Spotting a stroke or a heart attack in the first ten minutes

Call 911 before you're sure. That's the whole skill in one sentence, and almost everybody gets it backward. People stand in a kitchen for forty minutes running a debate about whether it's indigestion, and the debate is the thing that kills them.

Brain tissue dies by the minute during a stroke. Heart muscle dies by the minute during a heart attack. Neither one waits for you to reach a verdict. So learn the signs well enough to act on a hunch, and let the paramedics do the deciding.

A Saturday morning, a man in his fifties pushing a mower. He stops halfway across the lawn, leans on the handle, and says it's just the heat. He's sweating more than the job deserves, and he's a little gray. That's the moment. Not twenty minutes later when he's on the porch steps saying he feels better.

The ten-second stroke check: BE FAST

You can run this from across a room, and you can run it on yourself in a mirror.

• Balance. Sudden loss of coordination, staggering, a hard time standing up out of a chair they've used for years.
• Eyes. Sudden vision loss in one eye, double vision, a chunk of the visual field just gone.
• Face. Ask them to smile big. One side doesn't come along for the ride.
• Arms. Ask them to hold both arms straight out, palms up, eyes closed, for ten seconds. Watch for one arm drifting down or rotating inward.
• Speech. Ask them to repeat a specific sentence. "The sky is blue in Cincinnati." Slurred, garbled, or the wrong words entirely.
• Time. Call 911. Then write down the time.

One sign is enough. You don't need the full set, and the person having the stroke is frequently the last one in the room to believe it. That's not stubbornness. Strokes can knock out the part of the brain that notices something's wrong.

Sudden, worst-ever headache with no explanation belongs on this list too. So does sudden numbness down one side of the body.

The phrase that changes their treatment

When the dispatcher asks, give them this: last known well. Not when you noticed. The last moment somebody can swear the person was completely normal.

If he woke up like this at 6 a.m. but went to bed fine at 10 p.m., last known well is 10 p.m., not 6 a.m. That single detail decides which treatments are on the table when he rolls through the doors.

The American Heart Association's guidance puts the window for IV clot-busting medication at 4.5 hours from last known well for eligible patients, with mechanical clot removal available further out in selected cases. Which means the difference between calling at minute six and calling at minute ninety isn't a small thing. It's often the difference between a man who goes back to work and a man who learns to use a fork with his left hand.

Write the time on your hand in pen if you have to. In the noise of an emergency, people's memory for clock time is garbage.

The heart attack signs people talk themselves out of

Chest pressure, yes. Squeezing, heaviness, a weight sitting on the sternum, discomfort that lasts more than a few minutes or goes away and comes back.

But a lot of heart attacks don't announce themselves that way at all:

• Pain in the jaw, the neck, the upper back, one or both arms
• Shortness of breath with no exertion to explain it
• A cold, drenching sweat that feels wrong
• Nausea or vomiting
• Sudden lightheadedness or a sense of doom the person can't explain
• Indigestion that antacids don't touch

Women more often get the second list without the crushing chest pain. So do people with diabetes, who can have nerve damage that dulls the signal. If your wife says she feels like she's coming down with the flu and she's clammy and short of breath, don't hand her a blanket and go back to the game.

What to actually do, in order

1. Call 911 on speakerphone. Not the doctor's after-hours line. Not your daughter in Denver. Free your hands and stay on the line.

2. Note the time. Say it out loud so somebody else hears it.

3. Unlock the front door, turn on the porch light, shut the dog in a bedroom. Sounds trivial. Paramedics lose real minutes to locked storm doors and a friendly retriever.

4. Position them. Heart attack: sit them down, half-reclined, back supported, collar loosened. Standing up and walking around makes the heart work harder. Stroke: if they're drowsy, drooling, or vomiting, get them on their side. Give them nothing to eat or drink, not even a sip of water. Stroke often wrecks swallowing, and water goes into the lungs.

5. Stay put. Don't drive them. An ambulance runs an EKG in your driveway and transmits it ahead, so the cath lab team is scrubbing in before you'd have found parking. And if the heart stops in your passenger seat on the interstate, you have no options at all.

6. Gather the paperwork while you wait. Medication list or the actual pill bottles in a grocery bag, known allergies, blood thinners, past cardiac history, ID and insurance card.

Aspirin, nitroglycerin, and the line you don't cross

Dispatchers often instruct a caller to have a suspected heart attack patient chew a regular-strength aspirin. Chew it, don't swallow it whole, because chewing gets it into the blood faster. Let the dispatcher make that call, not you. Not if the person is allergic, not if they're bleeding, and never on a suspected stroke, because some strokes are bleeds and aspirin pours fuel on them.

Nitroglycerin is the same principle. If it's their own prescription and the dispatcher says go, go. You don't hand out somebody else's pills.

If they become unresponsive and aren't breathing normally, start chest compressions and send someone for an AED. Hard and fast in the center of the chest, and don't stop until help takes over.

Two honest caveats

Most chest pain isn't a heart attack. You will, at some point, call an ambulance for heartburn and feel foolish in a waiting room at 2 a.m. Every ER doctor in the country would rather see you for that than see you three hours late for the real thing.

And yes, the ambulance bill is real money. That's a genuine cost, and pretending otherwise is insulting. Weigh it against permanent paralysis on one side of the body and the math stops being close.

One more: if stroke symptoms disappear after a few minutes, that's a TIA, and it's not good news. It's a warning shot, and the risk of a full stroke in the days that follow is high. Go anyway. Same day.

Talk to your own doctor about your risk, your blood pressure numbers, and whether you should keep aspirin in the house. That conversation costs you twenty minutes on a Tuesday.

Teach the arm-drift test to your kids tonight at dinner. Nine seconds, and it makes them useful in the worst ten minutes of somebody's life.