Archive | February 9, 2012

Time is Muscle: How to Handle a Heart Attack

By Dr. Beth Renwick, Emergency physician at Lexington Medical Center

Dr. Beth Renwick, LMC Emergency Room physician


A heart attack is caused by a blockage of blood flow in the arteries that supply the heart muscle. Most often, blockages are caused when plaque ruptures within the artery. Plaque, which builds up over many years, does not cause any symptoms unless it suddenly breaks open. This rupture forms clot within the artery and halts blood flow, and therefore oxygen delivery, to the muscle cells supplied by that artery.

If not treated quickly, heart muscle can begin to die, leading to heart failure, dangerous abnormal rhythms (called arrhythmias) or death. It is of the utmost importance to be immediately evaluated at your nearest emergency department if you are having any symptoms of a heart attack. These symptoms may include chest pain, shortness of breath, nausea, vomiting, lightheadedness, dizziness or sweating. Chest pain may be described as a discomfort, pressure or squeezing. People sometimes feel this pain in other locations such as the neck, jaw, back, one or both arms or upper stomach.

Generally, men experience the classic symptoms of a heart attack. Women may experience more atypical symptoms such as fatigue, shortness of breath and weakness. Fewer than 43% of women will actually experience chest pain during an attack. A new study by the National Institute of Health states that women can show signs up to a month before a heart attack of sleep disturbance, unusual fatigue or shortness of breath.

If you or someone you know may be having a heart attack, call 9-1-1 immediately. Do not drive yourself or have someone drive you to an emergency room. Paramedics can begin lifesaving therapy on the way to the hospital and treat life-threatening arrhythmias. If you have time, chew a 325mg aspirin, which will absorb faster than a whole pill. Take a nitroglycerin pill if you have a prescription. If the patient loses consciousness while waiting on an ambulance, perform compression-only CPR at a rate of 100 compressions per minute. If you are unsure of what to do, 9-1-1 operators can instruct you by phone. If you have access to an automatic external defibrillator (AED), begin CPR until you can turn on the AED and apply it to the patient. If you saw the patient collapse, apply the AED right away. If not, attach it after one minute of CPR.

On the way to the hospital, you will likely have an electrocardiogram (EKG). Sometimes changes on the EKG will indicate that you need to skip the emergency room and go directly to the cardiac catheterization lab, where they can use equipment to open blocked arteries expediently.

When you arrive at the hospital, expect a flurry of activity. Emergency staff will attach an oxygen monitor and cardiac monitor by applying stickers to your skin. They will also draw your blood, obtain an EKG and place one or two IV lines. You will receive an aspirin if you haven’t taken one already and possibly medications to alleviate pain or lower high blood pressure. You may receive a chest X-ray or other tests depending on your symptoms. Be prepared to tell the nurse or doctor about your medical history, current medications and allergies. It is imperative to know if you took any medications for erectile dysfunction as treatment for chest pain may cause an unsafe drop in blood pressure.

The most important thing to remember is that time is heart muscle! Immediately call 9-1-1 if you or someone you know is experiencing symptoms of a heart attack. Prompt treatment can prevent or minimize any permanent heart damage and subsequent complications.

Keep in mind that not all chest pain is caused by heart disease. Evaluation by a doctor along with medical tests can help determine the cause of your chest pain and based on that, appropriate treatment can be given.

References:
http://www.nhlbi.nih.gov/health/health-topics/topics/heartattack/
http://usgovinfo.about.com/cs/healthmedical/a/womensami.htm