Dangerous Delay

The victim feels nauseated; his skin becomes clammy. It is difficult for him to breathe. Intense pain may start in his chest and radiate down into his left arm; his heart may begin to beat irregularly. Most people know that these are some of the classic symptoms of a heart attack. But many of them do not know that there is only one proper course of action if they are suddenly stricken with these symptoms: call the doctor.

That is the gist of a report in the Archives of Internal Medicine by three researchers--Drs. Arthur Simon of Duke University and Manning Feinleib of the National Heart and Lung Institute and Sociologist Angelo Alonzo of DePauw University. They base their conclusion on a year-long study of admissions to a single hospital in a suburb of Washington, D.C. During that period, 382 patients were brought to the hospital after complaining of symptoms of acute coronary disease; 138 of them were dead on arrival. By interviewing the surviving patients as well as the families of those who died, the researchers determined how the victims had responded to the first signs of their heart attacks.

Self-Treatment. Nearly 90% of the patients reacted to their heart attacks by immediately changing their physical activity. Many of them sensibly reduced their activity and lay down. But nearly half increased their physical exertions, some by pacing the floor, others by actually engaging in isometric exercises or even jogging, stupidly hoping that they could work the pain out of their systems.

The patients also placed great reliance on self-treatment. Three out of four took prescription drugs or household remedies prior to their arrival at the hospital. Many of them incorrectly diagnosed their problem as indigestion; they took antacids and emetics in an apparent attempt to purge themselves of the source of the pain. In fact, of those patients who died before reaching the hospital, three were found in their bathrooms, two of them on the toilet. Some patients, believing that they were about to die, put off calling the doctor while they tended to social or family arrangements, canceling appointments, tidying up or putting insurance papers in order. In several of the cases, say the researchers, it was that very delay that doomed the victims.

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