Stroke and Heart Attack: Recognising Them Fast, Because Time Is Tissue
Stroke and heart attack treatments are extraordinarily effective within a narrow window and much less so afterwards. In both conditions, the biggest determinant of outcome is not the hospital’s capability but how long the person waited before calling.
Stroke: FAST
F for Face. Ask them to smile. Has one side drooped?
A for Arms. Ask them to raise both arms and hold them up. Does one drift downward?
S for Speech. Is it slurred, garbled, or are they struggling to find words or understand you?
T for Time. If any of these are present, call emergency services immediately and note the time symptoms started.
That last point is not a formality. Clot-busting treatment is time-limited, and the first question the hospital will ask is when the person was last seen completely normal. If they woke with symptoms, the relevant time is when they went to sleep.
Stroke signs beyond FAST
FAST covers most but not all strokes. Also treat as emergencies:
- Sudden numbness or weakness of face, arm or leg, especially on one side
- Sudden confusion or difficulty understanding
- Sudden visual loss in one or both eyes, or double vision
- Sudden severe dizziness, loss of balance or coordination, difficulty walking
- Sudden severe headache with no known cause, often described as the worst ever, which can indicate bleeding
Posterior circulation strokes, affecting the back of the brain, commonly present with dizziness, imbalance and visual disturbance rather than face and arm weakness, and are missed more often as a result.
Transient ischaemic attack
Stroke symptoms that resolve completely, often within minutes. People feel reassured and go back to what they were doing.
A TIA is a warning of high short-term stroke risk, with much of that risk concentrated in the first days. It requires urgent assessment, not a routine appointment. Treatment started promptly after a TIA substantially reduces the chance of a stroke following.
What to do for suspected stroke
- Call emergency services immediately. Do not drive them yourself; ambulance services pre-alert the stroke unit and begin assessment en route
- Note the time symptoms began, or when the person was last normal
- Keep them comfortable, lying with head slightly elevated
- Nothing to eat or drink. Swallowing is frequently impaired and aspiration is a real risk
- Do not give aspirin. Unlike heart attack, stroke may be caused by bleeding, and aspirin would worsen it. The scan decides
- Stay with them and monitor breathing
- Gather their medication list if possible, especially anticoagulants
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Heart attack
Typical pattern: central chest pressure, tightness or heaviness, lasting more than a few minutes, possibly radiating to the left arm, both arms, jaw, neck or back, with sweating, nausea, breathlessness, or light-headedness.
Atypical presentations, which are more common in women, people with diabetes and older adults: breathlessness without chest pain, unusual fatigue for days beforehand, nausea and vomiting, indigestion-like discomfort, jaw or back pain, or simply feeling profoundly unwell.
What to do for suspected heart attack
- Stop all activity and sit down, leaning against something
- Call emergency services. Do not drive
- Chew 300 mg of plain aspirin, unless allergic or told not to take it. Chewing is faster than swallowing
- Take prescribed GTN if they have it
- Unlock the door
- If they become unresponsive and are not breathing normally, start CPR and send for a defibrillator
Why people wait, and why they should not
The commonest reasons for delay are hoping it will pass, not wanting to cause a fuss, attributing symptoms to indigestion or tiredness, and deciding to see how things are in the morning.
The arithmetic is unforgiving. In stroke, an estimated 1.9 million neurons are lost every minute of untreated large-vessel occlusion. In heart attack, heart muscle dies progressively from the moment the artery blocks, and the restoration of flow works far better in the first hour or two.
Being assessed and sent home is a good outcome that costs an evening. Waiting and being right costs function that does not come back.
Reducing the risk of both
Stroke and heart attack share most of their risk factors, so the same actions reduce both:
- Blood pressure control, the largest single modifiable factor for stroke
- Stopping smoking
- Atrial fibrillation detection and treatment. AF multiplies stroke risk several-fold and is often silent. An irregular pulse found on self-checking or a wearable is worth having confirmed, because anticoagulation prevents a large proportion of these strokes
- Cholesterol management proportionate to overall risk
- Diabetes control
- Physical activity
- Limiting alcohol
- Weight management
- Treating sleep apnoea
Checking your own pulse
Feel the radial pulse at the wrist for 30 seconds. A regularly irregular pattern can be normal variation; a completely irregular, unpredictable rhythm may be atrial fibrillation and is worth an ECG. It is a 30-second check with a meaningful payoff.
The short version
Face, arms, speech, time. Any one of them means calling an ambulance immediately and noting when symptoms started. For chest pressure with sweating or breathlessness, sit down, call, and chew aspirin. Do not drive, do not wait for morning, and do not give aspirin for a suspected stroke. The delay is almost always the patient deciding to wait, and it is the part that is entirely within your control.