Q:

Storytelling In Simple Present

When telling a story in the present tense, what tense should we use for actions that take place before another action in the story, for example:

The king turns to his wife, who has already had a heart attack, and asks her...[Present Perfect]
The king turns to his wife, who had already had a heart attack, and asks her...[Past Perfect]
The king turns to his wife, who already had a heart attack, and ask her...[Simple Past]
The king turns to his wife, who already has a heart attack, and asks her...[Present Simple]

A:

The tense you use for actions that took place before the action you are currently relating is determined by the usual criteria. 
If that prior action has a current relevance, use the present perfect:

He looks for the money he has lost.

If that prior action happened in finished time, use the past simple:

He looks for the money he lost the day before.

The reason why the first sentence you quote is the best of the 4 choices is because the word 'already' (in British English at least) generally requires the present perfect tense. We say: "I've already eaten", not "I already ate".

