Heart Attack!

Heart Attack!

It's 3 am. You just woke up. There's a heavy feeling in the center of your chest. You're sweating a bit, and you feel as though there's not enough air in the room. You sit up and open the window to let in some more air, and that helps you feel a little better. You feel a bit nauseous, so you think, "indigestion," and you take some Tums. That should help within a few minutes if it's indigestion. The Tums don't help. You notice that there's a strange feeling of discomfort in your left arm and shoulder and an odd pain in the side of your neck.

Now comes a critical decision point. You...

(a) Go back to bed and talk about it with your spouse in the morning.
(b) Smoke a cigarette, which calms you down while waiting for your doctor to call you back.
(c) Ask your spouse to drive you to the hospital or drive yourself.
(d) Don't do anything; it might just be gas.
(e) Call 911 and tell the emergency medical system what symptoms you're feeling and where you live.

The correct answer is (e). This may seem like an easy quiz when you read it at your leisure, but I've met lots of people in the emergency department who made the wrong decision in real life. Some of them were dead.

Decision (a), going back to bed and deciding what to do in the morning, could lead to two logical, but unfortunate, consequences. You may never wake up again, or you will lose crucial time that we could have used to treat your heart attack and preserve your heart muscle fibers.

Decision (b) is one reason you got into this fix in the first place. Your doctor will just tell you to call an ambulance, so you may as well skip that step. We won't let you smoke any more once you get to the hospital, but that's NOT a reason to smoke that one last cigarette. Every puff has bad IMMEDIATE effects on your heart and lungs. During a heart attack, you need every erg of energy available to your heart and lungs. Once you get to the hospital, we can give medication to calm you down, if you need it. That won't be bad for your heart. You might think, "But that's a drug, I want something natural, like tobacco, to calm me down." Think again. Nicotine is not merely a drug; it's a poison. Poison, even just a little drag of it, is not what you need during a heart attack. And anyway, you shouldn't smoke in bed. When you drop dead, the cigarette will fall out of your mouth, set the bed on fire, and your spouse and family will die in the resulting conflagration.

Decision (c), having your spouse drive you to the hospital, is also not a good idea. If your heart were to stop while in the car, your spouse couldn't do CPR while driving. When you drive yourself and your heart stops, your car won't -- until it hits the next tree. I've met people like that, too, in my capacity as county medical examiner. If your heart stops while in the ambulance, the county paramedic will get out his defibrillator and jump-start your heart right away.

Decision (d) is fine if it's just gas. If you decide to stay home with a heart attack, it could be the last decision you'll ever make. It's difficult for us to make the diagnosis until we've done a history, physical, EKG, and lab tests. Sometimes we need to observe you in the hospital for a day or two. We'll understand if you come in for chest pain and it turns out to be "just gas."

The reason that decision (e) is correct is that the symptoms I described in the first paragraph (in case you hadn't already made the diagnosis or read the title of this article) are typical symptoms of a heart attack. When you're having a heart attack, you are critically ill, even if you don't feel all that bad. The definition of being in critical condition is that you might die at any moment. When you're having a heart attack, that's an immediate possibility. It's our job to prevent your death, and we can't do that job if you're home in bed sleeping or smoking a cigarette.

In the hospital, we can put you on a cardiac monitor. If your heart starts to beat erratically, we treat it before it stops entirely. Or we defibrillate your heart if it does stop. This works best if done immediately -- hence the monitor, which sounds an alarm when it doesn't sense a heart beat every second or so. Coronary care units and monitors have saved millions of lives in the past thirty years.

Besides keeping you alive, our job also includes keeping your heart from weakening because of the heart attack. If you live, but end up with a weak heart, you may not be able to go back to your work or your hobbies. Surfing the net may be fun, but wouldn't you like to be physically able to do something else besides sit in a chair, breathe oxygen through a tube, and surf the net? We need your help to protect your heart from being damaged by the heart attack.

Your job is to get to the hospital just as soon as possible so that we can dissolve the blood clot that's causing the heart attack. That protects you from losing valuable heart muscle fibers. When you're having a heart attack, "Time is muscle." That little catch phrase means that, once you start having a heart attack, there's a part of your heart that's not getting a blood supply. It's blocked by a blood clot in one of the coronary arteries (the arteries that supply blood -- containing oxygen and nutrition -- to the heart muscle).

You may have heard the term, "coronary thrombosis." When you get a coronary thrombosis, the part of the heart that's not getting blood is unable to beat, so it stops. The rest of the heart keeps on beating if you're lucky. That's why people can survive a heart attack. But after a while, those muscle fibers that aren't beating, start to die. Some of the muscle fibers die right away. Others take a few hours to die. The goal of treatment is to keep as many of the muscle fibers of your heart alive as possible. Losing muscle fibers is about like losing cylinders in your car's engine. Without all the cylinders, the car's engine is not as powerful. Without power, your car may not be able to do things like accelerate or go uphill. Without power in your heart muscle, your body may not be able to do things like run, walk up steps, or walk on level ground depending on how many muscle fibers are left. Once heart muscle fibers are dead, they are replaced with scar tissue. Scar tissue can't contract, so part of your heart is then unable to help with the task of pumping blood around your body.

We use TPA, the "clot-buster" medication, to dissolve the clot in your coronary arteries. This works best if done within the first hour or two of your heart attack. Within two hours, most of the muscle fibers in the area of the heart that's affected can be saved. That way, your heart will still have most of the muscle power it had before your heart attack. If TPA is given more than six hours after the beginning of your heart attack, it may not help you very much at all because most of the muscle fibers in the affected area are already dead.

So if you have symptoms of a heart attack, come to the hospital right away, by ambulance. Remember, there's a certain delay that's unavoidable. It's going to take you fifteen minutes to decide that it's not just gas and call the ambulance. Even in the best of situations, it will take five minutes for the ambulance to arrive. If you live out in the country, it could take up to a half hour. Say it's fifteen minutes. That's already a half hour of time that part of your heart muscle has not been getting oxygen. Then it takes another fifteen minutes for the ambulance people to get you loaded up and get you to the hospital. That's three quarters of an hour gone. Once you're at the hospital it takes another five minutes to get your EKG done. If the EKG shows a heart attack, they need to make sure that the TPA won't harm more than help by causing a stroke or uncontrolled bleeding from somewhere inside your body. The ER staff will try very hard to be sure it's safe to use the "clot-buster" medicine, to explain the situation to you and get your consent, and to get the TPA into your blood stream within a half hour so that the heart muscle fibers can be saved. None of that rapid response helps a bit if you waited four to six hours before you even called the ambulance.

Even better than treating your heart attack quickly is preventing it in the first place. That's the subject of an entirely different article. The gist of that article would be "Get a checkup including measurement of your cholesterol and high density lipoproteins, and FOLLOW YOUR DOCTOR'S ADVICE after that checkup." That advice is likely to be -- "Quit smoking, lose weight, and get regular exercise."

(I don't smoke, and I do ride a bicycle. Two out of three....)

Henry Farkas, M.D., M.P.H. is a board certified emergency room (ER) physician and Fellow of the American College of Emergency Physicians. He has been an ER physician at Union Hospital in Elkton, Maryland USA for the past 21 years. In addition, he has been medical director of Northern Chesapeake Hospice and the president of his county medical society for the past ten years. He earned his M.D. and his Masters of Public Health from Johns Hopkins University. He and his wife write articles for laymen on medical subjects as a means of preventing illness. Prevention is always better than treatment, maintains Dr. Farkas.

Carolyn Farkas has a Ph.D. in medieval literature. Nobody is writing medieval literature anymore, so she writes modern literature. She has had poetry, short stories, and essays published. She has been teaching at Cecil Community College for the past 21 years.

For more information on heart attack and, even more importantly, on how to keep your heart healthy, go to:

American Heart Association: http://www.amhrt.org/

For a list of heart attack symptoms, go to:

Heart attack symptoms, American Heart Association: http://www.amhrt.org/heartg/ag06.htm

Article Source: American Heart Association

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