How
should be done if a heart attack is suspected?
When a heart attack occurs, it is extremely important
to recognize the
symptoms and respond rapidly. Nearly 50% of patients
suffering from a heart attack wait two or more hours
before seeking medical help. This delay reduces
the amount of heart muscle that can be salvaged
with treatment, raises the amount of disability
and increases the risk of sudden death.
A person experiencing
symptoms of a heart attack should be rushed to the
nearest emergency room that offers round-the-clock
cardiac care. Each person needs to recognize that
their symptoms of heart pain may be different from
the classical pattern described here and else where.
If chest discomfort occurs during exertion, the
activity should be stopped and the person be advised
to lie down.
If nitroglycerin
tablets have been previously prescribed, a single
tablet should be placed under the tongue and allowed
to dissolve. if pain continues, take a second and
third nitroglycerine tablet at five minute intervals.
If pain is not completely relieved, 911 should be
called. If time allows, notify the patient's physician
so that he or she can make appropriate preparations
for the patient's arrival in the emergency room.
What
happens when a heart attack patient arrives in the
ER? As noted earlier, a heart attack results
when a coronary artery is abruptly and totally blocked.
In the majority of cases, this occurs as a result
of a blood clot. The goals of treatment are to quickly
confirm the diagnosis, relieve the symptoms and
open up the closed artery (with a "clot buster"
medication or by means of angioplasty with or without
stents).
Panoramic View of the Cardiac
Section of an Emergency Room:
Move your move cursor within
the picture to pan left and right or pause the rotation.
You may also do so by placing the mouse cursor within
the image and moving it left and right or up and
down. Each open door reveals a typical room with
ready availability of emergency devices and medications.
The initial evaluation
of a patient with a suspected heart attack is usually
accomplished within 10 - 20 minutes of arrival to
the Emergency room.
Initial evaluation and treatment
usually consists of:
History
of illness is obtained by interviewing the
patient and family. This helps the physician determine
the likelihood and duration of the heart attack.
Physical
Examination is performed, including recordings
of the pulse rate, blood pressure, respiration
rate and temperature.
A nitroglycerin (NTG) tablet is
placed under the tongue if the blood pressure
is not too low. and the patient is continuing
to have chest pain. Intravenous NTG may also be
used in these cases.
Pain medication is delivered,
usually via an i.v. line.
Aspirin is given by mouth.
Blood is drawn and sent "stat"
to the laboratory. This helps confirm the early
indication of a heart attack.
The safety and feasibility of
using an intravenous "clot buster" medicine
versus taking the patient to the cardiac
catheterization laboratory (if promptly available)
is quickly assessed. If not contraindicated one
or the other form of treatment is used in the majority
of patients.
A portable chest x-ray
is commonly obtained, particularly if the patient
is having shortness of breath. In some cases, an
echocardiogram may be obtained in the emergency
room to asses the size of a heart attack.
All the above measures
may not be performed or needed in every case, and
is individualized on the basis of the patient's symptoms
and urgency of the situation.
The video shown above was
taken, during cardiac cath in a patient with angina.
It shows a 70% blockage in the proximal or beginning
portion of the right coronary artery (RCA) as shown
by the arrow. The patient desired medical treatment
and did well for a year.. You can also switch between
the gray scale and a colorized version by clicking
on the button.
A year later, the
same patient was admitted through the emergency
room with a heart attack, Unfortunately, the patient
continued to smoke and neglected his diet and exercise
for several months. He was taken from the emergency
room to the cardiac catheterization laboratory where
the x-ray films showed total blockage of the right
coronary artery. Click on the green arrow button
to see how the blockage was treated in the laboratory.
the
symptoms and respond rapidly. Nearly 50% of patients
suffering from a heart attack wait two or more hours
before seeking medical help. This delay reduces
the amount of heart muscle that can be salvaged
with treatment, raises the amount of disability
and increases the risk of sudden death.
