How to Help Someone Who's Having a Heart Attack

The Sex and the City reboot And Just Like That… dropped last week, and the first episode features a pivotal that scene fans — and doctors — are still talking about.

In it, Carrie Bradshaw comes home to find her husband, John James Preston (aka Mr. Big), collapsed in the shower while having a heart attack after his 1,000th Peloton ride. He dies in Carrie's arms. Viewers took to social media to question why Carrie didn't do more to try to save him, and media brands have been reporting on whether he could have been saved at all if she had acted differently. Even the American Heart Association weighed in, sharing a tweet about the life-saving powers of CPR (or cardiopulmonary resuscitation)

If all of this has you confused about how to act IRL. What are you supposed to do exactly if you ever find yourself in Carrie's shoes (the closest you might get to those blue Manola Blahnik's) as a witness to someone who you believe is having a heart attack?

The Difference Between a Heart Attack Vs. Cardiac Arrest

It's important to point out that the term "heart attack" is loosely used by the general population to describe any kind of serious and sudden heart issue — but that's not always the case.

An actual heart attack, aka a myocardial infarction, is what happens when the flow of oxygen-rich blood to a section of the heart muscle suddenly gets blocked, and the heart can't get oxygen, according to the National Heart, Lung, and Blood Institute (NHLBI). If the blood flow isn't restored quickly, the section of the heart muscle starts to die.

However, cardiac arrest is a condition where the heart suddenly and unexpectedly stops beating, the NHLBI explains. In that situation, blood stops flowing to the brain and other organs. It can be deadly if it's not treated within minutes.

Here's where things get slightly confusing: Sudden cardiac arrest is not technically a heart attack, but a heart attack can lead to cardiac arrest, signaled by loss of consciousness, according to the NHLBI. If someone is in sudden cardiac arrest, they will become unconscious and often won't have a pulse. This is when CPR comes into play. Conversely, during a heart attack, the person will still be able to talk and breathe, according to the Centers for Disease Control and Prevention (CDC).

Other common cardiac arrest symptoms include a racing heartbeat, lightheadedness or dizziness, fainting, chest pain, shortness of breath, nausea, or vomiting within an hour of the sudden cardiac arrest. (

Common heart attack symptoms include chest pain or discomfort, pain in the arms, back, shoulders, neck, jaw, or upper part of the stomach, and shortness of breath, though some don't experience any symptoms, according to the NHLBI.

What to Do If You Someone Is Having a Heart Attack

First of all, act fast.

Doctors agree that timing is crucial when someone is having a heart attack. "Time is muscle — heart muscle starts to die [during a heart attack]," says Holly S. Andersen, M.D., attending cardiologist and an associate professor of clinical medicine at the New York-Presbyterian Hospital, Weill Cornell Medical Center. When a heart attack hits, "you need to get the patient to a hospital so doctors can open up the blocked artery and restore blood flow," says Dr. Andersen. "This is done with medications and most often with stenting of the artery." (A stent is a wire mesh tube that can prop open an artery.)

Oxygen is a critical factor both in the case of a heart attack and sudden cardiac arrest. "The longer [you go] without oxygen to the heart, the more damage is done," says Christopher W. Meaden, M.D., assistant professor of emergency medicine at Rutgers New Jersey Medical School. "As we say in medicine, 'time is tissue.' If a patient receives medical attention and is evaluated by an emergency physician and cardiologist, they may be a candidate for treatment that would allow for oxygen to be restored to the heart, preventing further damage."

Doctors are particularly concerned with keeping the brain functioning normally since blood stops flowing to the brain during a sudden cardiac arrest, says Paul Natterson, M.D., a cardiologist at Providence Saint John's Health Center in Santa Monica, California, and medical consultant for Rithem Life Sciences. "With each minute there's no blood flow, there's going to be a decline in the likelihood of survival" and even with survival, the risk of cognitive complications is high, he says. (Those who survive cardiac arrest tend to experience "neurologic dysfunction, brain injury, disorders of consciousness, neurocognitive deficits, changes in quality of life, as well as physical and psychological wellbeing," according to NYU Langone Health.)

You're qualified to help.

Despite what you may have believed, you don't need to be certified to do CPR, says Dr. Andersen. You also don't need to do mouth-to-mouth (aka give rescue breaths), and thanks to Good Samaritan laws (laws that protect people who volunteer help someone in an emergency situation), there's no risk of being liable if something goes wrong (such as the person being injured or ultimately dying), she adds.

"Carrie should have called 911 as soon as she saw [Big] and begun chest compressions as soon as he passed out and stopped breathing," says Dr. Andersen. "I felt like shouting at the TV."

Follow These Life-Saving Steps:

Wondering exactly what to do if a person has a heart attack or other cardiac event? Here's a breakdown:

• Call 911. This should be the first thing you do and can help ensure that help arrives ASAP, says Dr. Natterson.
• Assess the person's status. Are they conscious? Unconscious? This is a differentiating factor between a heart attack and sudden cardiac arrest, and will dictate what you should do next. (Reminder: Loss of consciousness is associated with sudden cardiac arrest.)
• Give them an aspirin if they're conscious. If they are conscious and showing signs of a heart attack, give them an aspirin if you have one, says Dr. Andersen. Whether or not you have an aspirin, Dr. Natterson recommends having the person sit or lay down (in case they pass out), staying with them, and monitoring them.
• Try to get a response from the person if they're unconscious. If the person seems to be unconscious, tap them and ask them if they're okay. If you don't get a response, you should lay them on their back on a flat surface, according to the American Red Cross. Then, you should perform hands-only CPR, which can help save a person's life. "We can't save everyone but hands-only CPR can triple the chance of survival," says Dr. Andersen.

How to Perform CPR

Hands-only CPR (which doesn't involve breathing for someone via rescue breaths) is the American Red Cross' "recommended form of CPR" when a teen or adult suddenly collapses. Specifically, these are the steps you should take, as recommended by the organization:

• Kneel next to the person. Your knees should be near the side of their body at chest-height and spread about shoulder-width apart.
• Place your hands on their chest. The heel of one hand should be on the center of their chest, with your other hand on top. Interlace your fingers and make sure they're hovering off the chest.
• Adjust your positioning. Your shoulders should be directly over your hands, and your elbows should be locked.
• Start compressions. You'll want to push hard and fast, pushing in their chest at least two inches with each compression while allowing the chest to return to its normal position after each compression. Your goal is to do 100 to 120 compressions a minute (you can sing the Bee Gee's "Staying Alive" or Beyonce's "Crazy in Love" in your head to keep the time, says Dr. Andersen.)
• Keep giving compressions. You'll want to do this to keep pumping blood to the brain and heart until emergency services arrives or until someone locates a defibrillator, says Dr. Andersen.

Research estimates the heart attack survival rate is more than 90 percent, according to Harvard Medical School. And helping someone who's experiencing one can help their odds of making it through. "Every minute without CPR, the chance of survival goes down by 10 percent," says Dr. Andersen. "Within five minutes, brain cells begin to die. In 10 minutes, the chance of survival is virtually zero." If you want to learn more about CPR, Dr. Andersen recommends visiting the American Heart Association's resources on hands-only CPR.

When in doubt, act. "The worst thing you can do is nothing," says Dr. Andersen. "You can't hurt someone who will die without your help."