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Heart attack and acute coronary syndrome
What is heart attack / ACS?
A heart attack (acute coronary syndrome) happens when the blood supply to part of the heart muscle is suddenly reduced or blocked, usually by a clot in a coronary artery, causing chest pain or discomfort and risk of permanent heart damage. Symptoms can include central chest tightness or heaviness, pain spreading to the arm, neck, jaw or back, shortness of breath, sweating, nausea and a sense of impending doom.
Some people, especially women, people with diabetes and older adults, may have more subtle symptoms such as breathlessness, fatigue, indigestion-like discomfort or pain in the back or jaw rather than dramatic chest pain. Heart attacks are a medical emergency: the priority is to call 999 early and keep the person as calm and still as possible while you monitor for deterioration and prepare for potential cardiac arrest.
Around 1 person every 5 minutes is admitted to hospital with a heart attack in the UK, and rapid access to treatment significantly improves survival and outcomes.
Who needs this skill?
Health & Social Care
In health and social care, staff should be alert to sudden chest pain, unexplained breathlessness or collapse, particularly in people with cardiovascular risk factors, and follow local chest pain/ACS and resuscitation pathways rather than managing symptoms in isolation. Early ECG and treatment decisions rely on timely recognition and escalation, not just on availability of equipment.Licensed venues & nightlife
In nightlife and licensed venues, chest pain or collapse may be misattributed to alcohol or drug use; staff must still consider heart attack and call 999 if someone has chest discomfort, breathlessness, sweating or collapse that does not quickly resolve. CCTV and documentation can be important if timings or care are later scrutinised.Schools
Staff, parents and visitors can all develop chest pain on site; schools that understand heart attack warning signs and have clear procedures are better prepared for incidents at parents' evenings, sports fixtures and community use of facilities.Workplaces
In workplaces, first aiders may be the first to recognise suspicious chest pain in colleagues or visitors; they should know not to dismiss symptoms as 'indigestion' or anxiety and to call 999 promptly when ACS is suspected. Employers should factor heart attack and cardiac arrest risk into first aid needs assessments, especially in older or higher-risk workforces.How to manage heart attack / ACS
- 1Recognise possible heart attack symptomsAsk about chest pain or discomfort, including tightness, heaviness or pressure in the centre of the chest that may spread to the arms, neck, jaw or back, and look for associated sweating, shortness of breath, nausea or a feeling of severe anxiety.Treat unexplained, persistent chest discomfort in adults as heart attack until proven otherwise, especially if they have risk factors such as age, smoking, diabetes or previous heart disease.
- 2Call 999 immediatelyIf you suspect a heart attack, call 999 or 112 straight away and tell the call-handler you think it is a heart attack, following any advice given; do not drive the casualty to hospital yourself.Early activation of emergency services is more important than reaching a perfect diagnosis; time lost before calling cannot be regained later.
- 3Help them to rest and loosen tight clothingHelp the person to sit in a comfortable position, often half-sitting with support for the head and knees bent, and loosen tight clothing around the neck and chest while you wait for the ambulance.Offer calm reassurance and discourage unnecessary movement, as this reduces strain on the heart and anxiety.
- 4Consider aspirin if appropriate and within trainingIf local guidance allows and the casualty is 16 or over, not allergic to aspirin, not on anticoagulation where aspirin is contraindicated and has no history of serious aspirin-related problems, support them to chew one 300 mg aspirin tablet while waiting for help.Only give medicines within your training and organisational policies; when in doubt, prioritise calling 999 and monitoring rather than improvising drug treatment.
- 5Monitor and be ready for cardiac arrestStay with the casualty, monitor breathing and responsiveness and be prepared to start CPR and use an AED if they become unresponsive and stop breathing normally.Pass on clear information about symptom onset, pattern and any medications taken to the ambulance crew using a structured handover.
This guide is a learning reference only. It does not replace attended, assessed first aid training.
Qualifying courses
Common questions
Practical answers for employers, venue managers, and healthcare teams about heart attack / ACS training.
Can't find your answer? Contact us.
A heart attack is a circulation problem where a blocked artery reduces blood flow to part of the heart muscle; the person is usually conscious and breathing but unwell. Cardiac arrest is an electrical problem where the heart suddenly stops pumping effectively, causing loss of consciousness and absence of normal breathing, which requires immediate CPR and defibrillation.
No; persistent or recurrent chest pain or discomfort that you suspect might be a heart attack should be treated as an emergency and 999 called immediately rather than waiting to see if it settles. It is safer to be told by professionals that it was not a heart attack than to delay and lose the chance for early treatment.
Aspirin can reduce clot progression in many heart attacks, but it is not appropriate for everyone, for example people with certain allergies, bleeding disorders or specific medication regimens. Follow your training and organisational protocol: when in doubt, call 999 and explain the situation rather than guessing.