A while ago I read an article entitled “Don’t let yourself regret your life in front of a heart attack”. The old father in the article has a history of heart disease, sudden onset of myocardial infarction symptoms, after the advice of friends, go out to buy drugs, and move around a lot, but still very happy for the old man was finally saved. The author writes down many lesson tips in the article, and his fist heart leaps off the page. I agree with many of the author’s ideas, but the most basic and important ones are not addressed. In the face of a myocardial infarction, time is life and time is the survival of the heart muscle. There is no such thing as 6 hours or 12 hours of prime time for a heart attack. Every minute wasted in an infarction is a minute of myocardial necrosis and increases the occurrence of complications. Many of our friends have this practice of self-diagnosing and self-treating when they have a condition, and many times it is bad. The most important lesson is that once a heart attack is considered, the first thing to do is to call 120 and go to the nearest hospital with a cardiac catheterization laboratory as soon as possible. The question is, how do we know it’s a heart attack? As cardiologists, chest pain is the most common complaint we see in patients. Doctors can quickly gain insight into the cause of chest pain through a detailed history taking and physical examination. Chest pain can be a manifestation of many conditions, such as the heartburn of acid reflux, which is often related to diet and body position and can be effective with acid palliatives. For example, the dull pain of thoracic costochondritis, which has pressure points in the chest wall and can be exacerbated by moving the limb. The sharp pain of pleurisy, for example, is associated with breathing and is often accompanied by some symptoms of upper respiratory tract infection. There are many other disease etiologies not to be cited. When we are faced with a patient’s complaint of chest pain, the last thing we physicians want to miss is the manifestation of cardiac ischemia, i.e. angina pectoris. Neglecting the diagnosis and treatment of angina can endanger the life and health of the patient. So, what is angina pectoris? The heart is a blood pumping machine and a muscular organ. There are multiple blood vessels on the surface of the heart that are responsible for carrying blood and nutrients to make the heart work properly. Due to a combination of many pathogenic factors, cholesterol deposits form plaques on the endothelial surface of the heart’s blood vessels and gradually lead to narrowing of the vessels’ chambers, which is called coronary artery disease. The symptom of coronary artery disease is angina pectoris. The sensation of angina is not pain as we often say, but a feeling of stuffiness (pain) and pressure (pain), accompanied by difficulty in breathing and the feeling of an elephant stepping on one’s chest. The location of this sensation is in the precordial region, which is the center and left side of the chest, and often involves the jaw and left forearm. Some patients come to the doctor with a toothache and see the dentist without problems, but when they go to the cardiology department, it is coronary heart disease. Angina pectoris mostly occurs during activities, such as walking and running, or when emotionally excited, after stopping the above activities, the angina pectoris will slowly ease, usually lasting 3-5 minutes. We commonly see patients who think their activities are fine, but in the past month, they have been walking up and down the stairs with chest tightness and breathlessness, which is typical of angina, and then they have coronary heart disease. What we mentioned is a very characteristic manifestation of angina, each person will have some different expressions in the occurrence of angina, the elderly, women already diabetic patients often have atypical symptoms, but the relationship between performance and activity remains the same. Why is angina related to activity? As mentioned above, coronary artery disease is a narrowing and blockage of blood vessels in the heart. In resting conditions, the heart beats slowly, the heart muscle needs less blood nutrients and there are no symptoms. However, due to the narrowing of blood vessels, blood cannot be delivered smoothly and the myocardium does not receive blood and is in a state of ischemia, and the symptom of myocardial ischemia is angina pectoris. Therefore, in the differential diagnosis of chest pain, doctors often do a plate stress test, allowing the patient to reach a certain amount of exercise and heart rate elevation, to observe the patient’s angina symptoms and electrocardiogram changes, etc., so that they can diagnose coronary heart disease. When angina occurs, we often instruct the patient to take nitroglycerin under the tongue. Nitroglycerin is a vasodilator that widens the narrowed blood vessels and allows blood to flow smoothly, usually for 1-5 minutes to relieve symptoms. Important note: When feeling symptoms of angina or unexplained chest pain, always go to the hospital doctor for examination. Nitroglycerin is an emergency need, not a commonly used drug. Doctors give appropriate medication for coronary heart disease when the diagnosis is clear. What is a myocardial infarction? A myocardial infarction is an emergency situation in which a section of myocardial blood vessel is suddenly and completely blocked, resulting in myocardial necrosis downstream of the vessel. The painful symptoms of myocardial infarction are similar to those of angina pectoris, a dull feeling in the precordial region and dyspnea. If the area of myocardial infarction is large, heart failure may appear, such as shortness of breath, drop in blood pressure, dizziness, cold sweat, etc. The difference between heart attack and angina is that the symptoms persist without relief due to complete blockage of blood vessels. Another point of differentiation is that myocardial infarction is ineffective with nitroglycerin. Our advice is to take nitroglycerin once under the tongue at the onset of angina symptoms, and after 5 minutes of no improvement, immediately chew 325 mg of aspirin and call 120 for emergency care to get to the nearest hospital with a cardiac catheterization laboratory for the fastest possible treatment. Of course, if you don’t have any medication on hand, there is no need to waste time and call 120 directly for treatment. The management of myocardial infarction is a race against time. It takes the least amount of time to open the occluded heart vessels to save the heart muscle from complications. The routine is emergency coronary endovascular stent placement. At present, all major cities in China have opened green channels for heart attack, and there are corresponding standardized operations from 120 ambulance to emergency room to cardiac catheterization laboratory. The previous medical guidelines required that the time from the patient entering the emergency room to the opening of the obstruction by the endovascular balloon be less than 90 minutes, but the current requirement is less than 60 minutes, and there is a higher requirement that the time from the onset of chest pain to the opening of the obstruction by the endovascular balloon be less than 90 minutes. Regardless of which specification is for every second, for the safety of the patient, for the best interest of the patient.