Narayana Health Care

One of the most important causes of sudden cardiac death and cardiac arrest is Acute myocardial infarction or Heart Attack . Several lives have been lost the world over due to lack of awareness and education about how to deal with Heart Attack. This is even more so in countries such as India where we have no formal school training on how to deal with medical emergencies.

The number of people dying from Heart attack & cardiac arrests each year is roughly equal to the deaths occurring from Alzheimer’s disease, breast cancer, cervical cancer, colorectal cancer , Prostate Cancer , diabetes, assault from firearms, HIV, motor vehicle accidents, and suicides combined.

In such emergency situations, the first hour is the most critical called the ‘Golden hour’. If the patient receives medical attention in this timeframe, they have a much higher chance of survival. The right intervention at the right time can help save a life. In the case of Cardiac arrest,  the use of CPR (Cardiopulmonary resuscitation) and AED (Automated External Defibrillator), can significantly increase the survival rates to 38%.

The following article details what to do next when you suspect that you or someone around you is suffering from a Heart attack. Make sure that you memorize and bookmark this information, it may help you save someone’s life during an emergency.

Warning signs to watch out for:

Immediate treatment can reduce the damage suffered by the heart and brain and can save lives. So, you should not ignore even the slightest of the heart attack symptoms. A common misconception that people have is that all heart attacks begin with sudden and crushing Chest Pain . However, that’s not the case always. Sometimes, one can have a silent heart attack , where the attack can occur without any symptoms at all, especially to those with diabetes. They may have a slow start with just a slight pain and discomfort and can happen irrespective of whether you are active or at rest. Their severity depends on the age, gender, and medical conditions of the individual.

Some of the common warning signs to look for are:

• Discomfort in the chest that can be described as a recurring pressure or a crushing pain lasting for a few minutes every time it comes.
• Pain and discomfort that go beyond your chest and reach the parts of the upper body, such as one or both arms, back, neck, teeth, and jaw, and the lower part upto the umbilicus.
• Unreasonable shortness of breath, with or without chest pain.
• One might also get cold sweats, feeling of nausea or vomiting, light headedness, anxiety, and unexplained fatigue.
• Women are susceptible to getting additional discomfort in their neck, shoulder, and upper back.

What to do in case of a heart attack?

The first and foremost thing you should do when you are with someone having chest discomfort or other heart attack symptoms is to call 108 (or your respective state’s emergency ambulance helpline) right away.

You may think that the best way would be to drive them to the hospital yourself, but it’s safer and better to get an ambulance if one is available on short notice. Emergency medical services personnel are well trained to handle such emergencies. They can start treatment on the way to the hospital and can also revive a person if their heart stops.

However, if EMS personnel are out of your reach, you must drive the patient to the hospital. In case you’re the one who has the symptoms, don’t drive yourself to the hospital unless there’s no one to help you. If there is someone around you, ask them to stay with you until the EMS personnel arrive.

In many cases, patients doubt whether their symptoms indicate a heart attack or not, and delay the treatment. At times, they stay put because they don’t want to bother others, but it’s always better to be safe than sorry.

Acting fast is critically important to saving a life. A heart attack occurs due to blood clots in the coronaries (arteries supplying blood to the heart issue. There are clot-busting and artery-opening medications that can stop a heart attack if given quickly after the symptoms. Waiting longer for treatment only lowers down the chances of survival. Almost half of the deaths due to heart attacks happen within the first hour of the beginning of symptoms.

What to do until medical help arrives?

• Try to calm the patient down and get them to sit or lie down comfortably.
• You can give them an aspirin to chew or swallow if they are not allergic to it. Intaking an aspirin lowers the risk of a blood clot. During a heart attack, a standard dose of aspirin can slow down the blood’s ability to clot and also reduce the size of the blood clots that might have formed.
• If the person is unconscious, you have to check their pulse and breathing immediately. In case the patient stops breathing, you have to perform CPR right away.
• You should look for someone qualified enough to perform CPR. But if there’s no one, take help from the emergency helpline operator (108) until EMS personnel arrive.

The following steps are followed to start CPR:

1. Position the patient so that they are lying face up. Before that, you need to check for any head or neck injury. Moving the person during an injury can cause paralysis or serious complications.
2. Once the person is on his/her back, you need to push the lower part of  their chest hard and fast. To do that you need to use both your hands, one on top of the other. Use your body weight as well to apply the compressions. You should aim for compression of two inches deep at the least and allow for a full chest recoil.
3. Also, make sure that your arms are straight and your shoulders are directly over your hands. You need to deliver about 100 companions per minute (HANDS ONLY technique)
4. Keep repeating the process until help or the AED arrives. A point to note here is CPR can be an exhausting process. It can be intense as well, and you might break the person’s ribs while delivering compressions. If you get exhausted, ask someone else to continue the process.

Note:

• If you experience any of the symptoms while you are alone, remember to call 108, take an aspirin, unlock your door, and lie down near it. It will be easier to find you.
• If you are in a public space, call out for help immediately and ask whoever is around you to contact emergency services. Make sure to share details of your emergency contact as well as details of any allergies to whoever comes to your aid.

Using an AED:

In case you are able to access or find an AED (Automated External Defibrillator) you can utilize it to revive an incapacitated patient. The AED is a portable device that can check for any irregularity in the heart’s rhythm and send an electric shock to the heart so that the normal rhythm is restored.

You can use the AED on pregnant women also as no significant electrical current is delivered to the fetus. The machine delivers a shock only when it finds that necessary after analyzing the heart’s rhythm.

Follow the below-mentioned steps to use the AED:

1. A defibrillator works best when handled by a professional or someone with adequate training. So, it’s better to find someone who can use it. If you don’t see anyone, you can follow the voice prompts of the machine to use it.
2. Make sure that there is no water or puddle around the person. As water can conduct electricity, avoid using AED in such conditions. You can shift the person to a dry area and then use the machine.
3. If you are having trouble understanding the directions from the AED, take the help of the emergency operator.
4. AEDs have sticky pads that contain sensors or electrodes. Follow the voice instructions while applying the pads directly to the person’s chest.
5. You are good to go now. Press the ‘analyze’ button on the AED to check if the person has a pulse. Ensure that the person isn’t in contact with anybody while checking the pulse.
6. The machine will let you know if a shock delivery is required. Before you press the ‘shock’ button, maintain distance from the person, and ask others to do so as well.
7. Continue with the CPR for two minutes after the shock delivery. If there’s no pulse after two minutes of CPR, use the AED again and follow the instructions.

Be prepared: Prepare an emergency action plan

Heart attacks can come without warning. So, it’s best to stay prepared for the worst. Some of the steps you can take before symptoms occur are:

• Prepare a list of heart attack symptoms and commit it to memory.
• Keep in mind that calling 108 is the most crucial thing you need to do within five minutes of the onset of symptoms.
• Talk to your family and friends about it. Make them aware of the warning signs and the importance of calling 108 immediately.
• Identify your risk factors. Find out what you can do to reduce or eliminate them.
• Prepare an action plan that could help you out with the survival. Your plan must also include the list of medications you are taking, your allergies, your doctor’s number, contact info of people to contact during an emergency, closest hospitals, and routes to avoid traffic. You can keep it in your wallet.
• Arrange for someone who can take care of your loved ones or dependents if an emergency happens.

Dr. Dipankar Das, MBBS, MD, DM – Interventional Cardiology, Narayana Superspeciality Hospital, Guwahati