Community Advocacy & Education

Early Heart Attack Care™ (EHAC) education is a public awareness campaign created by Chest Pain Center founder Dr. Raymond Bahr.

The primary goal of EHAC® is to promote awareness that heart attacks have "beginnings" that can occur weeks before the actual attack. EHAC focuses on intervention during these beginnings to help prevent acute myocardial infarction (heart attack) and cardiac arrest.

Early symptoms, such as mild or stuttering chest pain, are identified as major risk factors for heart attack. Adults often ignore these warnings and put themselves at risk for significant damage to the heart muscle, or even death. The signs of an impending heart attack may occur days or weeks before the actual event. These early symptoms need to be recognized and treated early to avoid the damage caused by a full-blown heart attack.

The second goal of EHAC is to teach the public that individuals with heart attack symptoms be evaluated and treated in an emergency department (ED) or chest pain center (CPC).

Experts there are trained in the rapid evaluation of patients, bringing together ED physicians, nurses, cardiologists, and technicians who work as a team to establish a comprehensive management plan for patients with chest pain.

We pursue the mission of transforming cardiovascular care and improving heart health by providing education and accreditation to forward thinking healthcare facilities.

Early Heart Attack Symptoms

Not every heart attack displays the same symptoms as those we may see on the many medical TV shows we are exposed to daily. In fact, many people ignore the early signs of a heart attack, simply dismissing the more subtle symptoms because they expect the drama associated with a Hollywood episode. Unfortunately, when these early signs are ignored, we miss a "window of opportunity" to prevent the attack before any heart damage can occur. The following signs and symptoms are ones to be aware of in yourself or in your family members:

Shortness of Breath without Exertion

Although most of us experience shortness of breath when we are exercising or expending energy outside of what we do normally, difficulty breathing when performing normal activities is an early sign that should be investigated.


The sensation of heartburn or a burning in the chest can be mapped to spicy food and quickly discarded. This sensation can also be an early sign of a heart attack, especially if the condition becomes chronic. If you find yourself taking over-the-counter antacids on a regular basis, the underlying cause of your trouble needs to be discussed with your doctor.

Discomfort or Pain

Although we think of heart pain as pain occurring in the area of the heart, for some individuals this is not the case. People who have suffered a heart attack have described their early symptoms everywhere from crushing to squeezing to pressure occurring in the chest and even other areas of the body. Shoulders, neck, and jaw are areas reportedly affected prior to a heart attack. Always seek immediate attention if you are experiencing this type of pain, even if the symptoms disappear or are only intermittent.

A Feeling of Impending Doom

Some patients describe a feeling of anxiety and fear prior to the occurrence of a heart attack. Although not usually thought of as an early symptom, and certainly attributable to other matters, this "feeling" can still be an early indicator, especially when combined with any of the other symptoms listed above.

Call to Action

Dr. Bahr composed this letter that he would like to share with the American public.

To My Patient and Friend: A Heartfelt Message

I write this letter with the hope that I can help you gain some of the insight that I have learned after many years of working with heart attack patients. I offer you this take-home message: Heart attacks do not have to kill, and heart attacks do not have to destroy heart muscle. They do so only because you and I allow this to happen. It is important for you to understand this because, having done so, the next step is to be proactive in helping to correct the problem.

The heart is a tremendous pump. I say that because it has tremendous reserve capacity. It can pump 5 to 50 liters per minute, allowing you to do whatever is physically necessary to meet your needs and demands, whether it be sitting on the couch or running a marathon. To do this, the heart muscle needs nourishment. Three heart vessels are given the task of delivering oxygen and nutrients to the heart muscle. It is only when one or more of these vessels are blocked that this reserve capacity and the ability to function normally are compromised.

I could tell you about cholesterol, hypertension, and cigarette smoking and how controlling these risk factors can prevent the development of blockage within these vessels. But I want to emphasize that it is very important for you to understand when something is going wrong or when something happening within your body feels unusual to you, act quickly. A major blockage does not occur instantly; instead a vessel clogs over time. It is during this period of time that you have to be sensitive to subtle changes in your body. These changes are the early signs and symptoms of a heart attack. It is during this "grace period" that you must take action so that damage can be averted with lifestyle changes and cardio-protective medications, followed by diagnostic tests to determine the problem.

Prevention is a key word in medicine, and prevention of a heart attack is possible when you act quickly during the time that symptoms are minimal. About half of all heart attacks are preventable in that there are telltale signs that a heart attack is on its way. Patients may not go to the emergency room because they felt their pain wasn't severe enough to seek help; they may have felt just chest pressure, chest fullness, chest ache, chest burning, or other atypical symptoms. We should learn from these patients that heart attacks have beginnings, and early intervention can actually prevent heart attacks from taking place.

In many cases, the chest discomfort comes and goes, causing patients or those nearby to ignore the early signs and symptoms. Patients don't feel it is enough of an emergency to call 911, or first responders don't act because they are busy and feel that taking time would interfere with their schedule. Ignoring the early signs and symptoms makes these individuals enablers of the heart attack, rather than caregivers.

So, my patient and friend, please know what heart attacks are all about. Read the pages in this "For Patients" section of this website to gain a better understanding of the signs and symptoms and the plan of action to take in the event of an emergency. Be attuned to yourself and become an early heart attack caregiver to yourself and your loved ones. It is with this thought in mind that I ask you to take this pledge that commits you to action when you or someone in your presence has the early warning signs of a heart attack. All who take this pledge can form a network that will one day reduce heart attacks from being the number one health problem in our nation.


Raymond D. Bahr, M.D

EHAC® Pledge

"I understand that heart attacks have beginnings and on occasion, signs of an impending heart attack may include chest discomfort, shortness of breath, shoulder and/or arm pain, and weakness. These may occur hours or weeks before the actual heart attack.

I solemnly swear that if it happens to me or anyone I know, I will call 9-1-1 or activate our Emergency Medical Services."

Our objective is to enlist health care professionals and patients to take this pledge and educate themselves and their community on the early signs and symptoms of an impending heart attack.

Join us in the battle to defeat heart disease as the number one cause of death worldwide.

Download the EHAC Brochure English | Spanish

Share and read EHAC Stories

Heart Attacks Have Beginnings

Heart Attacks Have Beginnings badge

This badge is for everyone in the community, as well as hospital professionals, and can easily be part of your community outreach, (which is Key Element No. 1 to our customers).

We want everyone to understand that "heart attacks have beginnings."

We want them to take the pledge and commit to educating others. They are encouraged to take the 20-minute course and we urge them to deputize at least 50 fellow hospital employees to commit to early heart attack care and stand up for the cause hospital-wide, which we will count on our official tally (now more than 10,000 strong). Once those employees take the pledge, they become ambassadors and they should have the tools to educate the community, and other people within the hospital.

Buddy Badge

SCPC Buddy Badge

Once hospital professionals — Nurses, Physicians, Employees — are fluent on early heart attack education, we want to encourage them to weave the "buddy badge" into the community outreach programs. It reminds everyone that an accredited Chest Pain Center is the smartest place to take someone feeling symptoms.

The buddy badge emphasizes that individuals throughout the community — not just hospital professionals — should be aware that they can help save a life by taking time from their busy day to assist someone who might be feeling symptoms, but unsure of what to do. We urge them to take action, assist the person to the nearest Accredited Chest Pain Center and, possibly, save a life.

EHAC® Tools and Materials

EHAC is a fully developed outreach program with materials and information available for review and download at the Deputy Heart Attack website.

To assist in your efforts to educate your community, we have posted many materials available for download:

If you have other materials you need such as logos or images, please feel to request more items from

Two recent articles by Dr. Raymond Bahr continue to call attention to the importance of Early Heart Attack Care:

"Creating a Virtual Coronary Care Unit in the Community"
This article, which appeared in the December 2014 issue of Critical Pathways, outlines the strategy and vision that is required to achieve a Virtual Coronary Care Unit.

"EHAC Strategy Update"
Dr. Raymond Bahr wrote this article to update the accredited facilities on the growth in Early Heart Attack Care and his vision of new growth in 2015.