100. Recognizing and Surviving a Startup Heart Attack 🫀

This is the 100th article I have written for Feel the Boot.

I've been struggling for months searching for a topic worthy of this milestone.

Then, several weeks ago, I had a heart attack.

While I was lying on the operating table, and a doctor was putting stents in a couple of my coronary arteries (which they do under local anesthesia), I had time to think more profound thoughts. It seemed the right time for that.

I knew the three things I wanted to talk about.

The first is recognizing when something like a heart attack is happening to your startup and how to survive it.

Second, I wanted to talk about priorities. We all need to be more mindful about how we spend our limited time.

Finally, I want to share some of the early warning signs for physical heart attacks and strokes.

This article is part of the series of Founder Insights. You can find the rest of them here.

Startup Heart Attacks

Human heart attacks are caused by a lack of oxygen flowing to the heart muscle.

The heartblood of your business is money. Running out of money is the number one source of startup failure.

It's critical to watch for early warning signs so you can act before it is too late, like:

• Your runway is getting short

• Fundraising is taking too long

• Investors are not excited by your opportunity

• Sales fall below your projections

• Costs exceed your projections

These all indicate that cash flow is starting to constrict and your company is becoming sclerotic. If money flow constricts too much, real damage will begin. You don't want to wait for severe pain in your financials!

Left untreated, these signs can lead to imminent disaster, so it's critical to take early action to ensure you can get your business back on its feet and going in the right direction before you do irreparable damage to the company.

The key is to stay alert for these kinds of warning signs. When you go to the doctor, they check your blood pressure cholesterol, and run an EKG.

Your business needs the same thing; in this case, they are your KPIs.

The core numbers that indicate the health of your business may vary depending on the nature of your startup. You want to look for situations where your assumptions aren't being met.

As soon as your assumptions fail, look closely to see if that puts your business in danger. Does it just mean you grow more slowly, or are you headed off a cliff?

If there is trouble, but you have spotted it early, you need to start taking preventative action.

But what is the business equivalent of eating right and exercising? It's focusing on the fundamentals of your business, with particular attention to achieving profitability. This is not the time to spend heavily for growth, propped up by a constant flow of investor dollars.

During hard times, eating your broccoli means prioritizing immediate returns. Every expense must deliver its ROI within weeks, not years.

Otherwise, you will be forced to eat the truly bitter greens of significant layoffs and radical restructuring.

Back in 2000, my startup (Anonymizer) was financially precarious. However, an investor was poised to invest a few million dollars, and we were in due diligence with a company that wanted to acquire us.

But, this was during the early stages of the dot com crash. The investor pulled out, and the acquisition fell through, leaving us in a tough place.

We knew that we would not be able to find any new investors or acquirers before we ran out of cash. We immediately focused on getting the company to break even. We stopped all R&D and worked exclusively on bugs and features that would immediately contribute to sales and retention. We stopped all advertising and marketing that didn't generate a positive ROI within thirty days. We even laid off a significant fraction of our team to slash expenses.

As hard as that was, it allowed us to survive until the market improved and we could start growing again. In our case, that took about eighteen months.

Those actions would not have been enough if we had waited a bit longer. We would have had to resort to the business equivalent of open-heart coronary bypass surgery.

I have seen what that looked like when it happened to other companies. They had to let go of everyone, but the founding team, and they could not even pay themselves. The only option was to take their expenses all the way to zero. They often have to take outside jobs to keep a roof over their heads while trying to keep the startup going on life support. This destroys their team and drives away most of their customers. If they survive, they need to rebuild almost from scratch.

Priorities

While I was on the operating table, I had a lot of time to think about how I'm spending the time I have.

In those moments, you realize that time is not this infinite plane extending out from you but a very finite resource.

• Am I spending my time doing the things that I care about and have passion for?

• Am I having the highest impact possible?

• Am I spending my time in alignment with my goals?

• And do I even care about those goals?

I think that, in many cases, we have inherited our goals from society. They're what you think you should want after watching Shark Tank or reading interviews with successful executives. We are working to be the next unicorn founder.

Take a moment to think about what that means and if you want that. Do you want those long hours, thousands of reports, high stress, public criticism, and such?

If you just want wealth, there are many easier and far lower-risk ways to get it.

What drives you to wake up and work your ass off for such a low-probability payoff? Find that core nugget and ensure you spend your time on it, not the trappings surrounding it.

Finding that alignment will help you keep going during the inevitable hard times you encounter on your founder's journey.

I've spent substantial time thinking about this myself. I don't know exactly how it will alter Feel the Boot, the kinds of episodes we produce, and the schedule of my startup advising. However, I am already reasonably happy with how things are now, so I doubt anything will change significantly.

Signs of Heart Attack(in people)

And finally, I want to do a quick public service announcement.

I was not expecting to have a heart attack. I'm in good shape, healthy, not overweight, eat a good diet, don't have any family history of heart issues, and no indications of any problems.

So, when it happened, it came out of the blue.

I was fortunate. It was not a "Widowmaker." The symptoms were clear, and I took immediate action, preventing significant long-term impacts.

Even if you think you are low risk, you should still keep these signs in mind.

I'm also going to talk about signs of stroke because one of the people who used to work for me had a significant stroke entirely out of the blue.

Unfortunately, the founder lifestyle contains many aggravating factors that can cause heart attack and stroke.

Founders usually live with massive constant stress, insufficient sleep, too much sitting at a computer, too little exercise, and a poor diet.

Just as you want to monitor your startup's KPIs, you should monitor your key health indicators. That means checking your heart rate, blood pressure, and cholesterol at least yearly. Stress tests and EKGs can also spot trouble early on.

If there are indications of problems, there are very effective treatments to prevent or delay the condition's progression.

But, whether you are at risk or not, here are the heart attack symptoms to watch out for.

Chest pain

The best-known symptom is chest pain, often radiating down your arm. However, it might not feel like you would expect. Apparently, the sensation is very idiosyncratic. In my case, it felt like someone was jamming their thumb into the nerves in my armpit. Nerve-like pain radiated down my arm, with significant pain in my wrist.

Pain or discomfort that spreads to the shoulder, arm, back, neck, jaw, teeth, or sometimes upper belly.

This is a broad list that could relate to many other causes. Just be aware that you might feel a heart attack in surprising places.

Cold sweats

I had this one in spades. I was absolutely drenched in sweat.

Nausea, dizziness, lightheadedness

I did not get nauseous or dizzy, but absolutely felt lightheaded and faint.

Shortness of breath

I did not get this one, but it appears to be pretty common.

So, as you can see, you probably wouldn't get all the symptoms listed, and they might not present the way you expect.

I have a home blood pressure machine, so I also checked that. Both my pulse and blood pressure were sky-high, to the point that I thought the instrument might be broken.

Even with all these symptoms, I was not sure this was a heart attack, but I decided to rush to the emergency room anyway. I should have taken some aspirin before leaving, but it did not occur to me.

At the ER, they have tests to quickly confirm if it is a heart attack and start treatment.

Don't wait and hope the symptoms will fade. That is not an indication that this was not an attack. You can easily have another more significant attack soon after, and damage may occur the whole time.

My doctors told me that time = muscle. The longer you wait, the more of your heart dies, and it does not come back. 

Also, don’t allow cost to hold you back. If you are in the US and don’t have insurance (like many founders) check out Healthcare.Gov which can provide heavily subsidized plans.

Signs of Stroke

Strokes, too, require immediate action. Signs of a stroke are:

• Sudden Numbness or weakness in the face, arm, or leg, particularly if only on one side of the body.

• Sudden confusion

• Sudden trouble speaking or understanding speech.

• Sudden trouble seeing with one or both eyes.

• Sudden trouble walking, dizziness, loss of balance, or lack of coordination.

• Sudden severe headache without an obvious cause.

 If you, or someone else, experiences these, there is a quick test you can use. The acronym to remember is FAST.

• Face: Does one side of the face droop when smiling?

• Arms: When the arms are raised, does one then drift downward?

• Speech: Is speech slurred or strange?

• Time: If any of these is happening, call 911 immediately. Paramedics will start treatment while you are on the way to a hospital.

Thanks for supporting me over the last 100 episodes of Feel the Boot.

I hope you'll stick with me for the next 100. I've got ideas for a lot more, but I'm always looking for more ideas and topics.

Please let me know in the comments what you'd like to see me address.

 Until next time, ciao!