I was prompted to write about this when, in the last week or so, a couple of patients presented with upper back-pain in between the shoulder-blades and dismissed them off as ‘muscular aches’. In both cases, they turned out to be impending heart attacks. So what kind of symptoms are produced when the heart’s in trouble?
The reality is not all heart attacks happen suddenly and dramatically as in a TV drama where you clutch your chest in pain and fall to the ground. In many instances, the warning symptoms appear but are ignored because they appear in unusual parts of the body and may fade off after a while, only to reappear again especially when the heart is stressed.
The classical symptom is that of central chest-pain or pressure, not unlike someone standing on your chest. But sometimes, the pain can be in unusual locations include jaw or teeth pain, leading to a visit (wrongfully) to the dentist. An alert dental surgeon can recognise the differentiating features and refer the patient on to the cardiologist for urgent attention.
Another location for heart-attack pain can be the so-called interscapular area (the part between the shoulder-blades), even without chest-pain. Often, the pain can be excruciating with possible pain-free intervals, leading one to a false sense of security with disastrous consequences; because time is crucial in such circumstances : the well-known ‘golden hour‘, named because early treatment during an evolving heart attack can mean the difference between life and death.
Pain need not always be present as a heart attack develops. Especially in diabetics, breathlessness can be the only symptom. Of particular note is progressive deterioration of stamina, such as walking up a staircase.
Getting treatment within an hour of a heart attack cuts your risk of dying from it in half, so it is important to get to the nearest Emergency Department of a large hospital in double-quick time. Sometimes it may be better to rely on one’s own transport than to wait for an ambulance if that’s going to save time.
Are there any useful measures to do while waiting to receive medical attention? Anecdotally, several maneuvers have been promoted on the Internet, many without a proven basis. There’s certainly no place for home remedies! Sitting up and facilitating breathing (loosening tight clothing) and at the same time calming the patient does help as it is well-known that anxiety aggravates the heart. If aspirin is available (even the ones for headaches), putting a tablet under the tongue will help to thin out blood and prevent clots from developing.
Personally, I have encountered several instances where people hesitate to go to the hospital for fear of embarrassment in case it turns out to be a false alarm. Others deliberately neglect to call help, fearing the worst, but hoping their inner fears may be wrong. In any case, an important rule of thumb is that it is better to be proven wrong at the hospital than to miss a heart attack. No medical staff is going to chastise you, for sure, if you’re wrong.
- 20 Classic Heart Attack Signs Never To Ignore (positivelygood.net)
BBC News reported of a 69 year old man who suffered cardiac arrest while on one of his regular swimming exercises at his club pool. He had done about 20 lengths when he was noted to suddenly veer off,stopped moving and started to sink. The lifeguards sprang into action, commenced CPR while the pool manager ran off to get a defibrillator which was used to shock him. He was later transferred by ambulance to the ICU where he remained unconscious for a few days but subsequently recovered enough to have a heart bypass operation. Today, he has resumed his swimming exercises.
I have noticed that tales such as this are becoming more frequent nowadays. In this case, with the implementation of UK government-funded schemes where there are some 700 of these devices in high-risk places like airports, train stations and sports centres, about a third of those on whom the defibrillators were applied survived (without using this device the chances of survival during a cardiac arrest is virtually zero). In fact, some airlines do have them on board, just in case any passenger gets a cardiac arrest. American Airlines have now carried these devices for 10 years and claim that 76 lives have been saved as a result.
Basically, the usage of this device requires a previously-trained person( all flight attendants are taught to use these devices) applying a pair of paddle-like electrodes on the chest and pressing a couple of buttons to discharge a burst of high electrical energy anywhere between 200-400 joules. This is enough to cause the affected person to go into an involuntary jerk or spasm, quite similar to that seen in TV movies. This electric ‘jump-start’ then restarts the heart to beat properly.
The device has to be applied within a few minutes of the cardiac arrest, otherwise irreparable brain damage might set in due to the loss of the pumping action of the heart.
Why are there not more defibrillators placed in public places? Basically, its a question of cost-effectiveness as each one may cost about USD 1,500. Despite this, many health advocates have called for more of these devices as several studies, including this one, have shown that placing these devices in high-risk public areas meet the usual standards of health cost-effectiveness.
If bought and used by local airlines, it would give credence to the motto “now everyone can fly!”.