I'm about to share an incredible story with you that happened over this past summer. In my clinic I see patients before and after heart attacks, but not typically during one. My family and I had just exited a movie theater on a Sunday afternoon and I was walking ahead when suddenly my wife heard shouting…”Is there a doctor around?” and then grabbed my arm and alerted me. For some reason my gut told me this was going to be a South Asian male in cardiac arrest and sure enough it was.
An elderly Indian gentleman was lying flat on his back just outside the cinema entrance, looking pale and completely unresponsive with a crowd around him. He had no pulse and wasn't breathing. We immediately called out to have someone dial 911 while we initiated CPR. I have to be honest, I haven't done CPR in over a decade. I missed the last few recertification classes at my clinic and it has always been on my to-do list, but hadn't gotten done. However, I remembered the basics and fortunately so did my wife who was assisting along with keeping the gentleman's family informed.
After several rounds of CPR, the paramedics arrived and the heart tracing on the monitor was the ominous pattern for ventricular fibrillation (aka “v-fib”) which signals an extremely low chance of survival. He underwent cardioversion (electrical shock to the chest) and received intravenous medication, but remained in v-fib and the team decided to transport him to the hospital. Surrounded by his emotionally distraught family members, my wife exchanged numbers with one of them and we headed home wondering how this would turn out. Given his age and the amount of time he was in v-fib, I wasn't optimistic but we all hoped and prayed for the best.
Before sharing the outcome of this story, let's review a few key points on an individual experiencing a heart attack who is conscious vs someone who is in full cardiac arrest like the gentleman discussed. Be sure to read the remarkable end to this story!
The symptoms of a heart attack can vary and are not the typical “TV heart attack” where someone's clutching their chest. Symptoms can be any combination of the following:
- Dull, sharp or squeezing pain in the center and/or either side of the chest. Pain can, but not always radiate to the shoulders, back, neck, jaw, teeth, arms (one or the other).
- Shortness of breath
- Lightheadedness, dizziness
- General weakness
Women and diabetics in particular may not get the typical chest pain but instead experience symptoms like shortness of breath, stomach pain, fatigue, nausea or lightheadedness.
So what do you do if you think you may be having a heart attack?
1. Call 911: See the next section on cardiac arrest for details on how to dial 911 from a cell phone and if you're in a different country.
2. Chew Aspirin if you're not Allergic: A heart attack occurs when a blood clot blocks one of the blood vessels that feeds your heart (aka “coronary arteries”). The aspirin slows down clot formation and can prevent or lessen the damage caused by a heart attack. It can potentially save your life! Chewing rather than swallowing the aspirin allows it to enter your bloodstream faster. Drink a glass of water after. The type of aspirin you chew is a full strength, 325 mg dose that is NOT coated.
I highly recommend you keep full strength, uncoated aspirin in your purse or wallet, especially if you are at higher risk for heart disease. Don't give it to someone else unless you know for sure they are not allergic to aspirin.
The gentleman I discussed in this case was in cardiac arrest since he was unconscious and unresponsive. You can confirm this by shaking or tapping on the individual. If he or she responds, there is no need to do CPR. If there's no response, then take the following steps:
1. HAVE SOMEONE CALL 911: If you are going to be doing CPR, then delegate someone to call 911 immediately. If you're alone, call 911 and then start CPR. If you are dialing 911 from a cellphone the first piece of information you need to provide is your location since cellphones will not reliably provide an accurate location unlike a landline. “We have someone in cardiac arrest at Denny's in Smithtown on Main street.”
Next immediately provide your cell number in case you get disconnected. If you are the one doing the CPR and not making the call, give these instructions to a person making the call. This link provides a useful guide to using 911 in the US.
If you travel, know the “911” number at your destination, especially if you or someone you're with is at high risk. For example, the “911” number in India is 112 and in the UK it's 999, but 112 also works. The full wikipedia list for all countries is here.
2. INITIATE CPR: If the person is unconscious, unresponsive, not breathing or breathing in a very abnormal way (gasping, etc.), you need to start CPR right away. Everyone should be CPR certified, but if you're not, do hands-only CPR (no mouth-to-mouth) which can be as effective as CPR with mouth-to-mouth. Watch the 1 minute video below produced by the American Heart Association for how to do hands-only CPR. Watch it now and share with others. It can save a life!
For those who are trained, but maybe rusty on the numbers since it has been a while, you can provide 2 rescue breaths after every 30 compressions. Push hard and fast in the center of the chest to a depth of about 2 inches and at a rate of 100-120 compressions per minute. As the video illustrates, the rhythm of your compressions would be the same as the beat in the iconic song, Staying Alive by the Bee Gees.
This is a great detailed summary on the first aid principles, but it's recommended that you get re-certified.
My wife received a voicemail on her phone from the daughter-in-law of the individual in cardiac arrest. He miraculously survived. Every doctor and nurse in the hospital marveled at how he not only survived, but completely recovered with no deficits. Bystander CPR was credited for saving his life.
I want to make the point that doing CPR does not require a medical degree. It is a simple procedure that can be performed by anyone, so please take the time to get certified or at the very least familiarize yourself with the hands-on CPR video shown earlier.
We had the opportunity to have a wonderful dinner with the survivor and his family including his wife, son, daughter-in-law, and beautiful grandchildren. It was because of CPR that we were able to bond and share this special moment which otherwise could have had a tragic outcome.