Am I Having a Heart Attack? What to Expect in the Emergency Department

**By Julianna T. Yu, MD, FACEP**

As an emergency medicine physician, I am trained to prepare for every potential scenario. Conversely, most people do not plan ahead prior to coming to an emergency department for an urgent medical condition. A few simple, proactive steps can help ensure you receive the best care in an urgent situation, especially for any suspected heart-related concern.

ER stretcher
How do I tell if it’s a heart attack? 

For many people, it is not always clear when to seek emergency care. Heart attack symptoms are not always obvious. According to current American Heart Association guidelines, most heart attacks that warrant immediate medical attention involve:

  • Discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Cold sweat, nausea or lightheadedness.

If you have any of these symptoms, call 911 immediately.

What to bring to an emergency department

Ideally, create a personal health file in advance and update it regularly. It should fit into a wallet or purse and include:

  • Chronic health conditions and previous surgeries
  • Results of recent medical tests
  • Medication allergies
  • List of current medications, vitamins or herbal supplements
  • Names and contact information for your doctors, family and friends who may need to be alerted in the event of an emergency health issue
  • Advance directives

What to expect when you arrive at an emergency department

Emergency departments operate on a triage basis, which means team members treat the most serious illnesses or injuries first. If you are brought to an emergency department with a suspected cardiovascular condition, such as heart attack or stroke, you will be rapidly evaluated and treated. A team of clinicians – emergency medicine physicians and nurses – will work as a team to take your medical history and do a physical exam, confirm your diagnosis, relieve your symptoms and consult with appropriate specialists.

Depending on your symptoms and diagnosis, you may receive one or more of the following:

  • Intravenous (IV) fluids
  • Electrocardiogram (EKG or ECG)
  • Blood tests
  • Oxygen
  • Medications
  • Consultation with a cardiologist

A heart attack occurs when there is a blood vessel blockage that reduces blood and oxygen flow to the heart muscle. Rapid treatment by an experienced team is especially important because the longer an artery is blocked, the greater the chance of permanent damage to the heart muscle.

A little prevention can go a long way

The best way to avoid an emergency department visit for a cardiac condition is to reduce your risk factors for heart disease. I strongly encourage you to make some time soon to review your cardiac risk factors with your doctor. Your chances of having a heart attack are lower if you:

  • Treat high blood pressure and diabetes
  • Lower high cholesterol
  • Maintain ideal body weight
  • Exercise regularly (30 minutes of moderate intensity aerobic activity at least five days per week, under the supervision of your doctor)
  • Stop smoking
  • Reduce stress
  • Eat a well-balanced diet high in fruits and vegetables

To calculate your personal heart attack risk, visit

After meeting with your doctor, I recommend creating your personal health file and carrying it with you whenever you leave home.

I hope this information will help improve your heart health and assist you in becoming a more informed health care consumer.

Julianna T. Yu, MD, FACEP, is board certified in Emergency Medicine and medical director of the Emergency Department at Virginia Mason, located at the intersection of Spring Street and Boren Avenue (1010 Spring St.) on First Hill in Seattle. 

Heartburn or Heart Attack? Pay Attention to Symptoms

**By Gordon L. Kritzer, MD, FACC**

heartattackSince large meals are often part of celebrating, it’s easy to overdo it on special occasions. If you’ve just eaten a big meal and you feel a burning sensation in your chest, you might think it is heartburn, and it might be. However, there is a chance that the chest pain could be caused by reduced blood flow to your heart (angina), or an actual heart attack.

What is heartburn?

Heartburn, often called acid indigestion, is discomfort or actual pain caused by digestive acid moving into the esophagus, which carries swallowed food to your stomach.

Signs of classic heartburn are:

  • A burning sensation starting in the upper abdomen and moving up into the chest after eating, or while bending over or lying down.
  • Symptoms that awaken you from sleep, especially if you have eaten within two hours of going to bed.
  • Symptoms that are relieved by antacids.
  • Getting a sour taste in your mouth, especially when lying down.
  • A small amount of stomach contents rising up into the back of your throat (regurgitation).

Common confusion

Despite its name, heartburn is related to your esophagus, not your heart. But because the esophagus and heart are located near each other, either one can cause chest pain that sometimes radiates to your neck, throat or jaw. This is why many people mistake heartburn for angina and vice versa.

Since heartburn, angina and heart attack may feel very much alike, even experienced doctors cannot always tell the difference from your medical history and a physical exam. That is why if you go to an emergency department for chest pain, you will immediately have tests to rule out a heart attack.

What to do if you’re unsure

I often tell patients that if you burp and symptoms go away, it probably isn’t related to your heart, but to your esophagus. However, if you suddenly experience shortness of breath and sweating or persistent chest pain, then it’s likely a heart-related issue and you should call 911 immediately.

Also, call your doctor if you had an episode of unexplained chest pain that went away within a few hours. This is important because both heartburn and a developing heart attack can cause symptoms that subside after a while. The pain does not have to last a long time to be a warning sign.

Heart attack vs. sudden cardiac arrest

It is also important that people are able to recognize the difference between a heart attack and sudden cardiac arrest. When someone is having a heart attack, he or she is conscious and might complain of chest pain or other symptoms.

When a person is experiencing sudden cardiac arrest, the heart has unexpectedly stopped beating and blood is no longer pumping throughout the body or brain. The individual may lose consciousness and appear lifeless. Some victims gasp and shake as if they are having a seizure. Death can occur within minutes.

If someone is experiencing heart trouble, here are five ways to help them:

  • Call 911. Whether it is a heart attack or sudden cardiac arrest, step one is always to call 911 to report the emergency and allow emergency dispatchers to coach you through some simple, potentially lifesaving steps.
  • Ease strain on the heart. If the person is conscious and possibly suffering a heart attack, help move them into a comfortable position – half-sitting, with head and shoulders well supported and knees bent, to ease strain on the heart. Also, loosen clothing at the neck, chest and waist.
  • Have the person chew and swallow an aspirin. If the person is conscious, give them a full dose (300 mg) of aspirin. Have the person chew it slowly so it dissolves and is absorbed into the bloodstream more quickly when it reaches the stomach. Aspirin helps break down blood clots, minimizing muscle damage during a heart attack.
  • Perform cardiopulmonary resuscitation (CPR). If the person is unconscious, the next step is to start chest compressions. To do this, press down hard (about two inches deep) and fast (100-120 times per minute) on the center of the chest.
  • Look for an automated external defibrillator. These commonly found devices have clear instructions and are designed for use by the public. To use one, simply attach the pads as indicated on the machine, then it will talk you through the process. It will only deliver a shock if the patient’s condition warrants it. Leave the machine switched on at all times, and leave the pads attached – even if the patient has recovered.

Awareness is key

Learning to recognize simple heartburn and the symptoms of a serious heart condition will help you act quickly when it matters most. Knowledge is power as we become better health advocates for ourselves and for others.

Gordon L. Kritzer, MD, FACC, is a board certified cardiologist who specializes in interventional and invasive cardiology as well as cardiac rehabilitation. He practices in the Heart Institute at Virginia Mason Hospital and Seattle Medical Center (206-341-1111). For more information, watch Dr. Kritzer’s “Signs of a Heart Attack” video.