Imagine you are at home or at work when you suddenly experience chest pain. Could it be a heart attack? Should you go to the nearest emergency room? What should you do? One thing is for certain -- heart attack is a life-and-death emergency and every second counts.

What is a Heart Attack?

A heart attack occurs when the blood supply to part of the heart muscle is severely reduced or stopped. This happens when one or more of the coronary arteries supplying blood to the heart muscle is blocked by a build-up of fat-like substances called "plaque." The plaque can eventually burst, tear or rupture, creating a "snag" where a blood clot forms and blocks the artery. This leads to a heart attack. If the blood supply is cut off for more than a few minutes, muscle cells suffer permanent injury and die. That is why it is important to know the warning signs of a heart attack and know where and how to get quick, professional help when experiencing any sort of chest pain.

Evaluating Chest Pain

National studies have shown that when rapid and appropriate care is provided to patients complaining of chest pain, survival rates for those having a heart attack are greatly increased and the number of unnecessary hospitalizations for low-risk patients may be reduced.

Chest Pain Centers that are open 24-hours a day, seven days a week to more rapidly assess, diagnose, and - as needed - treat patients are one of the best options for those complaining of chest pain. "The Chest Pain Centers at John Muir Medical Center's Walnut Creek and Concord Campuses are located within our emergency departments, and provide a clearinghouse for determining a patient's risk of a heart attack and then either discharging them safely or admitting them to the hospital if further evaluation and treatment are necessary," says Agustin Argenal, M.D., F.A.C.C., cath lab medical director at John Muir Medical Center - Concord Campus.

"The team's first priority when a patient arrives in the emergency department with heart attack symptoms is to get him or her out of the danger zone," explains Dr. Argenal. "There's a saying that 'time is myocardium' (heart muscle)." Following a rapid assessment, EKG and stabilization, the patient will receive a blood test that measures for heart muscle damage and may be observed for up to 23 hours on a heart monitor to pinpoint any arrhythmias and other abnormalities.

According to John Krouse, M.D., F.A.C.C., cath lab medical director at John Muir Medical Center - Walnut Creek Campus, "If a patient is having a heart attack, they are immediately taken to our cardiac catheterization laboratory for a procedure called percutaneous coronary intervention (PCI) to open the blocked vessel and restore blood flow to the heart," says Dr. Krouse. "PCI consists of inserting a tiny wire with a balloon at the end through the blocked artery. The balloon is then inflated, opening the vessel and restoring blood flow to that area of the heart. The goal is to accomplish this as soon as possible, before the heart muscle is damaged."

"One of our biggest successes has been in preventing the early and late complications of myocardial infarction by opening these vessels as quickly as possible," says Dr. Argenal. Both the American College of Cardiology and the American Heart Association recommends that "door-to-balloon time" be 90 minutes or less. "We are continually working to see our door-to-balloon time become 60 minutes or less."

Warning Signs

The most common signals are:

• Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back.
• Pain that spreads to the shoulders, neck or arms.
• Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.

Less common symptoms are:

• Nausea or dizziness (without chest pain).
• Shortness of breath and difficulty breathing (without chest pain).
• Unexplained anxiety, weakness or fatigue.
• Palpitations, cold sweat or paleness.

"As with men, a woman's most common heart attack symptom is chest pain or discomfort," explains Dr. Krouse. "However, women are somewhat more likely than men to experience some of the other lesser recognized symptoms of a heart attack, particularly shortness of breath, nausea, vomiting, as well as back or jaw pain."

If any of these symptoms persist for more than five minutes, call 911.