PATIENT EDUCATION MODULE 7
Cardiac Emergencies

Most people who have had a recent heart attack are worried about what  might happen to them in the future.  Some worry a little and others far too much.  Some have questions they are “afraid to ask”.  Now is the time to think about and discuss these issues.  In most cases the future is a lot brighter than you think. 

You have already improved your chances of good health by taking part in this programme.  Your physical fitness is improving and equally important, you are now better informed than you were before about your heart and heart disease.  

The purpose of this module is to provide you with background information to help you assess your own symptoms and to determine what you should do, to enable you to give instructions to bystanders if you do have an emergency situation, and to provide you with some basic information that will enable you to help others if the need arises.  It is no secret that you are “in the age group” for heart disease and so are your friends.  If a situation arises at home, on the golf course, or on the street, you will be better prepared after this module.  Remember the same rules that apply to you with respect to emergencies will also apply to others.

Most of what we need to discuss can usefully be divided in to three broad categories:

 
PAIN       RHYTHM         PUMP

PAIN:        Most of you will have experienced chest pain or discomfort as part of your initial experience of the heart attack or angina.  People perceive pain differently and it is not surprising that some of your symptoms may differ from another individual.  We will discuss the generally common symptoms that people may experience with heart disease recognizing that each individual is different.

  How can I tell if it is my heart?

  1.    If it is the same or very similar to your heart attack pain and lasts more than a fifteen minutes - IT’S  YOUR HEART!       WASTE NO TIME IN THIS SITUATION.  CALL 911 NOW! (take your nitro)

2.    If it seems similar but less severe, the discomfort is probably angina.  If the feeling occurs only on extremes of exertion is promptly relieved by rest, you can avoid it exerting to a lower level, not exerting after meal, or by using nitro in advance.  In any event, report this to you doctor without delay.

3.    If the discomfort is similar and is beginning to come on with less effort or particularly if it is coming on at rest, this is unstable angina  and must be evaluated by a doctor, preferably the same day.

4.    Pain of  very brief duration, lasting just a few seconds, often “stabs and jabs” is common.  It is not a heart symptom that needs any attention.

5.    In general any predictable discomfort that comes on with exercise and is relieved by rest could be angina.  It may occur anywhere between the “nose and navel” and can be isolated to areas like the jaw, neck, or between the should blades.  These symptoms should be reported to your doctor.

  RHYTHM:            Disorders of the heart rhythm can occur after a heart attack.  Some are minor and need little or no attention.  Others are quite serious and need immediate response.  You will be shown how to take your pulse.  This will help you to identify whether or not the feelings you are experiencing are really from your heart.

  What should I do if I think there’s something wrong with the rhythm?

  1.    If you experience sudden profound weakness or actually blackout, regardless of whether or not you sense a rhythm disturbance, call 911 - THIS IS AN EMERGENCY!

2.    If you become aware of pauses in your rhythm that are associated with weakness or last longer than 2 seconds, see your doctor, preferably today.

3.    If you become aware of sustained fast beats, especially if the rate is over 100 beats per minute without any good reason, you must go to emergency or see your doctor the same day.

4.    If you notice intermittent skips in your heart beat, not accompanied by any other symptoms, they should be reported to your doctor and you likely should have a Holter monitor placed promptly.  This is particularly important if these symptoms are noted within the first month or two after the heart attack.

PUMP:       The purpose of your heart is to pump the blood with oxygen to all parts of your body.  By definition, since you have had a heart attack there is at least some damage to the pump.  Pump problems can be experienced as shortness of breath, weight gain, ankle swelling, fatigue and sometimes much more subtle symptoms.

  1.    If you experience sudden shortness of breath that does not resolve quickly (with or without nitro) and especially  if accompanied by “air hunger” and sweating CALL 911 - THIS AN EMERGENCY!

2.    If you experience a slow increase in shortness of breath over a few days especially if accompanied by a sensation that you can’t catch you breath when you lie down or you waken from sleep with shortness of breath, see you doctor the same day.

3.    If you notice increasing ankle swelling +/- shortness of breath, and especially if associated with swelling of the abdomen see your doctor, preferably the same day.

4.    If you are becoming increasingly fatigued even in the absence of shortness of breath, and especially if this is accompanied by lightheadedness when you stand, this may mean the pump is not working well.  Notify your doctor without delay.

WHAT ABOUT CARDIAC ARREST?

This is the most sudden and serious complication of heart disease.  If not treated properly it will lead to sudden death within a few minutes.  Your risks of this complication are very small and further minimized by your increasing fitness, good diet, medications designed to prevent this complication and most importantly, your ability to recognize the emergencies described above.

You  may one day find yourself in a situation where another individual appears to have suffered a cardiac arrest.  Take the following steps and use the opportunity to practice CPR with your nurse instructor.

  1.    Shake and Shout!  Try to rouse the person - do they respond?       Quickly listen for breathing.  Shout for help from other bystanders.  Send someone to call 911 (see # 6).

3.    If there is no breathing, extend the person’s neck to open the airway.  Remove any obvious foreign matter from the mouth.  Quickly make a seal over their mouth with your own, pinch their nose to prevent the escape of air and give four quick breaths.

4.    Feel for a pulse.

5.    If no pulse, begin chest compressions with your hands one on top of the other in the middle of the chest. Press firmly between 60 and 80 times per minute.  After every 8 to 12 compressions give two more breaths.

6.    Make sure you dispatch someone to call 911 and notify emergency services that there is a cardiac arrest.

7.    Tell the person to come back to the scene to confirm they have placed the call and to help you.

  This is a very basic overview of CPR, but it can allow you to help someone else in an emergency.  CONSIDER TAKING A CPR COURSE FROM INSTRUCTORS AVAILABLE IN YOUR COMMUNITY.