Affairs of the Heart

Cardiovascular or heart disease is now the number one leading cause of death in both men and women according to The American Heart Association. Symptoms of heart attack usually include squeezing or crushing chest pain, often described as “It feels like an elephant is sitting on my chest.”  Many times this chest discomfort is accompanied by shortness of breath, clamminess or profuse sweating called diaphoresis, pain down the left or both arms, pain in the neck or in the jaw, and nausea. Sometimes the pain is described as feeling like severe indigestion. A person may have any combination of these symptoms, only one or in the case of many diabetics, no symptoms at all. In the cases with no symptoms, we call this a silent heart attack, or silent MI. MI stands for myocardial infarction, the medical term for a heart attack.

While the symptoms previously described are the typical presenting patterns, it is important to note that a woman is far more likely to die of a heart attack, because women more commonly present with atypical cardiac symptoms, for example, rather than crushing chest pain , a woman may present with complaints of just not feeling good in general, or feeling “unplugged,” like all of the energy drained out of her  She may complain of cardiac equivalents like abdominal pain, pain in her shoulder or back, or even cramping in her hands or feet. Because these symptoms are often passed off as something else, valuable time may be lost in obtaining life – sustaining care.  Then there are the gender biases that cause women’s complaints of pain to be dismissed as insignificant far more often than occurs in men. This is significant because heart attack survival diminishes exponentially with treatment delays.

Time is of the essence when it comes to managing a heart attack.  Lives are usually either saved or lost before the patient ever even arrives at the hospital, determined by how quickly the patient receives pre- hospital care. There are two components of prehospital care that are of major significance. There is an electrical opponent and there is a mechanical component. The heart consists of four muscular chambers that pump the blood. These are the mechanical component. The pumping action is triggered by an electrical impulse that triggers the chambers to beat in a certain rhythm. This is the electrical component. A heart attack can be caused by heart muscle not getting enough oxygen to be able to pump effectively or by disruption of the electrical activity that normally causes the heart to beat rhythmically, amongst other reasons. At the end of the day, for a person to survive a heart attack, both the mechanical pump and electrical generator must be addressed (sounds kind of like your well, huh?)

There are two things that we as a community can do to provide rapid, adequate, life- saving pre- hospital care. We can address the mechanical needs of the heart by learning cardiopulmonary resuscitation (CPR). This is a method by which we use external compression to manually force silent heart muscle to pump life sustaining, oxygen rich blood to the heart and brain, until spontaneous and effective circulation can be re stored. We must also address the electrical needs of the heart by knowing how to use an automatic external defibrillator (AED), a device that searches for and analyzes the electrical activity of the heart and its rhythm, then provides an electrical shock, if needed, to put the heart back into an effective rhythm. Now I know the latter sounds daunting to non-medical personnel, but AED’s have become so refined in the past few years that they now do essentially all the thinking for you and then even verbally direct you as to what to do at any given point in the electrical resuscitation effort.  Even a child can now perform the tasks. Again, time is of the essence.

In the event of a cardiac arrest, the heart ceases to pump blood with life- sustaining oxygen to the brain and heart. After 4 minutes without oxygen, both began to suffer significant, often irreparable damage. Keeping the heart pumping and re- establishing the normal electrical activity of the heart as soon as possible determines the outcome of life or death cardiac events. Do NOT forget to dial 911, but in the case of rural living or situations where it may take emergency medical services more than 30 minutes to respond, it becomes essential that lay community members are trained in both CPR and in the proper use of an AED.  You never know when you may get to be a real life superhero!