"Usually people who come in on their own don’t think there’s anything wrong," says Kay Downey, a registered nurse with 18 years experience in emergency medicine. "They’re in denial. They think it’s heartburn or indigestion. They’ve waited sometimes an hour before coming in. It’s not a smart thing to do."

Emergency Department personnel have to get information fast. As they hook up the technology that will supply certain facts, they pepper the patient with questions: What about your mama and daddy? Do you have heart trouble? What about your brothers and sisters? Do you smoke? How long have you had this pain? When did you first notice it? What was it like? Did it seem to get worse as time went on?"

"In anticipating a heart attack," Kay says, "we’re looking for patients to say things like: ‘My chest feels tight...I feel like I can’t breathe...It feels like an elephant is sitting on my chest...I’m short of breath...My jaw, arm and neck hurt.’

"They’re sweaty, nauseous, and may have vomited. But the people who say that the pain feels like a sharp knife, or it hurts when I breathe and when I move, usually they’re not having a heart attack; they’re having a severe pain brought on by a muscle strain or an ulcer. Nevertheless, we take all of this seriously."

When patients who present with chest pains do not appear to have had a heart attack but remain in discomfort, they are placed in an observation room for 24-hour monitoring. Further decisions about their care are made by their cardiologists.

Like all heart care professionals, Kay worries that too many people lose their lives to heart attacks due to delay in seeking help. "Men, especially, often react in a macho way, ‘Aw, there’s nothing wrong with me.’ But the sooner one gets to the Emergency Department, the more muscle we can save. Time is muscle. And once muscle is severely damaged, it’s gone."