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A hunter, 41, has high blood pressure, borderline diabetes and a stressful job and smokes a half a pack of cigarettes a day. After hiking up a steep hillside with a 25-pound pack and a hunting rifle, he begins to experience a burning sensation in the middle of his chest and throat accompanied by a feeling of nausea. The first thing he should do is:

1.Eat a couple of Tums antacid tablets, and hope that his “indigestion” goes away.
2.Drink a cup of water.
3.Immediately hike back down the hill and seek emergency medical attention.
4.Swallow one aspirin tablet.

If you didn’t choose number 4 (the correct answer), read the rest of this article. The symptoms described above, in an individual who has several major risk factors for heart disease, are most likely due to a heart attack, and taking one aspirin tablet might save that person’s life. Aspirin, a blood thinner as well as an analgesic, can often help restore blood flow to the heart and prevent further blood clots from forming.

Heart attacks are exceedingly common. Every year about 1.5 million Americans have heart attacks and more than half a million people die, making it the leading cause of death in the United States. A heart attack occurs when the blood supply to the heart muscle is reduced or completely blocked due to an obstruction in one or more of the arteries that supply blood to the heart. When the heart muscle is deprived of blood for more than a few hours, it dies.

Who’s At Risk?
Many factors contribute to the risk of a heart attack. They include: a family history of early heart attacks; high cholesterol and triglycerides (LDLs); smoking; high blood pressure or diabetes; and being overweight. Just being a male increases one’s risk of having a heart attack.

If you’re a male over 40 years of age, have at least two of the above risk factors and don’t regularly exercise, you should consider getting your heart checked before you leave for a strenuous trip into the outdoors. A physical exam, blood tests and resting electrocardiogram (EKG) by your family physician, however, isn’t good enough. What you need is an EKG Stress Test, in which your heart and blood pressure are monitored while you exercise to your maximum heart rate on a treadmill. A normal result doesn’t guarantee you won’t have a heart attack in the next six months, but it does reduce the likelihood substantially.

What Are the Symptoms?
How can you tell whether that dull, pressure-like sensation in your chest is heart attack pain or just a sore pectoral muscle from the sternum straps on your backpack? It’s not always easy, and even the best cardiologists can be fooled. The primary symptom of a heart attack is chest pain that is often described as crushing or squeezing in the center of the chest. If the sensation also radiates up into the neck, jaw or shoulders, or down the arms, then the likelihood that the pain is a heart attack increases greatly. Sometimes there is only mild chest pain, or a burning sensation in the lower chest or upper abdomen near the solar plexus, or a feeling of indigestion. Cold sweats, nausea, anxiety and shortness of breath are also often present in a victim of heart attack.

If you experience any of the above symptoms during exercise, the first thing you should do is stop all exertion and see if the symptoms go away. If they do, you may be suffering from angina, a transient shortage of oxygen and other nutrients to the heart muscle. Angina produces heart attack-type pain that comes on with exertion and goes away with rest. It tends to be a progressive disorder and is often a predictor that the individual, if not treated, will suffer a full-blown heart attack in the near future.

What to Do
The first thing you should do if you think you’re having a heart attack is stop all exertion and rest. The second most important treatmennt, as mentioned before, is simply to take one adult aspirin tablet. If you have nitroglycerin tablets or spray, take them as prescribed.

Remain in a comfortable position and let your friends arrange immediate evacuation to a medical facility while you do as little of the work as possible. Do not carry a pack or even your own rifle. If you’re alone, walk slowly back to your car and seek medical attention as soon as possible. Of the half-million Americans who die of heart attacks each year, more than 300,000 die before they get to a hospital because they delayed seeking medical help for several hours after the onset of symptoms.

What About CPR?
Cardiopulmonary resuscitation (CPR) is used only when the victim of a heart attack is unresponsive, with no pulse or respirations (cardiac arrest). Unfortunately, the chest compressions and mouth-to-mouth rescue breathing of CPR can increase a cardiac arrest victim’s chances of survival only if the heart’s electrical system is restored to its normal rhythm by application of an external electrical shock from a defibrillator within 5 to 10 minutes, and in the wilderness, defibrillators are not readily available. Still, CPR should always be attempted on a heart attack victim who suffers a cardiac arrest, since there is a chance, albeit small, that CPR alone may revive the victim.

High Altitude
I am often asked if a history of having had a heart attack, bypass surgery or angina should preclude someone from hiking or trekking in the mountains above 8,000 feet. As you ascend in altitude, barometric pressure decreases, and with it the amount of oxygen available in the atmosphere. Because there’s less oxygen at higher elevations than at sea level, your heart gets relatively fewer oxygen molecules from each breath. This can place an additional strain on a heart that is already compromised by poor circulation.

Although there is no direct evidence that traveling to high altitudes increases the chances of a heart attack, there is some evidence that the incidence of angina increases at elevations above 8,000 feet. Although I do not dissuade my patients from venturing to high altitudes, I do warn them to avoid strenuous exertion, to carry nitroglycerin tablets with them and to descend immediately if any symptoms develop.