70,000 people die of a heart attack in Germany every year. Many of them because heart attack patients in Germany need around 15 hours (!) before they reach the hospital. Much too long! The reason usually lies with the patient himself: waiting to see if the symptoms disappear on their own, not taking 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. That is why they are grouped together under the term acute coronary syndrome. A heart attack or angina (chest tightness) usually results from deposits (plaques) in the coronary arteries on the back of years of progressive arterial calcification. The coronary arteries (synonym: coronary arteries) are intended to supply the heart muscle with oxygen and nutrients. If they are narrowed by the plaques, the heart muscle is not supplied with enough oxygen. This can manifest itself as recurring chest pain, especially during exertion, stress, and cold. In short: angina pectoris. But the occlusion of a coronary vessel can also go unnoticed or/and continue to progress until suddenly such a plaque ruptures and a blood clot attaches to it and abruptly closes the vessel: the heart attack, a life-threatening emergency!
Be alert to even the smallest alarm sign
If you experience the following symptoms, you should immediately think of angina pectoris or a heart attack:
- Chest discomfort: dull, squeezing, tight, burning, flat in the middle of the chest, lasting more than 5 minutes or going away and returning
- Discomfort elsewhere: in one or both arms, upper abdomen, neck, back, or nape of neck
- Shortness of breath: often with other complaints
- Other complaints: Nausea, dizziness, weakness, cold sweat.
- If these complaints occur for the first time and last more than 10 minutes: Immediately to the hospital, best to dial the emergency number 112!
First aid with nitro spray
Optimally, a few minutes after the onset of the above pain, an emergency physician is with the patient and accompanies him in the ambulance to the hospital. If he suspects angina pectoris or even myocardial infarction, he should first apply emergency medication No. 1: Nitro spray (e.g., Nitrolingual N spray). This drug, two strokes sprayed under the tongue, dilates the coronary arteries in minutes, improving blood flow to the heart. And it helps distinguish between infarction and angina pectoris. If nitro spray does not improve the symptoms, it is highly likely that the patient is suffering from a heart attack. The doctor will then administer painkilling, sedative and blood-thinning medication.
Emergency assistance in the hospital
In the hospital, an attempt is then made to make the coronary vessel pervious again.Due to the undersupply of oxygen, the heart muscle tissue dies irreversibly, the more, the worse the late consequences, such as cardiac insufficiency, according to Prof. Dr. Michael Kentsch, chief physician at Itzehoe Hospital. This process starts after just 30 minutes, so the faster the blood vessel can be made pervious again, the smaller the damage. Experts therefore speak of the golden first hour after a heart attack. According to Prof. Kentsch, it is unfortunately often missed because 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 particularly dangerous because sudden cardiac death and life-threatening ventricular fibrillation frequently 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.”
Cardiac catheter opens vascular occlusion
After a heart attack has been proven by symptoms and, if necessary, ECG, the vascular occlusion is best reopened by cardiac catheterization. Drug-induced clot dissolution is an alternative. In cardiac catheterization, a thin tube is advanced to the heart via the inguinal artery, with a small balloon at the end. Under X-ray control, the balloon is inflated precisely at the constriction and a stent is deployed on top of it. Even after the balloon is removed, it keeps the coronary vessel open – the blood can flow freely again.Ideally, this procedure happens in the first hour after the infarction – and no heart tissue has yet been destroyed.
Too late to the hospital
However, if the patient arrives at the hospital very many hours later, valuable time is lost and vasodilatation often no longer makes sense because too much heart muscle tissue has perished. In more than half of the patients, this is exactly the case. Late consequence: cardiac insufficiency, i.e. pumping failure of the heart with shortness of breath during exertion such as climbing stairs. If a patient is known to have angina pectoris with symptoms that recur regularly on exertion (stable angina pectoris), the doctor will usually prescribe a nitro spray for everyday use, along with other medications. In the event of discomfort, one to two strokes of this medication, sprayed under the tongue, bring rapid relief. If the discomfort disappears completely and persistently within a few minutes, the problem is acutely solved. Otherwise, the condition is referred to as unstable angina pectoris. Because a heart attack is imminent here, the emergency doctor should be called immediately.
What do I do if someone suffers a heart attack?
- First: dial 911 (tel. 112), say who you are and what you are reporting. Stay on the line until there are no more queries from the control center.
- If the victim is conscious: talk to him, reassure him. Loosen tight clothing (tie, shirt collar) and position him with slightly elevated torso.
- If he has nitro spray with him and a strong pulse, spray two strokes under his tongue!
- If the patient is unresponsive, not breathing and not moving, it means circulatory arrest. Quick action is now important – respiratory donation and chest compressions!
- Place patient on hard surface
- 30 times cardiac massage, (frequency: 100 times per minute): pressure point about 3 to 4 cm above the end of the sternum, the point where the ribs meet. Place one hand flat on it, the ball of the second hand over it. When pressing in on the rib cage (with arms extended), press in about four centimeters deep. Most common mistake: not pressing hard enough. Then breathe again twice.
- Head of the patient overstretch and 2 x mouth-to-mouth (hold the nose) or mouth-to-nose ventilation (squeeze the mouth).
- Continue until the emergency physician arrives or the patient is breathing on his own again.
“In the case of a heart attack, you have to weigh: Wait means: sudden cardiac death, heart failure, live shorter. Respond means: survive, remain efficient, live longer,” said Prof. Dr. Michael Kentsch.
