The first few minutes are critical to survival and well-being of a heart attack victim.

About one-half of heart attack deaths occur within a couple of hours after the onset of symptoms, and in many cases the victim never reaches a hospital. Heart attacks result because of deficient coronary (heart) blood circulation. When the electrical activity coordinating the heart becomes abnormal, there is a sudden life-threatening arrhythmia. Instead of pumping blood, the heart just quivers. Unless the circulation can be restored within four minutes, the brain is irreversibly damaged and death results.If nobody is around when a cardiac arrest takes place, the outcome is almost inevitably fatal. But if bystanders are nearby, as is often the case, there is a real hope of saving the person and returning him or her to a good quality of life.

Learn to begin cardiopulmonary resuscitation (CPR) - rhythmically compressing the chest about once each second and, at intervals, blowing air into the lungs. Mouth-to-mouth breathing is necessary when no equipment is available.

The main virtue of CPR is that it can be performed without special equipment and can be initiated immediately after a victim's collapse. If CPR is begun in less than four minutes, it appears to make a real contribution to the chances of survival.

CPR training is available in most communities through local hospitals, the American Heart Association or the American Red Cross.

Another intervention that increases the chance of the victim surviving besides CPR is the delivering of an electric shock across the heart. Known as defibrillation, the technique requires putting two paddle-shaped electrodes in a particular position on the chest and delivering a time current of electricity at an appropriate voltage. The jolt's effect brings the heart to an electrical standstill so that one of the heart's natural pacemakers can resume its coordinating activity.

The sooner the heart is defibrillated, the better the chances of recovery for the victim. Optimal results require defibrillation in less than 10 minutes and preferably less than 8 minutes from the onset of cardiac arrest. In other words, CPR needs to begin within 4 minutes, and defibrillation in another 4 minutes or so. Seconds count in cardiac arrest situations.

CPR should continue until a rescue team arrives and takes over.

Defibrillation requires personnel training to use it since they must be able to take an electrocardiogram (ECG) to determine whether ventricular fibrillation really is the problem - because, if it isn't, the shock could do a lot more harm than good.

Since every street corner can't have a trained person in defibrillation, three critical factors can serve well:

1. Every adult should know the sign and symptoms of a heart attack.

2. Everyone should know the emergency telephone number in his or her community.

3. A high percentage of a community should know how to perform CPR. It may only be helpful if applied within four minutes of cardiac arrest, and perhaps for another four to five minutes, but those minutes can make the difference between life and death.