Heart attacks: occurrence, symptoms and first aid

If you don’t react quickly enough in case of heart attacks, heart muscle cells die off. However, what exactly happens during a heart attack and what should you do in an emergency?


Lara Brunner

How heart attacks occur

An unhealthy diet, overweight, little exercise, smoking and lots of stress are bad for our heart. They are some of the risk factors for cardiovascular disease and facilitate atherosclerosis, for example. During this process, deposits form in the arteries, known as plaques. They consist of blood lipids and calcium. The bigger the deposits, the more disturbed the blood flow. If such plaques break open, this poses a great risk because a blood clot (thrombosis) can form very quickly in this location. This can completely block the artery.

Atherosclerosis can affect all arteries in the body, even the coronary vessels. They normally supply the heart with blood and oxygen. If there is no longer enough blood flowing through them, this can result in angina pectoris or even a heart attack. In the worst-case scenario, there is a risk of cardiac arrest. In this case, the person affected must be resuscitated immediately.

In order to ensure that as little of the heart muscle as possible dies off, the blocked location has to be reopened as quickly as possible. To that end, the doctor performs a coronary angioplasty. This involves inserting a plastic tube (known as a catheter) with a tiny balloon on the end into the blocked artery. The balloon is inflated, which causes the narrowed vessel to expand. In severe cases, a bypass operation is performed (which reroutes the blood).

First aid in case of heart attacks

1. Identify the symptoms

The symptoms of heart attacks vary between men and women. Men usually feel a sudden, strong, burning pain in the chest. Cold sweats, pain in the shoulders and arms and shortness of breath also occur frequently. Symptoms in women are often less specific: breathlessness, nausea or complaints in the upper abdomen. Until they reach the menopause, they are better protected against heart disease by their female hormones, but afterwards this protective effect decreases. Many women are unaware of this, which is why they don’t immediately suspect a heart attack if they have the symptoms mentioned above. That is the reason why women die almost twice as often from their first heart attack as men do.

If these symptoms are only weak or are entirely absent, it is called a silent heart attack. It goes unnoticed.

2. Call the emergency number 144

First tell the emergency services where you are located. Then describe exactly what happened. Is the person responsive? Are they breathing? If not, you will receive resuscitation instructions.

3. Immediately start to perform a cardiac massage

Kneel down beside the patient. In this way, your arms will not have to bear the full burden. Put one hand over the other and then place both hands in the centre of the lower half of the patient’s breastbone. Start the cardiac massage. The optimum frequency lies at 100 to 120 repetitions per minute. Press down until you reach a depth of about 5 centimetres. Release all of the pressure from the thorax, so that enough blood flows back to the heart.


  • Laypeople should refrain from performing mouth-to-mouth resuscitation. They lose too much time doing so and don’t achieve enough in the process. The cardiac massage is more important.
  • In case of a child, push down about 1/3 of the thorax using only one hand. In case of newborns, two fingers are enough.

Expert tips on performing a cardiac massage

  • Your own safety is paramount. Don’t put yourself in any danger, otherwise we will end up with two patients.
  • The only thing you can do wrong where a cardiac massage is concerned is not doing anything at all. Don’t be afraid of injuring the person. In 90 per cent of cases, one or more ribs are broken and 70 per cent of cases even result in a broken breastbone. However, these are not life-threatening injuries.
  • Look for people to help you and take it in turns. Tests have shown that people can no longer apply enough pressure after just two minutes. That is one of the four reasons why people stop performing the cardiac massage: because they simply cannot continue. Otherwise, you should only stop performing the cardiac massage if the doctor tells you to or the emergency services take over the resuscitation attempt. In the best-case scenario, you can stop performing the cardiac massage because the person in question starts breathing again themselves.

Alternative: use a defibrillator

Open the defibrillator. Spoken instructions will guide you through the resuscitation process. Stick the electrodes to the thorax and start the analysis by pressing the appropriate button. Deliver a shock if the device tells you to do so.

How to prevent heart attacks

Exercise regularly. Make sure you have a balanced diet. Don’t smoke and monitor your mental health. Avoid stress as much as possible. Further tips on a heart-healthy lifestyle are available here.

Smokers, people with high blood pressure, severe overweight or elevated cholesterol levels are at greater risk. They should therefore undergo regular medical examinations.

Life after a heart attack

After a heart attack, behavioural and lifestyle changes form the basis for all forms of treatment. They reduce the risk of having another heart attack or a different type of cardiovascular disease. Cardiovascular patients build up their strength again by following exercise programmes. Later on, it is about integrating what they have learnt into their daily routine and sticking to it. Quite a few patients also require psychological counselling to process the heart attack.

The Heart Experts

Dr Robert C. Keller, Managing Director of the Swiss Heart Foundation
Dr Robert C. Keller is the Managing Director of the Berne-based Swiss Heart Foundation. He has long-standing experience in the field of cardiovascular disease and heads up the areas of research and prevention at the foundation.

Michael Feuz, Paramedic with College of Higher VET Diploma
Michael Feuz works as a Paramedic with College of Higher VET Diploma at Ambulanz Region Biel AG. The qualified forest ranger retrained as a paramedic at the age of 31. To that end, he completed a three-year training programme.


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