If you were traveling and were to have a heart attack, would you know what to do? What if your traveling companion or someone on the plane were to have a heart attack on the flight, could you help them? In previous columns, I discussed heart disease in women and pre-trip travel planning for people with a history of heart problems. This month, I will focus on what you should do if you or someone else experiences a heart attack while traveling.

Despite immense medical progress in the last three decades, heart disease remains a major health problem in both industrialized and developing nations. About 1.5 million Americans suffer a heart attack each year (that’s one heart attack every 20 seconds). While many people die before getting medical attention, 90 to 95 percent of heart attack victims who reach a hospital in time for treatment survive.

The good news is that the availability of automated external defibrillators is becoming more common in public places — including in airports and on planes. The devices, which can be used by untrained bystanders, have been proven to significantly increase the chance of survival during a heart attack. AEDs analyze the cardiac rhythm and determine whether there is a life-threatening arrhythmia that is “shockable.”

Even if an AED is not available, bystanders can take part in the chain of survival by performing CPR on the heart attack victim until help arrives. The CPR ratio for adults (revised in November 2005) is 30 compressions to every two ventilations (mouth-tomouth resuscitation).

Heart attack symptoms vary. One person may experience only minor chest pain while another will endure crushing chest pain. A heart attack causes chest pain because arteries that supply blood to the heart become narrowed or blocked. A temporary blockage may last only a few minutes, but a full heart attack lasts more than 30 minutes and causes heart damage. Not all heart attacks are obvious; most begin with subtle symptoms such as mild pain or discomfort which may come and go.

Do not downplay your symptoms or brush them off as indigestion or anxiety. Five minutes is the limit to wait before seeking medical care. With each passing minute, more heart tissue is deprived of oxygen and sustains permanent damage or dies. It’s crucial to restore blood flow within the first hour, when most damage occurs. We have a saying in cardiac care that “time is muscle.” Recognizing the symptoms of a heart attack and seeking immediate medical attention may mean the difference between life and death. Immediate death may be avoided if CPR is initiated within four minutes of the cardiac arrest. Survival depends on quick action.

In the United States, call 911 if you or a traveling companion shows signs of a heart attack. Chew an aspirin to accelerate anti-platelet clotting properties while waiting for the ambulance to respond. (When medical help arrives, be sure to tell them that you have consumed an aspirin.) If a heart attack occurs on a plane, medical personnel traveling on the plane may assist the victim. Flight attendants will know where to find the onboard first-aid kit which contains basic cardiac drugs and oxygen. Many planes are now equipped with AEDs. Pilots are required to divert the flight to the nearest airport if a passenger exhibits signs of having a heart attack. As soon as emergency personnel arrive, they will assess the situation quickly and transport the victim. They may record an electrocardiogram. At the hospital, doctors will work quickly to restore blood flow to the heart and will monitor vital signs to detect and treat complications that may arise.

If you are traveling abroad and experience symptoms of a heart attack, check your hotel concierge regarding the availability of emergency medical assistance. The U.S. Embassy may also be able to provide emergency assistance information. Long-term treatment after a heart attack may include cardiac rehabilitation and lifestyle changes. Ask your doctor when you can return to normal activity including air travel.

Heart attacks are survivable. Many people who experience a heart attack return to fully functioning daily lives. The key to survival is to know, in advance, how to respond. For information, visit http://www.americanheart.org