Heart Attack & Chest Pain
Crushing central chest pain lasting more than a few minutes is a medical emergency until proven otherwise. Heart muscle dies every minute you wait.
When to call an ambulance immediately
- Central chest pain, pressure or heaviness lasting more than 15 minutes
- Pain spreading to the jaw, neck, left arm, both arms or the back
- Cold sweat, nausea or vomiting alongside the chest discomfort
- Sudden severe breathlessness, especially at rest
- Light-headedness, collapse, or a feeling of impending doom
- In women, older adults and people with diabetes: unexplained breathlessness, fatigue or indigestion-like discomfort without classic chest pain
What to do
Work through these in order. If you are alone, put your phone on speaker so the 108 call handler can guide you while your hands stay free.
- 1
Call 108 immediately
An ambulance can begin treatment on the way and can alert the hospital's cardiac team before you arrive. Driving in yourself wastes the one advantage you have, which is time. If the person collapses in a private vehicle, nobody can help them.
- 2
Sit them down and keep them still
Half-sitting, back supported, knees bent. This position eases the work of the heart and lungs. Loosen tight clothing at the neck and waist. Stop them from walking about, climbing stairs, or carrying anything.
- 3
Give aspirin, 300 mg, chewed
If the person is conscious, able to swallow, not allergic to aspirin and has no active bleeding, give a single 300 mg aspirin tablet and ask them to chew it rather than swallow it whole. Chewing gets it into the bloodstream far faster, and it measurably reduces death from heart attack.
- 4
Help with their own prescribed nitrate
If they have been prescribed a glyceryl trinitrate spray or a sorbitrate tablet for angina, help them take their own dose as prescribed. Never give someone else's cardiac medication.
- 5
Stay with them and keep them calm
Anxiety increases the heart's demand for oxygen. Speak calmly, keep the room cool and uncluttered, and note the time the pain started. The hospital will ask, and the answer shapes treatment.
- 6
If they collapse, start CPR
If they become unresponsive and are not breathing normally, begin chest compressions immediately and send someone for the nearest defibrillator. Push hard and fast in the centre of the chest.
Never do these
Most of these are well-intentioned and widely believed. All of them make the situation worse.
- Never let them walk to the car or climb stairs. Exertion can trigger a fatal rhythm.
- Never wait to see if the pain settles. Reversible damage becomes permanent within hours.
- Never give aspirin to someone with a known aspirin allergy, active bleeding, or a bleeding disorder.
- Never give food or water. They may need an urgent procedure under sedation.
- Never dismiss it as gas or acidity. An emergency department would far rather rule it out than miss it.
Once the immediate danger has passed
- Bring every medication box or prescription list with you to hospital.
- Note the exact time symptoms began. Thrombolysis and angioplasty decisions depend on it.
- Tell the triage nurse it is chest pain the moment you arrive. Do not wait quietly in the queue.
Frequently asked
Is it safe to give aspirin if I am not sure it is a heart attack?
For an adult with suspected cardiac chest pain and no aspirin allergy or active bleeding, a single 300 mg chewed aspirin carries a very small risk and a substantial benefit. If you are unsure, the 108 call handler will guide you.
The pain went away. Do we still need to go to hospital?
Yes. Pain that comes and goes can represent unstable angina, which frequently precedes a full heart attack. It needs an ECG and blood tests the same day.
Can a heart attack happen without chest pain?
Yes, and it is more common than people expect in women, older adults and people with diabetes. Unexplained breathlessness, sweating, extreme fatigue or upper abdominal discomfort can be the only sign.
Reviewed and written by
Dr. Poonam Sekhon Chahal, MBBS, MEM
Senior Emergency Physician, Manipal Hospital, Patiala · Certified in ACLS, ATLS, PALS and PoCUS