The Golden Hour If you ever experience what heart doctors call the "golden hour," it will probably be one of the most harrowing hours of your life. The golden hour is the hour that begins with the onset of a heart attack. The decisions you make and the care you receive during this hour may determine the quality of all the remaining hours of your life. Heart wrenching Emergency room personnel call it an "MI." Your doctor calls it a "myocardial infarction." Most of us laymen refer to it as a heart attack. And it's safe to say that far too many people don't understand the warning signs that let us know the heart is in dire trouble. A recent article by Gina Kolata in the New York Times tells the story of one heart attack victim who made some common mistakes during the golden hour. But he also made a few good decisions, caught some breaks, and was fortunate enough to survive. When I read the headline of the article - "Lessons of Heart Disease, Learned and Ignored" - I was afraid we'd be in for a seminar about the various heart medications we should be taking. And while there was a little of that, the article somehow, amazingly, avoided any mention of cholesterol-lowering statin drugs. Instead, some of the details of the article provide a useful guide to recognizing and responding to the symptoms of a heart attack. HEART ATTACK SYMPTOMS In TV shows and movies, heart attack victims grab their chests and fall to the floor, but this is not how most heart attack victims actually respond Rather than creating a sharp pain, a heart attack usually begins with discomfort - one or more of these sensations: pressure in the chest, shortness of breath, a feeling of heaviness, nausea, sudden exhaustion, or a cold sweat - Pressure in the chest may feel like it's radiating into the arms, neck, or stomach
- Among the elderly - especially elderly women - the only symptom may be exhaustion during a simple task, such as walking across the room
- Diabetics may experience only a sudden, overwhelming fatigue - a "silent" heart attack
- Sometimes a blood clot breaks up and reforms several times, causing chest pressure that comes and goes
- Less than 10 percent of heart attack victims recognize these symptoms and get to a hospital during the golden hour.
Make the call So if you're not clutching your chest and passing out, you're probably okay to drive yourself to the hospital, right? Or you could at least get someone to drive you. No need to upset everyone and call an ambulance. Wrong. Call 911 immediately. If you're having a heart attack, the LAST thing you should do is get behind the wheel of a car. And asking a friend or family member to drive you is not much better: You might get stuck in traffic, and your friend can't help you if you take a turn for the worse. Also, you're far more likely to receive immediate attention if you arrive at the ER in an ambulance. According to one cardiologist, the greatest delay during the golden hour is the time between onset of symptoms and the decision to call 911. This is critical because the heart muscle may be dying. Those who survive a heart attack but experience significant heart muscle damage will probably require rehabilitation and may never feel completely free of fatigue. But even if you do everything right and get to the hospital quickly, you may not get the specific care you need if you go to the wrong hospital. In most heart attacks, emergency angioplasty is the most efficient way to break up blood clots and keep them from reforming. But according to the Times article, only about one quarter of the 5,000 acute care hospitals in the U.S. are equipped to provide angioplasty. One doctor interviewed in the Times suggests that patients at high risk of heart attack should talk to their doctors or make some calls to find out the location of the nearest hospital capable of performing round-the-clock emergency angioplasty. | 
