What should we do in case of a heart attack?

Prof Upendra Kaul

Heart attack is the most catastrophic presentation of a heart disease. If not treated effectively it has a mortality of up to 25 per cent. A heart attack happens when blood supply to this vital organ gets blocked. It can be a silent disease and can cause of sudden death with increasing age in both man and woman.

The commonest cause is a sudden and complete blockage of a patent coronary artery by a freshly formed blood clot. The area of the heart supplied by this artery immediately gets affected and if blood supply remains cut off gets completely damaged (necrosed). The outcome of such a patient depends upon the size of the attack. If more than 50 per cent muscle is affected the mortality can be up to 80 per cent if not treated promptly.

Today very effective treatments for heart attack are available that can save lives and prevent sudden death. Its treatment is most effective when started within one hour of the beginning of heart attack symptoms. If patient get help during that first hour then chances of recovery increase. Many people hesitate to help heart patients because lack of knowledge and right information. It is very important to know the symptoms that may indicate heart attack and the emergency first aid treatments.

Symptoms of heart attack:-

Chest pain with shortness of breath: Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.

Shoulder/arm pain: Pain spreading to the shoulders, neck or arms. The pain may be mild to intense. It may feel like pressure, tightness, burning or heavy weight.

Other symptoms: May include anxiety, nervousness, cold, sweaty skin, Increased or irregular heart rate. Profuse sweating is a common accompaniment.

The patient may suddenly become breathless with severe air hunger and gasp for breath in a massive heart attack leading to heart failure. In some situations patient may loose consciousness and have what appears like a convulsion. This is related to either a very fast and chaotic heart beat or stoppage of the heart beat called a cardiac arrest.

Symptoms mimicking a heart attack and often ignored:

Severe upper abdominal discomfort with feeling of fainting or throwing up.

Pain in the jaw and teeth without any local dental problem, this is a referred pain and often accompanied by sweating and difficulty in breathing.

The actual diagnosis of a heart attack is always made by a doctor or a medical person. The diagnostic test is an Electrocardiogram which must be done as soon as possible and is a must before specific treatment can be started. There are situations though not very common in a full fledged attack in which ECG may not be diagnostic. Certain specific blood tests like troponin and MB CPK estimation are diagnostic in these situations.

A situation in which ECG may not be diagnostic is in patients with history of previous heart attacks and patients on permanent pacemakers. Blood tests and nuclear scintigrams are useful in such situations.

There are instances where the diagnosis of a heart attack is made by chance when an ECG is taken for clearance before undergoing surgery for an un related illness or for insurance purposes. These silent heart attacks are seen commonly in diabetics where the symptom of pain at the time of a heart attack is masked.

First aid in case of a heart attack:

Time is the most important factor to save the heart muscle from getting permanently damaged with bad short term and long term prognosis. The first
Hour after heart is also called the “Golden Hour” because effective treatment instituted within 1 hour to open the blocked artery can lead to complete reversal of the damage suffered. Delay in starting the treatment leads to irreversible damage to the heart. Treatment started more than 12 hours after suffering a heart attack is of very little use in most instances.

The best place to manage a patient with a heart attack is a hospital with facility of ECG monitoring and providing critical care. Coronary Care Units (CCU) are specialized areas where equipment and medical personnel to manage these sick patients is kept at one place. Early detection and prompt treatment is the goal of keeping these patients in this area which reduces the mortality of a heart attack from approximately 20 per cent to 3-5 per cent. This is achieved by restoring the blood flow in the blocked coronary artery either by using drugs “clot busters” (Streptokinase, tenectaplase etc) or if facilities exist by doing an emergency angioplasty and stenting.

General measures before patient is shifted to a hospital or a medical center:

1. Have the person sit down and calm. If clothing is tight then loose it.
2. Immediately transport to the nearest hospital or ambulance service. Do not leave the person alone.
3. Nothing should be given except for sublingual tablets or any other medication prescribed by the doctor. A tablet of aspirin helps person to limit the damage.
300 mgs of aspirin chewed at the time of heart attack can reduce the mortality by 15 to 20 per cent.
4. Make sure the patient continues breathing and has a pulse until the ambulance arrives or the patient reaches the emergency department of a hospital.
5. If there is no breathing or pulse, give Cardiopulmonary Resuscitation (CPR). Immediately place the palm of your hand on the patient’s chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again. If possible, raise the legs up 10 to 15 inches to allow more blood to flow towards the heart.
It should be remembered that prompt recognition and diagnosis of a heart attack is the key and such patients should be rushed to the nearest hospital without any delay. Delay can be fatal.

Awarded Padmashiri and Dr B C Roy Award, the author is Executive Director and Dean Fortis Escorts Heart Institute, New Delhi.

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