Why the first 60 minutes after a heart attack can make all the difference

The first hour after a heart attack can mean the difference between survival and lasting damage; doctors explain what to do in the Golden Hour

Why the Golden Hour is critical in a heart attack

 

Heart attacks are no longer confined to the elderly. Increasingly, young professionals in their 30s and 40s—juggling high stress, long work hours, and unhealthy lifestyles—are facing cardiac emergencies. Yet many delay seeking help, mistaking early signs for acidity, anxiety, or fatigue.

 

Doctors warn this delay can be fatal. The first 60 minutes after a heart attack, called the “Golden Hour,” are crucial. Timely medical care during this window can significantly reduce heart damage and save lives. Even brief delays could mean the difference between recovery and lifelong heart failure.

What happens during the Golden Hour?

The Golden Hour refers to the first 60 minutes following the onset of a heart attack. According to Dr Dibyaranjan Behera, Interventional Cardiologist at Manipal Hospital Bhubaneswar, this is the window in which blood flow to the heart must be restored to avoid permanent muscle damage.

 

Dr Rockey Katheria of Manipal Hospital Varthur adds that every minute counts: millions of heart muscle cells can be lost each minute. “Irreversible damage begins within 30 minutes of blockage,” he said.

 

In the first 10 minutes, there is often no major muscle loss. Between one and two hours, damage begins to affect the inner layers of the heart. After two hours, as much as 80 per cent of the affected heart muscle may be irreparably damaged.

What are the risks if you delay treatment?

Delaying treatment can lead to: 

• Massive heart muscle loss 
• Weakened pumping capacity 
• Increased risk of fatal arrhythmias 
• Higher chances of heart failure

 

“When treatment is delayed, damage spreads from the inner to the outer layers of the heart,” said Dr Katheria. “This reduces heart function, increases risk of complications, and decreases chances of recovery.”

What happens if you reach the hospital within the Golden Hour?

Arriving at a hospital during the Golden Hour triggers a rapid emergency response:

• Immediate ECG to confirm the heart attack 
• Clot-busting drugs (thrombolysis) if cardiac cath lab access is delayed 
• Emergency angioplasty (primary PCI) if facilities are available 
• Quick transfers to a cardiac centre when required

“It’s all about speed and logistics,” said Dr Behera. “Whichever method opens the artery faster is the right one.”

Why you must call an ambulance—not drive yourself

Dr Behera stresses that calling an ambulance saves precious minutes. “Paramedics begin treatment en route—oxygen, aspirin, ECG—and alert the hospital in advance. This cuts ‘door-to-balloon’ time and improves survival rates,” he said.

Why people ignore symptoms or delay seeking help

Many mistake heart attack symptoms for minor issues like gas, anxiety, or fatigue. Cultural guilt (“I don’t want to worry anyone”), work pressure (“just one more email”), and wishful thinking (“this will pass”) cause dangerous delays.

How to tell if it’s a heart attack or harmless pain

Doctors say heart attack pain typically presents as:

• Heavy, squeezing chest discomfort 
• Pain radiating to the left arm, jaw, neck, or back 
• Associated sweating, breathlessness, nausea, or dizziness 
• Pain that doesn’t go away with rest or antacids
• Sudden or gradually increasing discomfort

 

“When in doubt, do not wait,” said Dr Katheria. “Seek care immediately.”

What high-risk patients and families should do now

Dr Behera urges high-risk individuals and families to prepare:

• Control diabetes, high cholesterol, and blood pressure
• Learn CPR as a household skill
• Save emergency numbers on speed dial
• Identify the nearest cardiac centre
• Invest in health-monitoring tools if needed

“Each delay of 30 to 45 minutes after the Golden Hour leads to a 1 per cent drop in heart function,” he warned. “Early treatment can fully restore heart performance and prevent irreversible damage.”

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This content is for informational purposes only and is not a substitute for professional medical advice.