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insert the new heart
I don't believe a patient can sustain permanent heart damage from a heart attack, but if they did you would need to replace the heart with a new heart or a bionic heart to deal with any scarring. A healer mech serum would also cure it.
https://rimworldwiki.com/wiki/Ailments#Heart_Attack
Heart attacks always start at 40% severity. Every 5,000 ticks (1.39 mins) the heart attack severity will randomly change by a value between -40% to +60%. This means that it is possible for a heart attack to treat itself on its own, but usually the heart attack progresses to fatal severity.
In which case you need to be lucky, but here on rimworld we can't expect that and we should be planned&prepared for pretty much anything and any case. Try to get replacement hearts before such things happen. It's never bad to be prepared.
pretty sure they do this in real if too with pace makers
I don't think pacemakers are used for heart attacks. Pacemakers are used to regulate heartbeat. Heart attacks are caused by the blood flow being blocked in parts of the heart. The treatment for it is to remove the blockage which can be done by medicine or some sort of surgery I believe. Replacing the heart would probably work too but that seems a bit extreme.
Like Burrrkey said, heart attacks start at 40% severity and every 5000 ticks, the severity changes within a spectrum of -40% and +60%. If severity reaches or exceeds 100%, the pawn dies. If severity reached or goes below 0%, the pawn makes a complete recovery with no lingering side effects. This means that on the first severity change, there is a small (1% each) chance that the pawn immediately recovers or immediately dies, respectively.
In addition to the above, doctors can tend the heart attack, where each successful treatment reduces severity by 30%. Treatment for this condition has a capped success chance of 65%.
Using a heart transplant as a reaction to a heart attack is usually inadvisable, even if a spare heart is in stock - the randomness of severity change aside, if averaged out to a net change of +20% severity every 5000 ticks, you'll have 15000 ticks (just over four minutes) of time at base speed (on average) to get the pawn to a well-lit bed in a clean, preferably sterile room, have your highest skill doctor collect medicine and the heart, and perform the surgery. If the surgery fails, even if it does not do so in a way that kills the pawn, the spare heart will be lost, and even if still others are available, it is highly unlikely your doctor can collect the medicine and second heart and have time to spare for another attempted surgery. Performing treatment is a far more efficient solution, being much quicker to perform than surgery, only requiring medicine, and being significantly easier to do than a live heart transplant. Additionally, a failed treatment has no chance to directly kill the patient.
Treatment for a heart attack is usually inserting a wire (catheter) into the femoral artery and into the heart in order to inflate a balloon and remove the blockage. It usually also involves inserting a stent (hollow plastic tube) to prevent it from happening again.
https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction/management-and-treatment