Importance of pre-hospitalization in ‘golden hour’ in cardiac emergencies

September 03, 2021

Introduction

Cardiovascular diseases (CVD) such as heart attack, cardiac arrest, etc., are the leading cause of death and disabilities globally and in India. In India, every 1 in 4 deaths can be attributed to CVD and about 52% of these deaths are reported to occur before the age of 70 years. Indian ethnicity coupled with high burden of risk factors such as diabetes, hypertension, smoking, high cholesterol, sedentary lifestyle, westernized diet, etc., are important factors driving high rates of heart diseases among Indians, almost a decade earlier as compared to the Western countries.

One of the major reasons behind these CVD deaths is lack of awareness in dealing with cardiovascular emergencies.

Is a heart attack different from a cardiac arrest?

Cardiovascular or cardiac emergencies like cardiac arrest and heart attack are life-threatening situations that can happen anytime. With prompt recognition of symptoms and immediate intervention, death can be avoided.

  • Cardiac Arrest: Also known as sudden cessation of cardiac activity. It is characterized by a sudden loss of heart function, pulse, breathing and consciousness that is usually triggered by the heart’s electrical malfunctioning. The heart’s pumping action is suddenly disrupted and the blood supply to all the vital organs is stopped. If the treatment is delayed, it can lead to death. Cardiac arrest often occurs without any warning, and irrespective of the age group.
  • Heart Attack: Also called myocardial infarction, heart attack is caused by narrowing or blockage of the coronary arteries (blood vessels supplying to the heart) due to build-up of plaque. This causes poor blood and oxygen supply to the heart resulting in the rapid death of the heart tissues. The early symptoms of a heart attack may include sudden and extreme chest pain, chest heaviness, shortness of breath, loss of consciousness, sweating, nausea and vomiting, radiating pain to the jaw, upper portion of neck, radiating towards left arm and the little finger. It can also present has a pain in the right side of the chest.

What to do in case of a cardiac emergency?

Cardiac emergencies can strike you or your loved one without warning and can be scary. Don't worry!!! Majority have survived and are leading a healthy and productive life with timely treatment.

  • Call an ambulance service or the nearest hospital. You can also call your family or a friend, who can take you to the nearest hospital.
  • Avoid driving yourself to the hospital, as you may put yourself as well as others in danger.
  • Make sure to reach the hospital as quickly as possible without any delay so that your doctor can take fast action to save your life with good outcomes.

Providing first aid for heart attack or cardiac arrest

If you are a bystander and notice someone in a cardiac emergency, you can provide first aid by doing the following

  • Gently lift the chin of the person supporting his forehead. Check for any foreign bodies if your confident in removing the foreign bodies only.
  • Avoid attempting a blind finger sweep.
  • Keeping the airway open and give 2 breaths. Pinch the nose of the person tightly and seal your lips around his or her mouth and then slow inflation over 1 second and allow passive exhalation. While doing so remove the pinch of the nose.
  • Start chest compressions at lower half of the chest bone in the midline at the ratio of 30:2 (30 chest compressions and 2 breaths alternatively). Compressions can be up to 2 inches in depth.
  • Stop!! only when the medical help arrives or when the person starts to breath normally or when you get exhausted.

The concept of ‘Golden Hour’

The concept of ‘Golden Hour’ was first created by R Adams Cowley, an American surgeon, and a pioneer in open-heart surgery. The term "golden hour" is the window of time to receive emergency treatment to prevent death or irreversible damage to the heart and other organs.

Therefore, in the event of a cardiac emergency, the first 60 minutes soon after the onset of a heart attack and the vital few minutes after the onset of signs of cardiac arrest are crucial.

Evidence suggests that within the first two hours of a heart attack, around 85% of the heart is damaged due to lack of blood supply. In contrast only about 10% of the cardiac patients receive the emergency treatment within the first critical hour. A lot of valuable time is lost because of lack of awareness as most people are unable to recognize the early signs of heart attack or beginning early chest compression in cardiac arrest.

Management of Cardiac Emergencies at Hospital

In case of a heart attack, the blocked artery is opened and normal blood flow to the heart is restored using procedures like coronary catheterization, open heart surgery, etc.

In case of a cardiac arrest, an automated external defibrillator (AED) is used to deliver electrical shock waves to the heart to revive heart functioning. Once the condition is stable, medications are given to stabilize the heart rhythm.

After the condition of the person is stabilized, the doctor may discuss the long-term complications with appropriate treatment. Options like lifestyle changes, medications, and treatment procedures such as implantable cardioverter-defibrillator, coronary bypass surgery, radiofrequency catheter ablation, or a corrective heart surgery may be advised when required.

Frequently Asked Questions

1. What are the risk factors for cardiovascular diseases?

The main risk factors for cardiovascular diseases include:

  • High blood pressure or hypertension
  • High blood cholesterol
  • Diabete
  • Smoking
  • Alcohol abuse
  • Overweight and obesity
  • Unhealthy lifestyle
  • Hereditary

2. What is coronary angiogram and angioplasty?

Coronary angiogram is a minimally invasive, diagnostic as well as an interventional procedure used to diagnose and treat heart diseases. The procedure involves passing a liquid dye into the coronary arteries through a catheter (long, thin tube). The dye filled arteries are then inspected under an X-ray for areas of blockage.

Your doctor will treat that blockage using a tiny inflatable balloon to open up the artery (balloon angioplasty). This procedure is referred to as coronary angioplasty and is often followed by stent insertion to keep the artery open.

3. Are cardiovascular deaths preventable?

Although cardiovascular death rates are increasing alarmingly, they can be largely prevented by:

  • Avoiding consumption of tobacco
  • Avoiding smoking
  • Avoiding excessive use of alcohol
  • Reducing salt intake in the diet
  • Including more seasonal fruits and vegetables in the diet and reducing fatty foods.
  • Regular exercising for at least 20 – 30 minutes/day
  • Adequate sleep
  • Stress management
  • Routine health check-ups to detect early CV disease.

- By Dr. Firozahmad H. Torgal, Consultant, Emergency Medicine, Columbia Asia Referral Hospital – Yeshwanthpur (A unit of Manipal Hospitals).

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