When cardiac events occur, there are only a few minutes to respond. There’s no time to figure out if a victim is suffering from a myocardial infarction (heart attack) or a pulmonary embolism (clotting of blood vessels in the lungs). It’s best to leave the technical details to the doctors. The most urgent issue for a bystander is to call an emergency number and perform cardiopulmonary resuscitation (CPR) if needed. It’s important to stick to the basics.
CPR is not a treatment for cardiac arrest itself. The heart muscle is a pump controlled by electrical impulses, delivering oxygen-enriched blood throughout the body. Death comes quickly if the pump fails. Many of the body’s systems will shut down within minutes without oxygen.
CPR is performed to squeeze blood through arteries by putting pressure on the heart’s chambers. While this may not do anything toward fixing the pump itself, it can delay the shutdown of the rest of the body for long enough to allow a doctor to arrive with the equipment to get the heart working again.
One of those pieces of equipment is the defibrillator. Often seen in the movies, it is used in the most dramatic cases. What isn’t well known is that the defibrillator is the most critical lifesaving element in heart attacks. Contrary to common belief, the cause of most fatal heart failures is not that the heart has suddenly stopped beating; it’s actually rhythm trouble. It’s like a drummer who can’t keep time, and the music just can’t go on without that regular pulse. We call this ventricular arrhythmia — an electrical storm in the heart. There’s a lot of electrical activity, but no mechanical coordination.
To save a patient’s life, the storm must be stopped immediately — no one can survive without circulation for long. To beat the storm, a powerful electrical attack must be administered to overcome the chaos within the heart. The defibrillator will paralyse the heart, then everything will reset, and the heart’s normal electrical activity will resume as things start up again.
Defibrillators should be everywhere. It’s often the case that bystanders will manually pump a patient’s heart with CPR until a specialist arrives with a defibrillator. Sadly, however, most bystanders have no idea how to perform CPR properly.
Cardiologists like myself now recommend that defibrillators be installed widely, just as fire extinguishers are often found in public buildings. They’re now found on planes and private yachts. Five-star hotels should definitely have one as travellers nowadays tend to have vacations where this kind of medical equipment is available. Vietnam is sometimes left off itineraries because resorts here rarely have appropriate medical facilities. I would go further and suggest that defibrillators should be installed in public places and on any business premises.
Putting Your Heart Into It
When I see a patient who has recently suffered a cardiac event, I need to follow a whole diagnostic process to understand what course of treatment needs to be administered. Following that, I use a number of tools at my disposal to narrow things down. I can perform a Doppler ultrasound to check the carotid arteries for clots from the heart or a build-up of plaque constricting the blood flow. I can run a Holter Electrocardiogram (ECG) to detect rhythm trouble that could manifest in another attack. I can also perform a cardiac echo test to check for damage in the heart muscle itself and assess the extent of that damage.
This, combined with a thorough physical examination, is usually enough to know what treatment is required. I may need to perform an invasive procedure to insert a small balloon into the carotid artery to push out a blockage, or I may need to prescribe a series of medicines to dissolve clotting in the blood. Besides that, a recovering patient may need to make significant lifestyle and dietary changes to avoid further stresses on the heart and its systems, in particular regarding cholesterol intake.
The key is to avoid a situation where you’re at risk of a heart attack or cerebral stroke. Call for help if you start to experience symptoms of an impending attack; it’s better to get to the emergency room before you drop than leave yourself at the mercy of bystanders who may or may not know CPR.
Make those lifestyle changes before you need them for recovery; before your life is threatened by a cardiac event. Eat better, quit smoking, and fit some exercise into your day. Manage your blood pressure, as high blood pressure remains one of the leading causes of mortality worldwide. If you’re over 40, visit a cardiologist to have a cardiac assessment done so that you know your risk. There are so many factors that can cause cardiovascular disease, and you want to avoid them as much as possible.