Heart in danger – in an emergency, seconds count

Heart in danger – in an emergency, seconds count

Seventy thousand people die every year in Germany from a heart attack. Many of them because heart attack patients in Germany need around 15 hours (!) before they are in the hospital. It’s much too long! The reason usually lies with the patient himself: waiting to see whether the symptoms go away on their own, not taking the pain seriously, not wanting to bother anyone…

Chest tightness – When blood flow to the heart tissue is disturbed

Chest tightness and heart attack have very similar symptoms. Therefore, they are summarized under the term acute coronary syndrome. A heart attack or angina pectoris (chest tightness) usually occurs due to deposits (plaques) in the coronary arteries on the floor of arterial calcification that has progressed for years.

The coronary arteries (synonym: coronary arteries) are intended to supply the heart muscle with oxygen and nutrients. If the plaques constrict them, the heart muscle is undersupplied with oxygen. This can manifest as recurring chest pain, especially during exertion, stress, or cold. In short, angina pectoris.

But the occlusion of a coronary artery can also go unnoticed and progress until such a plaque suddenly tears and a blood clot adheres to it and closes the vessel abruptly: the heart attack, a life-threatening emergency!

 

Be alert at the slightest warning sign.

If you have the following symptoms, you should immediately think of angina pectoris or a heart attack:

  • Chest discomfort: dull, pressing, tight, burning, flat in the centre of the chest, lasting more than 5 minutes, or going away and coming back
  • Discomfort elsewhere: in one or both arms, upper abdomen, neck, back or neck
  • Shortness of breath: often with other complaints
  • Other complaints: nausea, dizziness, weakness, cold sweats
  • If these symptoms occur for the first time and last more than 10 minutes, go to the hospital immediately, preferably dial the emergency number 112!

​First aid with nitro spray

Ideally, a few minutes after the pain mentioned above occurs, an emergency doctor will be with the patient and accompany him to the hospital in an ambulance. If he suspects angina pectoris or even a heart attack, he should first use emergency medication No. 1: Nitro-Spray (eg Nitrolingual® N-Spray).

This drug, sprayed under the tongue for two squirts, dilates the coronary arteries in minutes, improving blood flow to the heart. It also helps distinguish between infarction and angina. If Nitro-Spray does not improve the symptoms, there is a high probability of a heart attack. The doctor will then administer painkillers, sedatives, and blood-thinning medications.

 

Emergency help in the hospital

In the hospital, an attempt is then made to make the coronary artery passable again. Due to insufficient oxygen supply, the heart muscle tissue dies irreversibly; the more, the worse the long-term consequences, such as cardiac insufficiency, says Prof. Dr. Michael Kentsch, Chief Physician at Klinikum Itzehoe.

This process starts after 30 minutes, so the following applies: the faster the blood vessel can be made porous again, the more minor the damage. Experts, therefore, speak of the golden first hour after a heart attack. According to Prof. Kentsch, it is unfortunately often missed because the patients initially wait a long time themselves or do not come directly to the hospital in the event of a heart attack.

“The first hour after the onset of symptoms is difficult because sudden cardiac death and life-threatening ventricular fibrillation often occur. Ventricular fibrillation means cardiac arrest. The heart can no longer pump. Only immediate resuscitation with electrical treatment (defibrillation) can help here. So, The sooner medical help arrives, the better.”

A cardiac catheter opens the vascular occlusion.

After symptoms have proven a heart attack and, if necessary, an EKG, the vascular occlusion is best reopened using a cardiac catheter. Drug-based clot dissolution is an alternative. During a cardiac catheter treatment, a thin tube is advanced through the inguinal artery to the heart, with a small balloon at the end. Under X-ray control, it is inflated strictly at the narrow point, and a vascular support (stent) lying on it unfolds.

Even after removing the balloon, it keeps the coronary artery open – the blood can flow freely again. Ideally, this procedure takes place in the first hour after the heart attack – and no heart tissue has yet been destroyed.

Too late to the hospital

However, if the patient only comes to the hospital many hours later, valuable time is lost, and the vasodilatation often no longer makes sense because too much heart muscle tissue has been lost. This is precisely the case in more than half of the patients. Long-term consequences: cardiac insufficiency, i.e. failure of the heart to breathe with exertion such as climbing stairs.

Suppose a patient has angina pectoris with symptoms that regularly recur during exercise (stable angina pectoris). In that case, the doctor usually prescribes a nitro spray for everyday use and other medicines. One or two squirts of this medication sprayed under the tongue provide quick relief in the event of symptoms.

If the symptoms disappear entirely and persistently within a few minutes, the problem is acutely solved. Otherwise, one speaks of unstable angina pectoris. Because a heart attack is imminent here, the emergency doctor should be called immediately.

 

What do I do if someone has a heart attack?

  • First, dial the emergency number (tel. 112) and say who you are and what you report. Stay on the line until there are no more questions from the control centre.
  • If the victim is conscious, talk to him and calm him down. Loosen tight clothing (tie, shirt collar) and position him with your torso slightly elevated.
  • If he has nitro spray and a strong pulse, spray two pumps under the tongue!
  • If the patient is unresponsive, is not breathing, and is not moving, this means circulatory arrest. Fast action is now essential – respiratory donation and cardiac massage!
  • Lay the patient on a hard surface.
  • Thirty chest compressions (frequency: 100 times per minute): Pressure point about 3 to 4 cm above the end of the breastbone, i.e. the point where the ribs meet. Place one hand flat on it and place the heel of the second hand over it. Press in about four centimetres deep when pressing in the chest (with straight arms). The most common mistake is not pushing hard enough. Then breathe again twice.
  • Extend the patient’s head and perform 2 x mouth-to-mouth (pinch the nose) or mouth-to-nose (lift the mouth shut) resuscitation.
  • Continue until the ambulance arrives or the patient is breathing again.

“In the case of a heart attack, you have to weigh things up: waiting means sudden cardiac death, cardiac insufficiency, life shorter. Reacting means surviving, staying fit, living longer,” says Prof. Dr. Michael Kentsch.

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