Should I take an aspirin if I think I'm having a heart attack?
Ask the doctor
Q. I've heard that if you think you're having a heart attack, you should call 911 and then chew a regular aspirin while waiting for the ambulance to arrive. Is that still considered good advice?
A. Although aspirin may be part of the treatment for a heart attack, the American Heart Association no longer advises people who think they might be having a heart attack to use it on their own.
The main reason? You might not actually be having a heart attack, and aspirin could make things worse. For example, sudden, severe chest pain may result from a tear in the aorta (the large artery that arches out of the heart), causing dangerous bleeding. Aspirin could make this problem worse because it prevents cell fragments (platelets) from clumping together, decreasing the blood's ability to clot.
A stomach ulcer — which can cause pain just above the stomach in the upper abdomen — can also be mistaken for a heart attack. Taking aspirin may cause the ulcer to bleed into the stomach. That's because the drug also inhibits helpful substances called prostaglandins that protect the stomach's delicate lining.
When a person is actually experiencing a heart attack, aspirin's ability to prevent clots may help keep blood flowing freely in the heart's arteries. However, there's no definitive evidence of an added benefit from starting this processes 15 to 30 minutes earlier — that is, if you took aspirin at home rather than waiting for emergency personnel with the ambulance team or at the hospital to give you an aspirin. They will determine whether to do so based on your symptoms, medical history, current medications, and test results.
Taking aspirin at the first sign of a possible stroke also isn't advised for similar reasons. Although most strokes are caused by clots, some are caused by ruptured blood vessels and bleeding. Taking aspirin could potentially make these bleeding strokes more severe.
What if you already take aspirin daily, which is only recommended in specific situations (see "Advice about daily aspirin" in the July 2021 Heart Letter)? Should you take your daily dose? That would be reasonable but probably not necessary. The aspirin you take regularly will last a week in the blood, so there is less of a need to take additional aspirin. However, you may get an extra dose at the hospital if a doctor confirms you've had a heart attack.
The bottom line: If you think you are having a heart attack or stroke, call 911. Do not start aspirin therapy on your own.
Image: © dszc/Getty Images
About the Author
Christopher P. Cannon, MD, Editor in Chief, Harvard Heart Letter; Editorial Advisory Board Member, Harvard Health Publishing
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