Surviving a heart attack: What to know, what to expect

Diagram of an atherosclerosis-caused heart attack. - Courtesy of the Bellevue Fire Department
Diagram of an atherosclerosis-caused heart attack.
— image credit: Courtesy of the Bellevue Fire Department

Ideally, everyone would learn to take every health precaution to avoid a heart attack. Ideally.

But heart attacks will happen, a fact recognized by the Bellevue Fire Department. So instead of spending Heart Week 2014, their annual education campaign on cardiac issues, discussing well-tread prevention measures, they changed tactics to discuss what to do after The Big One has already commenced.

“For years, we’ve talked about lowering your cholesterol, lowering your blood pressure, exercising, stopping smoking,” said Lt. Richard Burke. “We still want you to do all of those things. Absolutely. But every day, 365 days a year, while we’re standing here, there are 46 cardiac-related events. Every day.”

The good news is, if you have to have a heart attack, Bellevue is the place to do it. The department reports a 57 percent survival rate, well above the 2013 national rate of less than 10 percent.

The department would like to see that rate increase, Burke said.

“When we talk about a 57 percent save rate, for us that’s people,” he said. “That’s lives. They get to go home.”

What is a heart attack?
Dr. David Nelson, a cardiothoracic surgeon with Overlake Hospital, pointed to a diagram of the human heart. It didn’t look good. Spotted in deep purple bruises, the picture more closely resembled a rotten peach than the organ responsible for pumping blood throughout the body.

“Those purple spots are places where the heart isn’t getting oxygen,” Nelson said. “That’s what a heart attack is.”

Coronary disease occurs when oxygen-rich blood is suddenly cut off from the heart. This can happen from an arterial spasm that squeezes the blood pathway shut — a condition that can be associated with factors like smoking, cocaine use or cold shock.

A more common cause of heart attack is atherosclerotic plaque rupture. Plaque builds and builds in the arteries over time until a section breaks and the resulting clot blocks the path of blood.

“When the clot forms, that’s the heart attack,” Nelson said.

The classic warning sign of an impending heart attack is exertional chest pain, Nelson said. Your chest hurts when you’re walking, for example, and stops when you’re not. The same goes for shortness of breath.

This is because physical activity requires a greater flow of blood through the heart and to the rest of the body. In a person suffering from atherosclerosis, blood has less room to move and the heart has to work harder to move it.

“Hundreds and hundreds” of patients have come into Nelson’s office after months of simply not feeling well, he said. They didn’t realize their malaise had been the sign of underlying heart disease.

The Signs
Contrary to popular perception, heart attacks don’t always arrive in the form of world-stopping chest pain, Burke said. More common is the onset of mild pain and discomfort.

The same chest pain and shortness of breath that indicates heart disease can also indicate the heart attack itself.

Women can experience a heart attack differently, as aches and pains in areas other than the chest like the jaw or elbow.

People with diabetes can miss pain signs altogether if chronic high blood sugar has caused nerve damage in their extremities.

There are signs that can’t be confused, such as pallid discoloration of the skin or profuse sweating.

But the key is to know the signs that could even hint at a heart attack. According to a 2011 article on Acute Coronary Syndrome by the American Heart Association, most hospitals try to reopen a blocked artery and get oxygenated blood pumping again within four hours of an attack.

“Time is tissue,” Burke said.

Keep in mind that the sufferer of a heart attack should not lay down on their back. Heart attack sufferers can become nauseated and aspiration of vomit complicates medical care. The sufferer should lay or be lain on their side — their right side if they are pregnant.

Got any aspirin?
If you believe you’re exhibiting the symptoms of a heart attack, one of the steps you can take to minimize the fallout is to take one large — 325 milligram — aspirin or four baby aspirin, Burke said.

Because aspirin is a blood platelet inhibitor, it can help prevent blood clots from growing and causing total blockage of an artery.

A study published in the Journal of American Cardiology found that, when 12 volunteers had their levels monitored after taking aspirin by three methods — chewing it, swallowing it with water and drinking an Alka Seltzer solution. Chewing was most effective, achieving platelet inhibition within five minutes.

Thinking of it as an investment, aspirin is the penny stock that winds up paying blue-chip dividends. Burke recalled a local year-long double-blind study of the effectiveness of streptokinase, an anti-clotting drug that cost $2,400 per dose, against 12 cents of aspirin. The results showed aspirin to be more effective in the field, he said.

On the phone
Once you’ve called 911, time is of the essence and EMTs will need to make it to the heart attack victim as soon as possible. Dispatchers will thus try to get as much detail as possible about the location of the attack.

What’s your address Are the numbers of your home visible from the street. Is there anything distinctive about your home? What color is it?

It pays to memorize these details before there is an emergency, Burke said.

On arrival
Dispatch will ask about the nature of the emergency when you call 911 but, remember, heart attacks aren’t always easy to identify. The caller, not understanding what they’re seeing or experiencing, might not explicitly communicate “heart attack” over the phone.

But that’s why EMTs will assess the scene again when they arrive, Burke said.

“They’re going to ask a whole bunch of questions,” he said. “When did this start? That’s critical. What does it feel like? Have you ever had this pain before? And, if you did, when? Pretty critical questions.”

The technicians will begin stabilization procedures as needed — and if a knowledgeable bystander is able to perform CPR before technicians arrive, it can make a difference in the patient’s recovery, Nelson said.

Another valuable preparatory measure is to pick up a “Vial of Life,” a five-inch vial where you put forms with any special medical needs, such as prescribed medicines. Keep the vial in the fridge, where technicians are trained to search. Vials are free and can be obtained through the North Bellevue Community Center or the Medic One Foundation.

At the hospital
In the first five minutes of arriving in the emergency room, staff will begin suspected MI (Myocardial Infarction) protocol. An EKG is obtained right away and the hospital gathers registration and admission information.

At five to 10 minutes, Nelson said, an emergency room physician will verify a heart attack is taking place and begin an acute heart attack protocol. That protocol alerts several people within the hospital, including the catheterization lab team, the rapid response nurse and the critical care unit.

At 10 to 15 minutes, the physician has spoken to the cardiologist who will oversee percutaneous coronary intervention.

At 15 to 40 minutes, the physician will talk to family and inform them about what treatment is taking place.

At 40 to 50 minutes, as soon as the cardiologist and cath lab nurse are in the hospital, they contact staff to place the patient in the cardiology room, where they will be subjected to an angiogram and treatment.

Overlake Hospital’s goal is to have the artery reopened in 90 minutes, Nelson said.


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