Galway City Tribune
Friday 6 July 2012
Health Watch
With Dr. John Ryan
The characteristic chest pain of a heart attack is persistent, in the centre of the chest and severe, and often described as squeezing, pressing or tight. It is often accompanied by seating, faintness, nausea or vomiting and shortness of breath. The pain may start in your chest or one or both arms, more commonly the left, and into the neck, back and abdomen.
If any severe chest pain lasts for more than 15 minutes without easing, it should be assumed to be a heart attack and you should seek help immediately.
The warming signs of a heart attack vary, however, and one or more of these may occur. It is possible to have no pain, or the only sign may be indigestion-type pain.
Overall, this sequence of events is advised by the Heart Foundation:
- If you have had angina or a heart attack in the past and carry GTN, use your GTN tablet or spray under the tongue. Wait for five minutes and if the pain has not eased, repeat the spray or tablet. Repeat again if unrelieved after a further five minutes.
- Let someone know that you are or have been feeling unwell.
- If the pain has not improved after 15 minutes, dial 999 for an ambulance and say you think it might be a heart attack and then call your doctor.
- Chew an aspirin tablet – unless you are allergic to it.
- Sit in a comfortable position and rest quietly until the ambulance arrives.
During a heart attack, the part of the heart deprived of blood does not function properly. The pumping action could weaken, blood pressure may fall and the entire heart may become affected and cause abnormal heart rhythms.
The severity of this may cause uncoordinated electrical activity in the heart muscle, and the heart will stop beating effectively (cardiac arrest).
This is life-threatening and requires attention from a defibrillator that gives the heart a small shock to restore the heart rhythm.
These early minutes after a heart attack are critical and the reason why prompt action is so important. DO NOT drive yourself or have someone else drive you to the hospital. Dial 999 immediately, requesting an ambulance.
Remember, severe chest pain or sudden onset requires immediate action! If you are someone in this situation, bear in mind that people often play down their symptoms, and you should never take a chance. Insist on prompt action – it saves lives! People who have previously had angina or a heart attack are likely to recognize a heart attack occurring and statistically re more likely to have another one.
How do I know if someone has had a cardiac arrest?
- The person is unconscious
- Their heart has stopped beating
- Their skin turns pale or blue
- You feel no pulse.
What should I do?
Act fast: get someone to call for skilled help.
Start CPR (cardiopulmonary resuscitation)
Call an ambulance: dial 999 and call the person’s family doctor, if you know who they are
If you do not know how to do CPR, open the airway and start rescue breathing.
Ambulances attending people with chest pain generally have a paramedic crew member trained in coronary resuscitation. They will also have all the appropriate equipment, the drugs they will need, and a defibrillator, which can deliver a measured electric shock to the heart, should a dangerous heart rhythm occur.
They will also have an ECG monitor and set up an intravenous line to enable the doctor in the cardiac ambulance to give you drugs quickly and effectively. You may be given aspirin and pain relief by the ambulance officer. The west of Ireland has been a world leader in this regard as many ambulances in Dublin do not have a doctor in them.
On arrival at hospital you will be treated in the emergency department. ECG leads will be attached to your chest and limbs and linked to monitors at the nurses’ station.
The first task is to decide whether or not a heart attack has occurred. This may be possible to diagnose from an ECG tracing and a bedside blood test for cardiac enzymes, released into the bloodstream by damaged heart muscle cells.
Often the characteristic ECG changes do not develop for several hours. Cardiac enzymes released into the bloodstream may be assessed by various blood tests.
You will be given a variety of medication to help in your recovery process, such as aspirin to thin your blood, morphine to control pain and possibly others for treating persisting or dangerous abnormal heart rhythms.
If appropriate, a clotbusting (thrombolytic) drug is given through the IV in your arm. Then you will be transferred to the Coronary Care Unit, and your progress monitored by specially trained nurses.
Staff will decide when you can start to walk around and, if there are no problems you can look forward to going home in a few days.