced a dull ache in the middle of her chest; it felt as if someone was pushing on it. Her left arm felt heavy, and she felt slightly nauseous. A colleague from the next office stopped by her door a few minutes to ask a question and told her that she looked pale. Amelia described her symptoms and the colleague said, “I’m calling 911.”

Judith, a retired teacher, was 72 years old. She experienced a previous heart attack five years earlier but had recovered without any complications. She was exercising regularly, taking prescription medications, and following a heart-healthy diet. During a morning walk she experienced pain along the left side of her jaw that radiated to her neck. The pain came and went. After several days, she called her dentist and made an appointment, thinking that she might need a root canal. She was surprised to hear that her symptoms sounded more cardiac in nature. She went to urgent care, underwent an electrocardiogram, and 911 was called.

At age 48, Marsha was a dental hygienist whose family had immigrated from Japan. On weekends she went on bike rides of at least 20 miles with her friends. She considered herself physically fit and not at any risk of heart disease, so she was surprised when she experienced what she knew were classic heart attack symptoms (chest pain and shortness of breath) while on a bike ride. The symptoms came and went.Marsha decided to wait a few days and not bother anyone in her family. After three days, she drove herself to the emergency room. Tests confirmed that she had suffered a myocardial infarction, a heart attack.

Over the past three decades, amazing advances have been made in the diagnosis and treatment of heart attacks and strokes. When a person experiencing symptoms of either type of health emergency comes to an emergency room within an hour of symptom onset, the arteries feeding oxygen and nutrients to the heart muscle or the brain that have become blocked can be opened. Antithrombolytic medicine and cardiac stents can quickly restore circulation and prevent permanent damage. Hospitals have organized treatment protocols to achieve amazingly rapid treatment once the patient arrives in the emergency room. However, the key is seeking treatment quickly, something that all too often doesn’t happen when people experience their first symptoms.

The delay times from symptom onset to arrival in an emergency room have remained stubbornly unchanged over the past three decades, despite numerous public health education programs urging quick response. The average amount of time from symptom onset to arrival in the emergency room is three hours. The median delay times in various studies range from two to seven hours and are significantly longer for women. Part of the problem may be that women do not realize that they are at risk for heart disease or stroke. Both are often thought of diagnoses that predominately affect men.

Characteristics That Predict Delay Seeking Treatment

Women are more likely to delay seeking treatment for symptoms of a heart attack than men. Although this phenomenon has intrigued researchers for the past two decades, no one has been able to give a good explanation of the reason for the longer delay by women. Women are slightly more likely than men to have symptoms that are not commonly recognized as those of a heart attack: fatigue, jaw pain, or insomnia. Researchers have demonstrated that when women experience symptoms while at work, the delay to seeking treatment is significantly shorter.Unfortunately, the majority—75 percent—of heart attacks occur at home where times to seeking treatment are characteristically longer.

Knowing the symptoms of a heart attack does not translate to shorter times getting to the emergency room. In fact, the treatment-seeking time for a second heart attack is no shorter than the initial heart attack and may even be longer. In some situations, the delay in responding to a second heart occurs because the cardiac symptoms are quite different from the first heart attack.

Heart attacks may present initially with mild chest discomfort that is intermittent, while a second heart attack may manifest by pain that radiates from the chest, up the neck to the jaw. The fact that symptoms are often not the classic (and often dramatic) ones shown in movies can add to the confusion, as does the fact that symptoms can come and go.

The following symptoms can all indicate a heart attack: chest pain or pressure, pain radiating down the left arm, shortness of breath, nausea and vomiting, lightheadedness, unexplained fatigue, or insomnia.

The Importance of Seeking Treatment Immediately

This discussion is important because half of the women and men who experience a heart attack do not survive their trip to the hospital.Seeking immediate treatment by calling 911 is the key to both survival and preventing long term damage to the heart. Current treatments can restore circulation in the blocked artery and prevent long-term damage that can lead to heart failure and a severely impaired lifestyle.The reward for quick action when experiencing heart-related symptoms is great.