Recognising a heart attack and a stroke
With a heart attack or stroke every minute counts. Warning signs of a heart attack are persistent pain, pressure or tightness in the chest, often spreading to the arm, neck, jaw, back or upper abdomen, together with breathlessness, nausea or cold sweat. A stroke is recognised with the FAST test: Face (is one corner of the mouth drooping?), Arms (does one arm drift down?), Speech (slurred, hard to understand?), Time (call at once). Call the emergency number at once (112 in the EU), reassure the person, do not leave them alone. If unconscious without normal breathing: resuscitation and AED. This text does not replace a first-aid course.
- Immediately; care until help arrives
Explained simply
The heart and the brain constantly need blood with oxygen. In a heart attack a blood vessel on the heart becomes blocked; in a stroke, usually one in the brain. Then every minute counts.
A heart attack often shows with severe pain, pressure or tightness in the chest that can spread to the arm, neck, jaw or back. You recognise a stroke with the FAST test: Face – does one corner of the mouth droop when smiling? Arms – does an outstretched arm drift down? Speech – does the speech sound slurred? Time – call at once!
If you suspect it, you call the emergency number at once (112 in the EU, in Austria also 144), reassure the person and stay with them. If they become unconscious and are not breathing normally, you start resuscitation and someone fetches an AED. This text does not replace a first-aid course.
How it works
In a heart attack a coronary artery becomes blocked, usually by a blood clot. The part of the heart muscle behind it receives no oxygen and starts to die. In addition, the heart can lose its rhythm and suddenly stop.
In a stroke a part of the brain no longer receives blood – usually because of a blocked vessel, less often because of bleeding. Depending on which part is affected, the face, an arm, a leg, speech, vision or balance suddenly fail. In both cases: hospital treatment helps the more, the earlier it starts.
What really matters
Do not wait. Many people affected play down their symptoms – "it'll pass". Even if stroke signs disappear after a short time, it is an emergency. Note the time it started; this is very important for stroke treatment.
If a heart attack is suspected, let the person sit or half-lie with the upper body raised and avoid any exertion. If a stroke is suspected, position the upper body slightly raised and give nothing to eat or drink, because swallowing may be impaired. Do not drive to hospital yourself – the ambulance crew can start treatment on the way.
Safety and limits
In women, older people and people with diabetes a heart attack often shows differently: with breathlessness, nausea, upper abdominal pain or great exhaustion. Some organisations extend the FAST test to BE-FAST, with Balance and Eyes. Any single sign is enough to call the emergency number.
First aiders give no medication unless the dispatcher says so or it is an emergency medicine prescribed to the person by a doctor for exactly this situation. If the person becomes unconscious: if they breathe normally, recovery position; if they are not breathing normally, resuscitation and AED.
How to practise it
You can memorise the FAST test with family and friends – it takes less than a minute. You practise resuscitation and using an AED on a first-aid course with a practice manikin.
Remember where an AED is located in your daily life. And keep the most important sentence in mind: better to call the emergency number once too often than once too late.
Step by step
- 1
Recognise heart attack signs
Persistent pain, pressure, burning or tightness in the chest, often spreading to the arm, neck, jaw, back or upper abdomen; breathlessness, nausea, vomiting, pallor, cold sweat, anxiety.
- 2
Stroke: the FAST test
Face – ask the person to smile: does one corner of the mouth droop? Arms – ask them to hold both arms out, palms up: does one arm drift down? Speech – ask them to repeat a simple sentence: is the speech slurred or hard to understand? Time – call at once. Sudden problems with vision, balance or walking can also be signs.
- 3
Call at once
Call the emergency number (112 in the EU) and state the suspicion. Note the time the symptoms started – this is very important for stroke treatment.
- 4
Position
If a heart attack is suspected, let the person sit or half-lie comfortably with the upper body raised, loosen tight clothing and avoid any exertion. If a stroke is suspected, position them with the upper body slightly raised and give nothing to eat or drink.
- 5
Reassure and monitor
Stay with the person, speak calmly, cover them and monitor consciousness and breathing. If possible, send someone to guide the ambulance crew in and to fetch an AED.
- 6
Unconscious: act
If the person does not respond and breathes normally: recovery position. If they are not breathing normally: start resuscitation at once as the dispatcher instructs and use the AED.
Common mistakes
- Waiting to see whether the symptoms pass
- Not taking stroke signs seriously once they disappear
- Driving the person to hospital yourself
- Giving something to drink when a stroke is suspected
- Letting the person walk around or climb stairs
- Missing atypical signs in women or older people
Quick view
Materials
Mobile phone
Emergency call and the time symptoms started
The battery drains quickly in cold and with continuous screen and GPS use.
Do not plan on it as your only means of navigation or emergency calls.
AED (automated external defibrillator)
If unconscious without normal breathing
Switch the device on and follow its voice prompts; nobody touches the person during analysis and shock delivery.
Wool blanket / duvet
Keep away from candles, stoves and heaters.
Suitable for
- Sudden chest pain, breathlessness or paralysis at home, on the move or at work
- Adults of any age, especially older people
Not suitable for
- Waiting to see whether it "gets better on its own"
- Driving the person to hospital yourself instead of calling the emergency number
Prerequisites
- Knowing the warning signs
- Knowing the emergency number
Safety
- This text does not replace a first-aid course. First aid is learned through hands-on practice under instruction. In an emergency always call professional help – via the local emergency number (112 in the EU) – and follow the dispatcher's instructions.
- If a stroke is suspected, give nothing to eat or drink – swallowing may be impaired. Give no medication unless the dispatcher says so or it has been prescribed to the person by a doctor for exactly this situation.
- In women, older people and people with diabetes, a heart attack often shows less typically, for example with breathlessness, nausea, upper abdominal pain or marked exhaustion instead of clear chest pain.
How it works
In a heart attack a coronary artery becomes blocked and part of the heart muscle no longer receives oxygen. In most strokes a vessel in the brain becomes blocked; less often there is bleeding into the brain. In both cases tissue dies the longer it lasts – hospital treatment works best the earlier it starts. A heart attack can also trigger cardiac arrest. First aiders cannot treat the cause, but they can recognise the signs, call at once, relieve the strain on the person and start resuscitation if needed.
Advantages
- The FAST test is simple and quick
- An early call clearly improves the chances of treatment
Disadvantages
- Atypical signs are easily missed
- People affected often play down their symptoms
Deep knowledge
Background
The ERC first-aid guidelines recommend that lay people use a simple recognition test such as FAST when a stroke is suspected and alert the ambulance service at once, and describe an immediate emergency call for chest pain. They stress that an early call and early recognition of cardiac arrest save lives.
On German-language courses, heart attack patients are usually positioned with the upper body raised, stroke patients with the upper body slightly raised. Medication is not for first aiders to give – unless the dispatcher instructs it or it is an emergency medicine prescribed to the person by a doctor.
Variants
- BE-FAST
- Some organisations extend the test to BE-FAST: Balance (sudden loss of balance, dizziness) and Eyes (sudden vision problems) come before Face, Arms, Speech and Time. Any single sign is enough to call the emergency number.
- Far from help
- Even outdoors, call at once and give your location. Do not let the person descend or walk; wait for evacuation by rescuers.
Common mistakes
- Waiting to see whether the symptoms pass
- Not taking stroke signs seriously once they disappear
- Driving the person to hospital yourself
- Giving something to drink when a stroke is suspected
- Letting the person walk around or climb stairs
- Missing atypical signs in women or older people
Limits and risks
- Does not replace a first-aid course
- No medication or dosages
- No diagnosis – only recognising and alerting
- Resuscitation only as the dispatcher instructs or as learned on a course
Material alternatives
Derived from material properties: a substitute must have all relevant properties. Observe the notes on the substitute.
- Mobile phone
- Headlamp / flashlight, Battery lantern / LED light
- Wool blanket / duvet
- Sleeping pad, Dry leaves, grass or conifer boughs (Collect only where allowed; no protected plants. Check for ticks and insects.), Backpack, Dry spare clothing (Carry it in waterproof packaging – wet clothing barely insulates.), Insulated cool box (Keeps cold only for a limited time; without ice packs or ice it is not a fridge.), Sleeping bag (Do not store compressed long-term; do not pack away damp.), Newspaper and cardboard (Flammable – keep away from candles, stoves, heaters and embers.), Insulated cooking box (hay box, thermal cooker) (Never put open flame or embers inside – only the hot, closed pot.), Long-stemmed thatch (reed, grass, rushes) (Extremely flammable – no open fire and no sparks nearby.)
Results come exclusively from structured entries. No improvised instructions are generated.
Sources
European Resuscitation Council – Resuscitation (journal) (2021): European Resuscitation Council Guidelines 2021: First Aid
Recognising stroke with a simple test, immediate call; emergency call for chest pain
European Resuscitation Council – Resuscitation (journal) (2021): European Resuscitation Council Guidelines 2021: Basic Life Support
Resuscitation and AED in cardiac arrest
Deutsches Rotes Kreuz (DRK): Erste Hilfe – Informationen und Kurse
Positioning for suspected heart attack and stroke