- Diseases, Disorders & Conditions
What You Should Know about Heart Attacks
Heart attacks, unlike angina, come out of the blue. They can as easily start in bed, or sitting watching television, as when playing squash, or losing your temper. They may strike when relaxing after a period of intense physical or mental stress. The attack that tragically ended the life of Jock Stein, the great Scotland soccer manager, happened just after his team scored the goal that put them into the Finals of the 1986 World Cup. His anxiety suddenly gone, he relaxed, and the heart attack started.
There are at least three heart attacks arising in similar circumstances:
- a 39-year-old professor who collapsed minutes after winning a grueling game of league squash
- a 51-year-old doctor who died on the beach after rescuing a small child from drowning
- a 61-year-old businesswoman who had a heart attack half an hour after fighting off a would-be mugger in the street.
There may be a common link between them. In each case their blood pressures would have been very high in the period just before the attack, then dropped suddenly. This sudden change may have been just the stimulus needed to block off the flow of blood in one of the main coronary arteries. The heart rhythm may have been disturbed, and the chaotic beats that followed led to injury to the heart muscle.
In the case of two of the four - the football manager and the - doctor, the damage was too great to survive. The professor and the businesswoman happily survived.
However, this is not the only pattern. People have fallen as if pole axed while running for a bus, or suddenly pitched forward while reading, near bedtime. Heart attacks have taken people while asleep in bed or in an easy chair.
What does a full heart attack feel like? Survivors of the immediate attack describe the sensation very consistently. You feel a chest pain that is 'gripping' or Tike a vice' that goes on and on, unlike angina, even at rest. You may mistake it at first for indigestion, and try antacids and other 'stomach remedies' to clear it, unsuccessfully.
If you are already prone to angina attacks, you may delay asking for help in the belief that it is just another of the same. However, it is usually much more intense, and more persistent, and does not disappear with rest.
The centre of the pain is usually behind the breastbone, often higher, rather than lower, but it may spread from there to the jaw, neck, arms, back and into the upper abdomen, between the ribs. You become restless and anxious, and break out into drenching cold sweat. Onlookers see you as very pale and ill. You will know that this is something different from an angina attack. The moment that you realize this, ask for help.
If you are caring for a person who has suddenly entered this state, you must ring immediately for help. In most developed countries there are mobile coronary care services on an emergency telephone available to anyone. If you cannot immediately contact a doctor, then call that service. You will find that the response is fast and highly professional, with fully trained 'paramedic' ambulance men and women who know how to deal with any heart problem.
In the unlikely event that neither doctor nor coronary ambulance is immediately available, then arrange to drive the patient to the nearest hospital with an emergency unit, avoiding all unnecessary noise, fuss or excitement.
The patient must be kept at rest all the time until he or she has professional help. In the meantime, the only medicine you should give is one tablet of aspirin: this will do no harm, and may just help by preventing further clotting in the coronary artery concerned.
If it is happening to you, try to remember that if you keep quietly at rest, and let everyone around you take all the strain, mental and physical, you have an excellent chance of survival. Don't try to organize yourself or to put last minute things in order - they can all wait until you come back, no matter how urgent they seem. Don't attempt to walk, or pack, or put on make-up or shave - just lie there and give your heart a chance to get into its resting state.
Absolutely, do not try to drive yourself! (That may seem unnecessary advice, but I would bet that every family doctor has witnessed the results of just such a decision by a very sick patient.) As for drugs, chew, then swallow one aspirin with a little water, but that is all. Have a list of any drugs you may be taking to show the ambulance or hospital staff.
Once you get into the hands of the ambulance men or emergency doctor, you will start to feel better, even before you are given anything more. Now 4s-the4jme really to relax and lie back, because the risk to your life will rapidly-diminish from now on, as the cardiac team take control.
Things will now begin to happen in quick succession. You will be linked up to machines to monitor your EEG-and blood pressure. You will be given an injection to combat the pain and the anxiety. Blood tests will be taken to measure the extent of the heart muscle damage, if any; and you will be admitted to an intensive care ward, where every change in your condition will be monitored.
Visiting an intensive care ward when you are well can be frightening. Being a patient in one when you need the care is unbelievably reassuring and preferable to any other environment. So, if you are having a heart attack, don't hesitate to accept intensive care.
If, instead, you are caring for a heart attack victim at home, accept the advice that he or she should be admitted to intensive care. There is plenty of proof that the chance of survival is better, and that the quality of life after survival is now better after intensive care therapy.
What is it about intensive care that makes it so much better than home treatment? To understand the answer you must know what happens to the heart in an 'attack', and the complications that may follow. These complications must be reversed immediately - something that cannot be done at home.
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