What to do if you're having a heart attack: An aspirin changes everything

At first, there was a strange tingling in his left arm. Nothing serious, he thought. But then the pressure in his chest came, as if someone had decided to sit on him.

The air began to thin, each breath shorter than the last, and a cold sweat broke out on his forehead even though he was still. Suddenly, fear appeared uninvited: that instinctive certainty that something was terribly wrong. It wasn't tiredness, it wasn't simple indigestion.

The heart was letting out a desperate cry.

A heart attack can present itself in many different ways, some obvious and others so subtle they're deceptive. Today I'm going to tell you how to detect these signs and, above all, what to do to react in time and save your life.

But before talking about the symptoms, let's talk about what a heart attack is.

What is a heart attack and what causes it?

A heart attack occurs when the blood flow that feeds the heart is suddenly blocked. The culprit is almost always a coronary artery clogged by a plaque of fat, cholesterol, and other substances that have accumulated over time on its walls. These cholesterol plaques are called atheromas. When this plaque ruptures, a clot forms that acts like a plug, cutting off the flow of oxygen to the heart muscle.

Now, why does a plaque rupture? It's not a matter of chance. Arterial walls are subjected to constant pressure, and when a plaque becomes unstable, either because its covering is thin or because inflammation weakens its structure, a rise in blood pressure, intense physical exertion, or even a rush of adrenaline due to stress is enough to cause that thin layer to tear. At that instant, blood comes into contact with the fatty interior of the plaque, and the body reacts as if there were a wound: it activates platelets to clot. But instead of protecting the artery, the clot seals the artery and triggers a heart attack.

The result is dramatic: heart cells begin to die within minutes. The longer medical care is delayed, the greater the damage to heart tissue and the lower its ability to recover.

But plaque doesn't just appear. High blood pressure, high cholesterol, smoking, diabetes, a sedentary lifestyle, or even chronic stress are all pieces of the puzzle that make it more likely that artery will eventually close at the worst possible time. In other words, a heart attack doesn't happen suddenly; it's the consequence of years of accumulated habits and risk factors that, in an instant, become a life-threatening emergency.

In what cases is a heart attack not caused by a blockage of a coronary artery?

Although the vast majority of heart attacks are caused by a classic coronary artery blockage, not all follow that pattern. Here are the main scenarios where the cause is different:

• Coronary spasm (Prinzmetal's angina): The artery isn't blocked by plaque, but rather suddenly constricts, blocking the flow of blood. It can last for minutes and cause a heart attack, even in arteries that appear "clean" during tests. It usually occurs at night and while resting.
• Spontaneous coronary artery dissection (SCAD): The artery wall tears from within, and blood leaks through, creating a "false channel" that compresses the real one. It is rare but occurs primarily in young, healthy women, often after childbirth.
• Thrombosis without prior plaque: In some cases, a clot forms in the coronary artery due to coagulation disorders, without the need for an unstable atheromatous plaque.
• Coronary embolism: A clot or fatty fragment that originated in another part of the body travels and ends up lodging in the coronary artery.
• Type 2 heart attack (imbalance between oxygen supply and demand): There is no physical blockage, but the heart requires more oxygen than it receives. It can occur with severe anemia, very rapid arrhythmias, severe asthma attacks, or even prolonged hypotension.

What are the symptoms and how can you tell if you are suffering from one?

A heart attack doesn't always strike with the classic chest pain we all imagine. Sometimes it's disguised: a heartburn that feels like indigestion, a dizziness that doesn't quite fit, a sudden, unexplained fatigue. This ambiguity is what makes it so dangerous. Recognizing the signs, even the most subtle, can mean the difference between calling for help in time or wasting vital minutes.

Main and very frequent symptoms

• Severe pain or pressure in the center of the chest, which may last for more than a few minutes or go away and return. This is a VERY intense pain that is difficult to mistake for anything else.
• Pain radiating to the left arm, shoulders, neck, jaw, back, or even the stomach.
• Shortness of breath, even at rest.
• Sudden cold sweat.
• Nausea, vomiting or dizziness accompanied by chest discomfort.

Secondary symptoms (less typical, but possible)

• Unusual fatigue without prior exertion (common in women).
• Persistent indigestion or abdominal pain that does not improve with antacids.
• Palpitations or a sensation of irregular heartbeats.
• Pain located only in the jaw, back, or both arms without chest pain.
• Intense anxiety or an unexplained feeling of “impending doom.”
• A strong urge to defecate or sudden diarrhea: a vagal response that, when combined with chest pain or a cold sweat, can be a warning sign.

Symptoms can vary from person to person: in women, older adults, and diabetics, atypical forms sometimes appear, with more fatigue, dizziness, or shortness of breath than chest pain. Therefore, the golden rule is clear: when in doubt, treat it as a heart attack until a doctor proves otherwise.

How to survive a heart attack?

When your heart sounds the alarm, every minute counts. This is no time to hesitate or make excuses: immediate response can mean the difference between life and death.

5-step protocol for surviving a heart attack:

• Call emergency services immediately (112 in Spain): don't try to "tough it out" or wait to see if it passes. Every second without assistance increases the damage to your heart.
• Don't drive alone: the risk of losing consciousness while driving is extremely high. Wait for an ambulance or ask someone nearby for help.
• Remain completely at rest: Sit or lie down in a comfortable position, remaining as calm as possible. Do not attempt to walk or exert yourself.
• Take an aspirin (if you are not allergic or have any contraindications): Chewing it helps it act faster and reduces the formation of clots.
• Notify someone you trust: If you're alone, open your front door and keep your phone handy so emergency services can access it quickly.

A heart attack is not the time for heroics or minimizing symptoms. The only intelligent decision is to recognize the danger and act quickly.

Why aspirin?

Aspirin (acetylsalicylic acid) isn't magic; it's chemistry working against the clock. When a coronary plaque ruptures and a clot forms, platelets (those small blood cells responsible for sealing wounds) activate en masse. They clump together, stick together, and form a plug that blocks the coronary artery. The problem is that, in the context of a heart attack, this plug doesn't save, it kills.

This is where aspirin comes in. This drug irreversibly blocks a key platelet enzyme (cyclooxygenase-1, COX-1). In doing so, it prevents them from producing thromboxane A₂, a molecule that acts as an alarm signal and normally causes platelets to clump together. Simply put, aspirin disarms platelets and prevents the clot from growing further.

Now, the way you take it also matters. If you swallow a pill whole, it must pass through the stomach, reach the small intestine, and then be absorbed into the bloodstream. This process can take between 20 and 40 minutes. In contrast, when tablets are chewed or crushed, the aspirin is released immediately, and some of it is absorbed directly through the highly vascularized oral and gastric mucosa. This means that effective blood levels are reached much more quickly: within 5 to 10 minutes, aspirin is already blocking platelets.

Therefore, the recommendation is clear: in the event of a heart attack, if there are no contraindications and your doctor has previously prescribed it as an emergency measure, chew the aspirin before swallowing it. It won't dissolve the existing clot (which requires hospital treatment), but it can slow its growth and buy time for help to arrive.

A key detail: not everyone should take aspirin without medical advice. Allergies, active ulcers, or bleeding disorders can make it dangerous. Therefore, this step should always be accompanied by calling emergency services.

Myths and curiosities about heart attacks

• Myth: “If I feel chest pain but it goes away in a few minutes, it can’t be a heart attack.”
  Fact: Symptoms can come and go. Intermittent pain can also be a warning sign of an impending heart attack. Never ignore it.
• Myth: “If I’m alone and have a heart attack, coughing hard can save me.”
  Fact: So-called "cough resuscitation" only makes sense in a hospital, under medical supervision, and in cases of arrhythmias. In a real heart attack outside the hospital, coughing doesn't unblock the artery or stop the damage.
• Myth: “Heart attacks only affect older or overweight people.”
  Fact: Although age and being overweight increase the risk, it can also occur in young, seemingly healthy people, especially if factors such as smoking, high blood pressure, diabetes, or elevated lipoprotein(a) are present.
• Myth: “The pain is always on the left side of the chest.”
  Fact: The pain may be felt in the center, on the right side, radiate to the neck, jaw, back, or even manifest as abdominal discomfort.
• Myth: “Heart attacks are a men’s thing, they rarely happen to women.”
  Fact: Heart attacks are one of the leading causes of death in women. Many tend to minimize symptoms because they believe it's a "man's disease," and this delays seeking medical attention. Furthermore, atypical symptoms (extreme fatigue, shortness of breath, back or jaw pain) are more common in women.
• Myth: “All heart attacks hurt.”
  Fact: In people with diabetes, heart attacks can occur without typical chest pain. Diabetic neuropathy affects the nerves that transmit pain, masking the symptoms. In these cases, shortness of breath, extreme fatigue, or cold sweats may be the only signs.
• Myth: “Heart attacks come on suddenly, without warning.”
  Fact: Many heart attacks are preceded by episodes of angina: chest pain or pressure during exertion or stress that can appear days or weeks before. These are warning signs that people often downplay or mistake for fatigue or indigestion, until they eventually lead to a full-blown heart attack.
• Myth: “If it’s a panic or anxiety attack, nothing will happen.”
  Fact: The symptoms of a heart attack and those of an anxiety attack can be very similar: chest pain, shortness of breath, palpitations, dizziness. But while anxiety doesn't kill, a heart attack can. Therefore, when in doubt, the best thing to do is always go to the doctor or call emergency services. It's better to be told it was "just" anxiety than to risk not treating a heart attack.
• Interesting fact: Some people experience unexpected symptoms during a heart attack, such as an intense urge to defecate or a sudden feeling of impending doom. These aren't the most common, but they have been documented.
• Interesting fact: The speed with which you act is crucial. It's often referred to as the "golden hour": the first 60 minutes after symptoms appear are critical for survival and recovery.
• Interesting fact: Cardiovascular risk is not distributed equally throughout the day: heart attacks are more frequent between 6 a.m. and 12 p.m., when the body releases more adrenaline and cortisol, increasing blood pressure and the heart's oxygen demand. That's why The most common time for a heart attack is Monday morning, when the stress of the work week and the peak cortisol levels combine to increase cardiovascular risk.

Final reflection: Cardiovascular health

A heart attack is the brutal face of an uncomfortable truth: the heart never forgets how we treat it. Every cigarette, every sleepless night, every plate loaded with bad fats leaves a silent mark on the arteries. And although medicine has given us tools to respond in an emergency—such as aspirin, defibrillators, or surgery—the reality is that the best way to survive a heart attack is to never have one.

Prevention is the most powerful remedy. Regular exercise keeps arteries flexible and the heart strong. It's not just about running: strength training is equally important, as it helps control glucose, weight, and blood pressure. Added to this is a balanced diet rich in fruits, vegetables, legumes, fish, and nuts, with fewer ultra-processed foods and sugars.

There are silent factors that also matter. Lipoprotein(a), which we've discussed in another article, is a genetic marker that increases cardiovascular risk and is still overlooked in many checkups. Knowing its levels is a powerful prevention tool.

Let's not forget the invisible enemy: chronic stress. Sustained emotional tension raises blood pressure, alters heart rhythm, and weakens vascular health. And, as a curious fact that should give us pause, the most likely time of the week to suffer a heart attack is Monday morning, when the cortisol surge and the return to work stress hit hardest.

The heart is a tireless engine, but also vulnerable. It doesn't wait forever. And right now, during World Heart Day, it's worth remembering: there's no better excuse than life itself to take care of it.

Annex: International emergency numbers

Remembering the emergency number is just as important as knowing the symptoms. It's not always the same in every country, and it can make a difference if a heart attack occurs far from home.

• European Union: 112
• United States and Canada: 911
• United Kingdom: 999 (although 112 also works)
• Australia: 000 (and 112 from mobile phones)
• Mexico: 911
• Brazil: 192 (SAMU)
• Argentina: 107 in many provinces, 911 in others
• Peru: 106 (ambulances), in some areas already 911
• Chile: 131 (SAMU)

📌 Travel tip: Always save the emergency medical number for the country you're in on your phone. You never know when you might need it.