Heart Attack and Angina

If this suddenly happens

• Severe pain in the middle of the chest — like being squeezed, crushed, or torn
• The pain lasts more than 30 minutes — it does not ease even when you rest
• The pain spreads to the back, shoulder, arm, neck, or jaw
• You break into a cold sweat and feel like you are dying
• You are short of breath, feel sick, and want to vomit
• You suddenly lose consciousness

If even one of these is true

# Call 119 right away

The National Emergency Medical Center advises: **"Ask 119 for help as soon as you find the person.
When you call, ask for an automated external defibrillator to come too."**

Until 119 arrives

• Let the person stay in the position that is most comfortable for them
• If they have their own prescribed nitroglycerin, they may take it
• If there is no breathing and no pulse, start CPR (cardiopulmonary resuscitation). The 119 crew will tell you how to do it over the phone

Please do not do this

• ❌ "It feels like indigestion, it will pass in a while" — this is the most common reason people lose time
• ❌ Giving someone else's nitroglycerin — the National Emergency Medical Center advises that "the medicine must be the patient's own medicine"
• ❌ Driving there yourself — the heart can stop on the way. Ambulances carry a defibrillator
• ❌ Pricking the fingers or patting the back — this does nothing and only takes time
• ❌ Giving water or indigestion medicine

Why time matters

Asan Medical Center gives this guidance.

• Treatment within 2 hours means no damage to the heart muscle
• Within 12 hours means no major complications
• If the person can be taken within 2 to 3 hours to a hospital that can place a stent, the outcome is better than with medicine alone

And with acute myocardial infarction (a heart attack), 1/3 of people die before reaching hospital.
"Waiting it out" is the most dangerous choice.

Remember the time the symptoms started.
It is used to decide the treatment.

The same root, a different urgency

Both are problems in the blood vessels that carry blood to the heart (the coronary arteries).
Seoul National University Bundang Hospital separates them like this.

• Angina — a chronic disease in which the vessel narrows slowly
• Myocardial infarction (a heart attack) — an acute disease in which a blood clot blocks the vessel suddenly. It is life-threatening

Asan Medical Center describes acute myocardial infarction as
a disease in which "a coronary artery is suddenly blocked completely and the heart muscle dies".
The longer the vessel stays blocked, the more heart muscle dies. It does not come back.

Telling them apart by the pain

| | Angina | Heart attack |
|---|---|---|
| When | Mostly when you move | Even while resting |
| How long | 5–10 minutes | More than 30 minutes |
| Nitroglycerin | Eases within 1–2 minutes | Does not ease |
| Feeling | Tight, heavy, pressing | Tearing, like dying, cold sweat |

If you have taken nitroglycerin and the pain does not ease, you should suspect a heart attack.
Do not wait. Call 119.

Angina can be an emergency too

Seoul National University Bundang Hospital divides angina into three types.

• Stable angina — it hurts when you exercise, and rest usually clears it within 5 minutes
• Unstable angina — pain that used to come only with exercise suddenly gets worse, and comes with light activity or even at rest → this is an emergency
• Variant angina — it is unusually common in Korean and Japanese people. It mostly appears in smokers in the early morning

If "the chest pain I have always had now comes more often and more easily",
that alone is a reason to see a doctor.

Can I know in advance

Asan Medical Center advises that "more than 50% of people with myocardial infarction have no symptoms beforehand".

That means more than half get no warning.
So instead of waiting for symptoms, managing your risk factors is what matters.

Risk factors

• High blood pressure
• Diabetes
• Hyperlipidaemia (high cholesterol)
• Smoking
• Obesity, lack of exercise
• Family history, older age

If you have symptoms right now — do not pick a department

Call 119.
If chest pain lasts more than 30 minutes or you break into a cold sweat, it is an emergency.
119 will take you to a hospital that can place a stent.

If the symptoms have passed, or you want tests and follow-up

• Cardiology (순환기내과 / 심장내과) — the main department for diagnosis, medicines, and stent procedures
• Cardiothoracic surgery (흉부외과 / 심장혈관흉부외과) — when surgery such as a coronary artery bypass is needed
• Rehabilitation medicine (재활의학과) — when cardiac rehabilitation is needed
• Internal medicine / family medicine (내과 / 가정의학과) — for managing blood pressure, diabetes, and cholesterol

Some local clinics also carry a cardiology (순환기내과) sign.
If your chest just feels tight or you get short of breath on stairs, you can start there.

Do I need to go to a big hospital

Not every hospital can do a stent procedure to open a blocked vessel.
It needs the equipment and staff on hand 24 hours a day.

A 'cardiovascular center' or a hospital that can do heart procedures 24 hours a day —
it helps to find out in advance where the nearest one is.
If someone in your family has several risk factors, please do check.

Once you are stable after the procedure, you can carry on with prescriptions and follow-up at a hospital that is easy for you to reach.
After the acute stage it does not have to be a big hospital.

If you go to the outpatient clinic of a tertiary hospital, you need a referral letter (진료의뢰서) for national health insurance (건강보험) to apply.
(This does not apply when you are brought into the emergency room.)

You can look for local clinics and large hospitals together on the map.

When you arrive at the emergency room

• Electrocardiogram (ECG, a heart tracing) — Asan Medical Center explains that "it can be diagnosed as soon as you arrive at the emergency room". Electrodes are placed on your chest and it is over in a few minutes.
• Blood test — this checks for the substances released when heart muscle is damaged (cardiac enzymes).
• Coronary angiography — a thin tube is passed through a vessel in the wrist or the groin, and dye is released so the doctor can see directly which vessel is blocked. In many cases treatment (a stent) follows on the spot, right after it is confirmed.

Tests when it is not an emergency

This is for people who come to the outpatient clinic because the chest feels tight or they are short of breath.

• Electrocardiogram — the basic test
• Exercise stress test — you walk on a treadmill while the ECG is watched. It catches angina that only appears when you move
• Heart ultrasound (echocardiography) — this shows whether the heart moves well and whether the valves have a problem
• Coronary CT — this shows whether any vessel has narrowed
• Blood test — this checks risk factors such as cholesterol and blood sugar

When you go to hospital for chest pain,
it helps to write down when it hurt, in what situation, and for how long.
With angina, the ECG can look normal if you have no symptoms at the time of the test.
Then what you tell the doctor becomes an important clue.

Opening the blocked vessel is the key

• Coronary angioplasty (stent placement) — Asan Medical Center describes this as "the surest method". A balloon or a metal mesh (a stent) widens the narrowed or blocked vessel. It is done through a vessel in the wrist or the groin, and the chest is not opened.
• Thrombolytics — medicine that dissolves the clot. Asan Medical Center advises that it is used in limited cases, when the procedure is not possible.
• Coronary artery bypass surgery — surgery that builds a new path in place of the blocked vessel. It is done when several places are blocked or when the procedure is difficult.

Medicines

Seoul National University Bundang Hospital explains that medicines
"not only improve symptoms but also play an important role in preventing dangerous complications such as a heart attack".

Even if you have had the procedure, you keep taking the medicines.

Is a stent the end of it

No. This is the most important misunderstanding.

A stent opens the blocked spot. It does not make the vessel young again.
Another place can become blocked, and the inside of the stent can narrow again.

So after the procedure

• you must take antiplatelet medicine (medicine that keeps blood from clumping) for the set period, and
• you must keep managing your blood pressure, diabetes, and cholesterol

Stopping antiplatelet medicine on your own is dangerous, because a clot can form inside the stent.
When you have a procedure or a tooth taken out at another hospital,
be sure to say that you are taking this medicine.

It differs by hospital and by the person's condition, but the flow is usually like this.

The acute stage

1. An ECG is taken as soon as you arrive at the emergency room.
2. If it looks like an acute heart attack, coronary angiography is done straight away, and in many cases a stent procedure follows on the spot.
3. For a few days after the procedure, your heart rhythm and condition are watched closely.
4. Once you are stable, further tests follow to check the cause and the risk factors.

After you go home

• You come back to the outpatient clinic at the set times so your condition can be checked
• You must keep taking your medicines for the whole period you were told
• Some hospitals offer a cardiac rehabilitation program. It teaches you how much exercise you can safely do, so it is good to take part if you can

What the family should know

• Tell the medical staff the time the symptoms started
• Bring a list of the medicines the person usually takes
• After the procedure, there is a period when the wrist or groin site has to be pressed
• After going home, if the chest pain comes back, do not put up with it — contact the hospital right away

What to do if it hurts again

When you are discharged, be sure to ask the hospital
"which symptoms mean I should come back straight away".
If you know that line, you will not hesitate next time.

The length of the stay and the recovery differ by hospital and by person.
Ask the hospital treating you for the exact details.

With a heart attack, the best treatment is to stop it before it comes.
More than half of patients get it with no warning symptoms.

Here is the prevention advice from Seoul National University Bundang Hospital.

• Stop smoking — this is the surest single step. Variant angina in particular is common in smokers
• Drink less — no more than one or two glasses a day
• Keep a healthy weight
• Have your blood pressure, blood sugar, and cholesterol checked regularly
• Eat a low-salt diet
• Exercise steadily for at least 30 minutes a day

For those already diagnosed

• Keep taking your medicines even when you have no symptoms, especially the antiplatelet medicine
• Ask your doctor for your target blood pressure, blood sugar, and cholesterol, and remember them as numbers
• If the chest pain changes from before (more often, more easily, for longer), go to hospital right away

What the family can prepare

• Learn CPR (cardiopulmonary resuscitation) once. Public health centers and fire stations run free classes
• Find out where the automated external defibrillators (AED) near your home and workplace are
• Check which hospital nearby can do heart procedures 24 hours a day

With acute myocardial infarction, 1/3 of people die before reaching hospital.
What the person next to you knows changes the outcome.
Please show this page to your family once.

The special cost-sharing program (산정특례)

Depending on the conditions, heart disease can qualify for the special cost-sharing program for serious illness.
But unlike cancer, the conditions and the period are set differently.

Check the exact conditions and period with the hospital administration office
or with the National Health Insurance Service.
If you are in hospital, asking there is the fastest way.

Things to know

• Insurance cover can differ by the type of stent. You will get an explanation before the procedure.
• Cardiac rehabilitation programs also have a set range that insurance covers.
• Costs are structured differently when you come in through the emergency room and when you book an outpatient visit.

Also

• There are medical cost support schemes based on income.
• If the hospital has a social work team (사회사업팀), ask for a consultation. They will help you find support schemes.

Programmes and out-of-pocket rates change.
What follows is a summary as of the reference date, so please always
check the latest rules with the National Health Insurance Service.