|What Do I Do If I'm Having A Heart Attack?
1 If you or someone else are showing heart attack symptoms, dial 911 and call for an ambulance. If you call for emergency services from your cell phone be sure to mention your location. Cell phones cannot be traced as quickly as landlines. If you are having a heart attack, the sooner you call, the sooner you will be treated and the more heart muscle you will save. Literally time is muscle.
2 Chew on one 325-mg aspirin and this will help to keep blood clots from forming. It is important to chew the tablet because it acts faster (within 5 minutes) than if you swallow it with water (takes 12 minutes to take effect). If do have heart attack risk factors, it is recommended to have an aspirin nearby at all times. Ideally choose one which is not enteric-coated because these take longer to digest (check the label it will say ‘coated’ or ‘non enteric-coated’). If you have no aspirin, Alka-Seltzer will do. If you have prescribed nitrates take 1 at a time, up to 3 pills, under the tongue every 5 minutes if symptoms persist.
3 You may have read a hoax email recommending cough CPR. This is where the person is supposed to cough vigorously, a sort of self-administered CPR to restore blood flow to the heart. This treatment is a hoax and is no way recommended by cardiologists.
4 Do not be tempted to drive yourself to hospital instead of waiting for the ambulance (unless of course there is no other choice). The emergency paramedics are trained to begin life saving procedures at your place of location so that precious minutes to restore blood flow to your heart will not be lost. They will begin by giving you oxygen therapy and administering drugs. Also, you will receive much faster attention at the hospital or chest pain clinic if you arrive in an ambulance. Don't forget, if you are by yourself to leave the door unlocked so that the paramedics can get in.
What If Someone Is Unconscious?
If someone falls unconscious from what is presumed to be a heart attack, they may have suffered sudden cardiac arrest (SCA). This is a condition caused by an electrical failure in the heart which causes the heart to suddenly stop pumping. It has many causes, including a heart attack. The following are signs of SCA:
• Loss of consciousness.
• Breathing stops.
• Loss of heartbeat (no pulse).
If you encounter this, first dial for an ambulance. If you have had training in emergency procedures, begin cardiopulmonary resuscitation (CPR). This will help deliver oxygen to the brain and heart. Even if you have not been trained you should begin CPR chest compressions. Press down on the person's chest (about 5cm) for each compression about 100 times a minute. If you have been trained in CPR you can check the person's air passage and deliver rescue breaths every 30 compressions. If you have not been trained, continue with the compressions only. Also, check for signs of an automated external defibrillator (AED - image) in the vicinity. For more information see:
When is CPR necessary?
How is hands only CPR performed?
What Happens at Hospital?
The first thing doctors will want to do is find out if you are having a heart attack or not. This is important because a high percentage of people presenting at emergency with symptoms of chest pain turn out to have gastroesophageal disorders such as acid reflux or ulcers. The doctor will order heart attack tests such as an electrocardiogram (ECG/EKG) (image) and blood works to check if a heart attack has occurred. If the ECG returns a normal result (indicating no issues with blood flow to the heart), more tests may be necessary but the patient will be kept for observation. Emergency room doctors are trained to recognize the signs of a heart attack so that they can begin treatment quickly. If a heart attack has occurred, the primary aim is to restore blood flow as soon as possible. Each minute lost damages the heart further. Depending on the severity of the heart attack, treatment can include medications or invasive surgery (or both).
If you have not already self-administered the paramedics may administer the drug. In emergency doctors may prescribe antiplatelet medications which are like super aspirins and prevent new clots from forming. These medications include clopidogrel (Plavix), ticlopidine and dipyridamole.
Thrombolytic therapy is perhaps the most important drug for treating heart attacks. It also called a clotbuster. It helps to dissolve the blood clot which is blocking the flow of blood to your heart. The earlier you receive this therapy, the less the damage to your heart. Ideally thrombolytics should be administered within 30-90 minutes of a heart attack, although they can be taken up to 12 hours later. After this, it is usually too late and the drugs will not have any effect.
Beta blockers help to relax the heart to reduce its work load. This can help prevent further heart attacks.
If the patient is in significant pain, a powerful pain relief medication such as morphine may be administered.
Blood thinning medications like heparin may be given in the days following the heart attack to reduce the chance of further recurrences. Cholesterol drugs may also be prescribed to improve your survival rate.
If the hospital has suitable facilities (and not all do), an emergency coronary angioplasty (image) may be performed to unblock your arteries. The surgeon inserts a thin tube (catheter) through the artery of your leg or groin and directs it to the blocked artery near your heart. The catheter is equipped with a special balloon which is inflated at the point of blockage and squeezes the artery open. A small metal stent may be inserted at the same time to keep the artery permanently open. Coronary angioplasty is normally performed at the same time as coronary angiography (image). Angiography is usually performed first to locate the blocked artery. Numerous studies show that early intervention with angioplasty and stenting during a heart attack can save lives. If a patient arrives in hospital due to a heart attack and the hospital has an interventional cardiologist on duty, then angioplasty is the treatment of choice. If the facilities are not available, then thrombolytic therapy is used instead.
Coronary Artery Bypass Surgery
In severe cases doctors may perform an emergency heart bypass surgery (also known as CABG). Usually however this procedure is reserved for elective surgery, after you have had time to recover from the heart attack. This surgery is complex and involves taking a vein from one part of the body and sewing it onto the site of the blocked artery, bypassing the narrowed section.
Useful article: Silent heart attack - when there are no signs.
Once The Emergency Is Over
When the doctors feel you are no longer in danger of another heart attack they may say you can go home. If for any reason you are not happy with this decision, ask to see a cardiologist and insist on staying overnight for observation.
Heart Attack Prevention: How to prevent further attacks.