Managing Cardiac Events

There are so many things that can go wrong with the cardiovascular system, leading to a heart attack, stroke, or other cardiac emergency. As a cardiologist, I think it’s important to keep the information we share with the public as simple as possible—because when a cardiac event occurs, you usually only have minutes to respond, so there’s no need to waste time trying to figure out if a victim is suffering from a “myocardial infarction” (heart attack) or a “pulmonary embolism” (the clotting of blood vessels in the lung). It’s best to leave such technical details to the doctors, whereas the most urgent issue for the bystander is to call the *9999 emergency number* and perform Cardiopulmonary Resuscitation (CPR). If a patient experiences an intense gathering pain in the chest that feels like a blockage or a heavy pressure within the ribcage, time is the critical factor, and it’s important to stick to the basics.

What many people don’t understand about CPR is that it’s not exactly a treatment for cardiac arrest in itself. The heart muscle is a pump controlled by electrical impulses, delivering oxygen-enriched blood to every system in the body. Death encroaches very quickly if the pump fails, as many of the body’s systems will shut down within minutes without oxygen. CPR is a technique to manually squeeze the blood through the 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 in an ambulance with the equipment to get the heart working again.

One of those pieces of equipment is called the defibrillator. Many people have seen this device in movies, where it is often used in the most dramatic cases of cardiac arrest. What isn’t well known is that the defibrillator is perhaps the most critical lifesaving element in most heart attacks—because contrary to common understanding, 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—a total electrical storm in the heart. There’s a lot of electrical activity, but no mechanical coordination. For the heart to work effectively, there must be good synchronization between its parts to keep the blood flowing in the right direction. If the cells are going crazy and contracting randomly, then the pump will fail even if there’s no blockage or damage to the muscle.

To save a patient’s life, you need to stop that storm immediately, because no one can survive without circulation for very long. To beat the storm, you need to administer a powerful electrical attack to overcome the chaos within the heart—so we place the defibrillator pads on the chest and blast the patient with a solid burst of energy. The desired effect is that the heart will be immediately paralysed, just for a moment; then everything will reset, and the heart’s normal electrical activity will be resumed as things start up again.

There is no doubt in my mind that defibrillators should be everywhere. It’s often the case that bystanders will manually pump a patient’s heart via CPR until a specialist arrives with a defibrillator; sadly, the majority of people who fall victim to this situation aren’t so lucky. Ambulances may take time to arrive, and the people standing by may 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, for example. Five star hotels should definitely have one—travelers nowadays tend to consider spending their week in paradise where this kind of medical equipment is available, and Vietnam is sometimes skipped on international itineraries because of the lack of such medical facilities in its resorts.

I would go further to suggest that defibrillators should be installed in public places and on any business premises. The reason why is simple—the main cause of heart attacks is electrical trouble, and the main treatment is the defibrillator. An excellent semi-automatic defibrillator can be purchased for one or two thousand dollars; they’re not difficult to use, and the audio instructions tell you exactly what to do. Anyone with a basic understanding of how to use the machine can apply the pads and follow the instructions to give the patient the best chance of recovery.

Rebooting the cardiovascular system is often the answer to overcoming an emergency. Sometimes it takes a little more than that, which is why you want to have a medical professional arriving in an ambulance as soon as possible after the event occurs. Treatment can begin immediately upon ambulance arrival, and in some cases it’s even necessary for a doctor to open the arteries or perform an IV before transferring the patient to an interventional unit. This is the importance of rapid response, and the reason why you should call the medical emergency hotline as early as possible.

The path to restoring true health for the heart is a process that takes a far longer time. Sometimes the heart has been damaged beyond repair, and transplantation is the only option. This is nothing simple—such a patient would have to undergo a medical evacuation, usually to their home country, to be put on the national waiting list while the search for a compatible donor gets underway. Here in Vietnam, where heart transplants are—shall we say, “less trendy”—prospects would be grim, especially for locals without the option of going overseas.

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. In fact, I can establish the most likely causes of the event just by asking a few simple questions—how old are you, are you a smoker, and do you suffer from hypertension or diabetes? Following that, there are 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 buildup 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 the treatment should be. 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.

If all that seems like a huge rigmarole, it most certainly is. The key here, of course, is to avoid a situation where you’re at risk of a heart attack or cerebral stroke, or needing extensive medical treatment or even a transplant following a heart failure. Certainly call for help if you start to experience symptoms of an impending attack; it’s much better to get to the emergency room before you drop rather than leave yourself at the mercy of bystanders who may or may not know CPR while the clock is ticking. Before even that is a danger, make those lifestyle changes before you need them for recovery, before your life is threatened by a cardiac event. Eat better (especially cutting down on your cholesterol intake), quit smoking, and fit some exercise into your day. If you have even borderline high blood pressure, this needs to be carefully managed—high blood pressure remains one of the leading causes of mortality worldwide. Especially 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 make sure to avoid them as much as possible.

*In case of medical emergency, dial *9999. Callers will receive advice, rapid emergency response, and in cases such as stroke or myocardial infarction, medical treatment begins immediately upon doctor arrival.

Dr. Nguyen Forton Guillaume Ngoc Kim is in charge of cardiology at Family Medical Practice’s clinic in HCMC. He has had 25 years of experience in both Cardiology and intensive care units in France, and has been in Vietnam for over a decade.