When a Heart Attack Hits ...

Sometimes it begins with a mild discomfort in the chest. Other times the pain may be excruciatingly severe, holding the chest in a viselike grip.

The ache, usually persistent, may radiate down the left shoulder and arm, and perhaps also affect the neck, jaw or back. The victim may become extremely short of breath, break into a cold sweat, feel weak and nauseated and possibly vomit. Along with these signs and symptoms, there may be palpitations. The face can turn a ghastly gray, and the patient may experience anxiety, even a sense of impending doom. Says Cardiologist Marshall Franklin of San Diego's Clairemont Community Hospital: "It is like nothing the patient has ever known before, a feeling that something cataclysmic is happening."

These are classic symptoms of a heart attack, or what doctors call a myocardial infarction. Such attacks occur all too frequently in the U.S., striking one American every 21 seconds. They can hit suddenly, without any obvious hint of previous disease, when coronary arteries pinch shut in a spasm. But they usually result from a lifelong buildup of fatty deposits in the arteries that nourish the heart. If these coronary vessels become badly obstructed, the flow of vital blood and oxygen is reduced or cut off entirely. When that happens, parts of the heart are starved. It is the death of cardiac muscle that constitutes a heart attack.

Still, even a heart with significant muscle loss can effectively pump blood. The real killer is disturbances in the heart's rhythm. These are most likely to occur in the first minutes or hours after the attack, caused by irregularities in the flow of electrical signals that control the beat of the heart. The heartbeat may develop abnormal rhythms and degenerate into a useless twitching or quivering. No longer is the heart able to drive blood through the body. Cardiac arrest ensues.

A heart attack may be triggered by unaccustomedly vigorous exercise or emotional crisis, but often it occurs during a period of little stress or activity, like sleeping. There are even "silent" heart attacks, accompanied by virtually no symptoms at all. Frequently the victim will shrug off the initial signs, even if the pain is quite strong, saying, "It's only indigestion." Some men have been known to do push-ups during an attack just to show they are all right. But such bravado can prove suicidal, because the greatest danger comes in the critical moments immediately after the attack.

Prompt emergency procedures can help restore normal heartbeat. This may be done by electrical stimulation, drugs or, in the absence of any other medical aid, chest massage. Keeping a list of emergency phone numbers and knowing what hospitals are best equipped to treat coronary cases can save valuable time and perhaps a family member's life. Because every second counts, more and more Americans are learning the life-and-death skills of cardiopulmonary resuscitation (CPR).

Even so, many people delay in seeking medical help. The consequences can be fateful. More than half of the 550,000 Americans who die of heart attacks each year succumb before they reach a hospital. In a study of coronary patients at the University of Rochester, cardiologists found that the average interval between the onset of symptoms and hospitalization was 3 1/2 hours, yet some 80% of these patients had experienced severe chest pains from the start. At least one reason for this hesitation is a belief that a heart attack always results in total incapacitation.

Actually the contrary is more likely to be true. If a heart attack patient is promptly hospitalized, the chances of recovery are excellent. As many as 85% of those who reach hospitals live to tell about their experience. Most return to vigorous lives of work and play, sex included. In fact, they are openly encouraged to do so by their doctors.

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