Respond to a Heart Attack

Coronary Artery Disease, or CAD, is the number one cause of death worldwide.[1] CAD causes a build–up of fatty plaque that accumulates in the coronary arteries, creating a blockage in blood flow, which results in a heart attack. Without blood and oxygen, the heart begins to die rapidly. Given this fact, it is important for people to understand the disease and to remain vigilant for signs and symptoms of a heart attack. If you suspect that you or someone else is having a heart attack, respond immediately, as the quicker the response, the more likely the patient is to survive.[2]

Steps

Recognizing Heart Attack Symptoms

  1. Stop what you're doing if you experience chest pain. Pay close attention to your symptoms. People who have had a heart attack describe the pain as discomfort, chest tightness, a squeezing sensation, burning or an uncomfortable pressure or heaviness in the middle of the chest. This chest pain is called "Angina."
    • The pain may come and go. It typically starts out mild, gradually intensifies and peaks within the next few minutes.
    • Pain does not worsen when applying pressure to the chest or when taking deep breaths, if it is the result of a heart attack.
    • Typically this chest pain is brought on by exertion, any type of exercise or yard work, even a heavy meal in your blood as your blood flows and is moved towards your gastrointestinal tract. If the symptoms occur at rest, it is termed “Unstable Angina, and poses a greater risk of a lethal heart attack.[3] Identify Female Heart Attack Symptoms are more likely to experience atypical angina.
  2. Assess whether your chest pain is likely a heart attack. There are several reasons you could be having chest pain. The most common are indigestion, panic attacks, a pulled muscle, and heart attacks.[1]
    • If you have just eaten a rich meal or have just done a hard chest workout, you probably are having the symptoms due to reasons other than a heart attack.
    • If you can't think of another reason for the symptoms, then assume you are having a heart attack and seek out help as soon as possible.
  3. Look for other symptoms. During a heart attack, most people will have chest pain along with at least one other symptom. You often experience shortness of breath, dizziness or palpitations, sweating, or you may feel sick to your stomach and vomit.
    • Common heart attack symptoms include feeling a choking sensation or a lump in the throat, heartburn, indigestion, or the need to swallow repeatedly.
    • A person having a heart attack may perspire and become chilled at the same time. She or he may have periods of cold sweats.
    • Heart attack victims may feel numbness in either arm, hand or both.
    • Some people experience a rapid and irregular heartbeat, heart palpitations, or shortness of breath.
    • Look for atypical symptoms. For instance, although uncommon, the patient may feel a sharp or dull pain or ache in the middle of the chest.
  4. Look for symptoms of related illnesses. Disease of the coronary arteries, coronary plaques, and atheromas are more complex conditions than CAD but they can result in the same blockage of the arteries to the heart. For instance, coronary “plaques” are a layer of cholesterol in the lining in the artery that creates small tears where at different times the plaque has started to tear away from the artery wall. Blood clots have formed at the site of tiny tears on the inside lining of the artery and the body has responded to this with more inflammation.[4]
    • Since this progression of the plaque can occur slowly over time patients may experience periods of chest pain or discomfort and ignore it. Or specifically only experience it when they are under increased cardiac stress.
    • The patient may consequently not seek any medical treatment until the plaque has gotten so big as to stop blood flow significantly even when the person is at rest, when cardiac demand is low.
    • Or worse, when the plaque breaks off and blocks flow altogether, causing a heart attack. This can happen anytime, and for many this is the first sign that they are having a heart attack.
  5. Take your risk factors into consideration. When you seek evaluation for your symptoms, most specifically chest pain, the next most important factor or perhaps equally important, is your “risk factor profile." We have so much data and evidence regarding CAD that we know it occurs more often in certain populations. Cardiovascular Risk Factors (CVRF) include: being male, smoking, diabetes, hypertension, obesity (BMI greater than 30), age greater than 55 years, and a family history of heart disease.
    • The more risk factors you possess, the more likely the symptoms you are experiencing are due to underlying CAD. Knowing these risk factors will allow your healthcare provider to evaluate your symptoms, depending on how likely they are due to coronary disease.

Responding to a Heart Attack

  1. Be prepared for an emergency before one actually happens. Know where the closest hospital is to your home and your work. Also keep a list of emergency numbers and information at a central and visible location in your home, so that someone visiting your home will see it if there is an emergency.[1]
  2. Act quickly. Prompt action can prevent serious damage to your heart, and it may even save your life. The quicker you respond to the symptoms of a heart attack, the more likely you are to survive. [1]
  3. Call emergency services or have someone drive you to the hospital. Do not drive yourself. Get trained medical help as quickly as possible. In general, do not leave the person alone except to call emergency help.
    • Seeking help in the first hour of a heart attack greatly improves your chance of recovery.
    • Describe your symptoms to the emergency response operator. Be brief and speak clearly.
  4. Administer CPR after calling for help, as needed. If you are witnessing someone having a heart attack, it may be necessary to perform CPR. You only need to do CPR if the person having the heart attack is unconscious and has no pulse, or if the emergency operator instructs you to do so. Continue to administer CPR until the ambulance and medics arrive.
    • An emergency response operator can give you instructions detailing how to perform CPR if you do not know.
  5. Get a conscious sufferer comfortable. Sit or lie down and keep the head elevated. Loosen any tight clothing so that the person can move and breath easily. Do not allow a person with chest pain or who has had a heart attack to walk.
  6. Take nitroglycerin tablets, as directed by your doctor. If you have a history of heart attacks and have been prescribed nitroglycerin by your doctor, take the pills when you experience symptoms of a heart attack. Your doctor should have given you recommendations about when to take the pills.
  7. Chew one regular aspirin while waiting for the ambulance. Aspirin makes your platelets less sticky, reduces the chance of blood clots and keeps your blood flowing through your arteries. If you don't have any aspirin available, do not give the sufferer anything else. No other over-the-counter painkillers will do the same thing.
    • Chewing helps the aspirin absorb faster into the bloodstream than simply swallowing it. Speed is necessary for treating heart attacks.

Treating a Heart Attack Medically

  1. Give a full accounting of the event. Your visit to the hospital or doctor's office will begin with a careful history of your symptoms, with special attention to the timing and characteristics of your pain and associated symptoms. You will also need to give a careful inventory of your risk factors (CVRF).
  2. Get a full medical work-up. You will be hooked up to cardiac monitors by the nursing staff for continuous heart monitoring. The electrocardiogram (EKG) will look for changes consistent with your heart not getting enough blood.
    • Labs will be drawn, including “cardiac enzymes” that the heart puts out when there is damage; these are called Troponin, and CPK-MB.
    • You will likely receive a chest X-ray to look for heart enlargement or fluid in the lungs from heart failure, The cardiac enzymes are drawn three times, once every eight hours, to be most accurate
  3. Get immediate medical treatment. If any of these tests come back abnormal you will be admitted. If your EKG shows elevation of certain segments, you will consult with a cardiologist about having an emergent cardiac catheterization, called angioplasty, to restore blood flow in the heart.[5]
    • A cardiac catheterization involves gaining access to your femoral artery and feeding a wire with dye to take pictures of your coronary arteries, looking for blockages. The number of arteries involved, which arteries are involved, and the precise location of blockages will determine management.
    • Typically lesions of greater than 70% blockage are opened with a balloon catheter and stented. Lesions that are between 50-70% blocked are considered intermediate and until recently were not opened up, but relegated to medical therapy alone. [6]
  4. Get surgery if necessary. Bypass surgery is preferred if you have disease of the left main artery or more than two arteries with blockages. Surgery is scheduled and you will likely await surgery in the coronary care unit (CCU).
    • Coronary Artery Bypass Graft surgery (CABG) involves taking the veins from your leg and harvesting them for transfer to literally “bypass” the blockages on your heart arteries.
    • While this surgery occurs, you are taken into a hypothermic state and your heart is stopped for a period of time, while your blood is circulated outside of your body by a cardiopulmonary bypass machine. The cardiothoracic surgeon can then sew on the heart. The beating would not permit this delicate work, as grafts must be sewn on the heart from veins and arteries.
    • Also, because arterial grafts are better than vein grafts, your own Left Internal mammary artery is carefully dissected out from its location on your chest wall and diverted from its normal course and carefully sewn into your Left Anterior Descending Artery just past the blockage. This gives you the very best chance of having a long-lasting patent graft that will not block up again. The LAD is a very important heart artery, feeding your all-important left ventricle, which is why this laborious process is undertaken.
    • The other coronary blockages are bypassed carefully with harvested vein from the saphenous vein in your leg.

Managing Coronary Artery Disease

  1. Focus on medical recovery. If you had CAD but your blockages were not sufficient to require intervention, you may simply receive suggestions for avoiding further episodes. You may have undergone intervention with angioplasty with blockages less than 70% or you could have had surgery to replace some of the arteries to your heart. In either of these cases, follow your doctor's recommendations about recovery. Make sure to avoid stress and focus on relaxation when trying to physically recover from a heart attack.
  2. Lower your cholesterol. There is significant research that we can lower the risk of heart attack with aggressive cholesterol management.[7] This can be accomplished with medication and lifestyle changes, such as a adopting a healthy diet.[8]
  3. Lower your blood pressure. Blood pressure is a primary risk factor for CAD. In patients with known CAD, a drop in Systolic Blood Pressure (the top number) of just 10 mm/.Hg decreased cardiovascular events by a full 50 percent.[9]
    • There are several classes of drugs, from beta blockers to ace inhibitors, that can help patients lower their blood pressure.
    • Contact your medical provider for suggestions, and a prescription, for a blood pressure medication.
  4. Modify your lifestyle. It is very important to lower your risk of having another heart attack. While this can be helped with medication, it is also your responsibility to make changes to your lifestyle that will lower that risk. Some important changes you can make include:
    • Adopt a low-sodium diet: Adopt a low-sodium diet. This means that your should be eating less than 2 grams of sodium per day.
    • Focus on stress reduction: Some people relax via meditation, a supervised exercise program, and others use hobbies, such as reading or yoga. Music therapy is another suggestion.
    • Lose weight: Get your BMI below 30 via healthy and balanced diet. Consult with a nutritionist or dietician to create a diet that will work well for you. However, with any suspected CAD get your healthcare provider permission prior to starting any exercise program, as exercise may precipitate a heart attack
    • Stop smoking: This is the single most important thing you can do. Cigarette Smoking contributes heavily to coronary plaques and atherosclerosis. It increases your risk of heart attack by between 25 and 45% according to the Framingham Heart Study for primary and secondary prevention, respectively.

Tips

  • With respect to CAD, there are terms called primary prevention and secondary prevention. Primary prevention refers to prevention for people who have never had a coronary event before, despite having risk factors such as family history or diabetes that they cannot change. Research demonstrates that you can significantly decrease the chances of having a first cardiovascular event by optimizing your CVRF ‘s, this is termed primary prevention. If you have CAD and have had an event and are in the category of “secondary prevention” you can still improve our quality of life and live longer by optimization of your CVRF’s and preventing a second cardiovascular event. Research shows it's very possible to reduce your risk for a coronary event.

Related Articles

Sources and Citations

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