The Position That Can Save Your Life During a Heart Attack

If you think you are having a heart attack, the very first thing you should do is call 911. The second thing? Take a seat. Experts say that safely getting into a seated position can protect you from additional complications and relieve some of the strain on your heart.

Let’s explore why being seated can help save your life, and what else you should do if you or someone you are with appears to be having a heart attack.

A heart attack (what doctors call myocardial infarction) occurs when your heart’s supply of oxygen-rich blood gets cut off. This causes heart muscle cells to die, weakening your heart, explains Hosam Hmoud, M.D., a cardiologist at Northwell Lenox Hill Hospital in New York City. If blood flow does not get restored quickly, the damage can be permanent or fatal.

Heart attacks are usually triggered by a blockage in one of the arteries that supply your heart. A common culprit: plaque. This is a sticky, fatty substance that can accumulate on the walls of your arteries that results in a process called atherosclerosis. Plaque builds up over time, narrowing your arteries. Eventually, that can hamper blood flow. But plaque can also break apart suddenly.

“That plaque becomes unstable, ruptures, and a blood clot forms in a matter of seconds or minutes,” says Rani Hasan, M.D., an interventional cardiologist at Johns Hopkins Medicine in Baltimore, MD. “It can go from a moderate degree of narrowing of that artery with very little obstruction of blood flow to suddenly no blood flow going through that artery.”

There are a few different reasons that taking a seat may be the best position if you are having a heart attack.

It Improves Blood Pressure and Blood Flow

Your heart pumps blood to the rest of your body through a network of arteries, then that blood travels back to your heart via your veins. Your blood pressure determines the force at which your blood flows. The position of your body can affect both blood pressure and blood flow, says Jim Liu, M.D., a cardiologist at The Ohio State University Wexner Medical Center in Columbus, OH.

“For example, in a standing position, blood pressure may be lower and the return of blood to the heart may be less because gravity is distributing blood more to the legs,” he says.

During normal times, your heart can easily make adjustments for any changes that occur when you’re sitting or standing. That is not the case during a heart attack. Your heart’s ability to pump blood can drop as heart muscle cells die and your heart weakens. And that spells trouble.

“In an already struggling heart, you need adequate return of blood to the heart to ensure that it can continue to pump blood as effectively as possible to the rest of the body,” says Dr. Liu. “If not, other organs, like the brain, may not get enough blood, which can cause people to pass out.”

When you take a seat, notes Dr. Liu, “it helps blood flow back to the heart.”

It Reduces Fluid Buildup in the Lungs

During a heart attack, a lack of blood flow through your circulatory system can also cause shortness of breath. “Blood may back up on the left-sided chambers of the heart—think of a failing basement sump pump during a storm—and eventually cause fluid buildup in your lungs,” says Dr. Hmoud. “Staying in an upright and seated position is essential to improve shortness of breath should fluid buildup in the lungs occur.” This is because when you’re seated (as opposed to prone), gravity works in your favor, reducing the amount of fluid that stays in the lungs.

It Minimizes Other Concerns

Sitting also reduces your risk of other serious problems:

• Aspiration can occur when something accidentally enters your lungs—for example, if you swallow a piece of food or a sip of liquid the wrong way. In addition to being an immediate choking risk, this can also cause a bacterial infection called aspiration pneumonia. Aspiration is more likely to occur if you are lying down, says Dr. Hmoud.

• Falls can cause significant injury and may occur if you pass out while standing.

“Being in a seated and upright position will protect you from traumatic injuries should you lose consciousness and aspiration should you vomit during a heart attack,” says Dr. Hmoud.

There are plenty of ways to sit down, but if you are having a heart attack, try to sit on the floor with your knees bent and your back against the wall, which is called the half-sitting position. Although this position has not been well-studied, says Dr. Hasan, this appears to be the safest option. “Sitting down and resting is probably the best thing you can do for yourself,” he notes.

Dr. Hmoud points out two more important factors to consider: where to sit and whether you can get there safely. “Try to move to a position that is easily accessible by emergency medical personnel,” he says. Avoid places near stairs and places with sharp objects, he advises, both of which could make things a lot worse if you were to fall.

But before you move at all, ask yourself if you feel up to it. “If you’re alone and believe you’re experiencing a heart attack, you should first assess yourself [to determine] if you can move to a secure and seated upright position,” says Dr. Hmoud. “Having symptoms of dizziness, vision changes, and/or an unsteady walking pattern are signs that you should stay put.”

Resist the urge to lie down. Remember how blood can back up in the lungs during a heart attack, causing shortness of breath? “That’s less well-tolerated if you are lying flat,” says Dr. Hasan.

If you think that you or someone you’re with is having a heart attack, the key is to act fast and follow these steps:

1. Call 911. “First and foremost, activate emergency medical services,” Dr. Hasan says.

2. Take aspirin, unless you’re allergic. A clot may be causing your heart attack. Aspirin, a blood thinner, will help break up that clot. “Aspirin is enormously helpful,” says Dr. Hasan. Ideally, he recommends chewing four low-dose (81 milligram, or mg) tablets, although a single adult aspirin of 325mg will also work. Chewing gets the aspirin into your system right away, notes Dr. Hasan. Sip water to take it if necessary, but otherwise avoid food and drink.

3. Find an automated external defibrillator (AED) if you are with someone who is having a heart attack, if possible. AEDs are used when someone goes into cardiac arrest, which can result from dangerously fast heart rhythms that may develop during a heart attack, says Dr. Hasan. (A heart attack means blood flow to the heart is blocked; cardiac arrest is when the heart stops beating completely, and it is fatal if not treated within minutes.) The AED will shock your heart to get it beating properly again. These devices are often available in public places, like malls and office buildings.

4. Be ready to administer CPR. If there’s no AED in the area, chest compressions can keep blood pumping to the brain and other organs if the person goes into cardiac arrest. How do you know if this is happening? The person passes out, has stopped breathing, and doesn’t have a pulse. “If there’s any question or you don’t know how to check for a pulse, start doing chest compressions,” says Dr. Hasan. The American Heart Association recommends pushing down about two inches at the center of the chest, then allowing the chest to return to its normal position before pressing again. Aim for 100 to 120 chest compressions per minute. “If they are not in cardiac arrest, pushing on their chest is not going to cause a problem. But if they are, you are going to save their life,” he adds.

5. Get a medical history. While you wait for the ambulance, gather important info for the medical team that could be helpful. Things to take note of include whether someone has a history of heart attack or other heart disease, what medications they take, and when they last ate, because undigested food can interfere with surgery should that be necessary. “It could inform what kinds of medication we use, what sedation we use, and other precautions we may take to prevent any issues from arising in that setting,” says Dr. Hasan.

After calling 911, get into a safe, seated position if you think you are having a heart attack. This can help ease the strain on your heart while you wait for the ambulance to arrive. If you are with someone having a heart attack, stay with them until help arrives and be prepared to administer first aid, such as CPR.