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Emergency Heart Care

A few minutes late may be too late in Cardiac emergency

On a lazy friday morning, while you are enjoying your third cup of tea with a newspaper in hand, the doorbell rings non-stop. Annoyingly, when you open the door, you find your panicky neighbor mumbling and trying to explain that his father fell from the chair unconscious, holding his chest. What is the least you could do as a responsible neighbor?

Knowhow of Emergency Cardiac situations

 

What is Cardiac Emergency?? How to know or identify a Cardiac emergency??

Cardiovascular emergencies are life-threatening disorders that must be diagnosed quickly to avoid delay in treatment and to minimize morbidity and mortality. Patients may present with severe hypertension, chest pain, abnormal heart beating, or cardiopulmonary arrest.

 

Symptoms of Cardiac problems require emergency intervention

Coronary Artery Disease

Disease that affects the arteries of the heart is referred to Coronary artery disease (CAD). Reduced blood flow to the myocardium is the major cause of Cardiac emergencies. The most common symptom of coronary artery disease is Angina, or Chest pain.

Angina can be described as a discomfort, heaviness, and painful feeling in your chest along with Shortness of breath, Palpitations (irregular heartbeats), weakness or dizziness, Nausea and Sweating. It can be mistaken for indigestion or heartburn. Angina may also be felt in the shoulders, arms, neck, throat, jaw, or back.

Heart Attack

Symptoms of a heart attack can include:

  • Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone.
  • Discomfort radiating to the back, jaw, throat, or arm.
  • Fullness, indigestion, or choking feeling (may feel like heartburn)
  • Sweating, nausea, vomiting, or dizziness.
  • Extreme weakness, anxiety, or shortness of breath.
  • Rapid or irregular heartbeats.

During a heart attack, symptoms typically last 30 minutes or longer and are not relieved by rest or oral medications. Initial symptoms may start as a mild discomfort that progress to significant pain.

Some people have a heart attack without having any symptoms, which is known as a "silent" myocardial infarction (MI). It occurs more often in people with diabetes.

What is the immediate treatment of heart attack one can expect in a hospital?

Once the patient reaches the hospital, the primary goal of treatment would be to dissolve the obstructing clot, and restore blood supply to the affected part of the heart.

This is done, most commonly, by clot busting drugs. But of late, the preferred modality is mechanical dissolution of the clot by a procedure called as primary angioplasty.

The only prerequisite for angioplasty is that it can be done only in hospitals where a cardiac catheterization laboratory and doctors well versed with this procedure are available.

What is angioplasty?

Primary Angioplasty is a procedure that involves inserting a catheter through the blood vessels up to the heart, and identifying the location of the clot, so that it could be dislodged with a balloon and a stent. The blood supply is then re-established to that portion of the heart.

Arrhythmia

Arrhythmias are abnormalities in the electrical activity controlling the rate or rhythm of the heartbeat.

Symptoms of arrhythmias may include:

  • Palpitations and Pounding in your chest
  • Dizziness or feeling light-headed
  • Fainting
  • Shortness of breath
  • Chest discomfort
  • Weakness or fatigue (feeling very tired)

Atrial Fibrillation

Some types of arrhythmias maybe life-threatening, like Atrial fibrillation (AF). Most people with AF experience one or more of the following symptoms:

  • Heart palpitations (a sudden pounding, or racing feeling in the heart)
  • Dizziness (feeling faint or light-headed)
  • pain, pressure, or discomfort in the chest
  • Shortness of breath (difficulty breathing during normal activities)

Heart Failure : Congestive heart failure is the inability of the heart to pump out all the blood that returns to it from the rest of the body. Heart failure provides some of the most difficult cardiac emergencies to stabilize. 

Symptoms of heart failure can include:

  • Shortness of breath noted during activity
  • Cough that is productive of white sputum.
  • Rapid weight gain (a weight gain of two or three pounds in one day is possible).
  • Swelling in ankles, legs, and abdomen.
  • Dizziness, Fatigue and weakness.
  • Rapid or irregular heartbeats
  • Other symptoms include nausea, palpitations, and chest pain.

Acute pulmonary edema:

This is a life-threatening situation in which the patient suffers extreme shortness of breath, cyanosis, pallor, fainting, restlessness, anxiety, a sense of suffocation, and, perhaps, wheezing or fainting. This situation may occur following a heart attack.

Cardiogenic shock:

This is characterized by left ventricular failure (LVF) and most common cause acute myocardial infarction. Cardiogenic shock leads increase heart rate and contractility.
Symptoms of Cardiogenic shock:

  • Weak, rapid pulse
  • Chest pain
  • Blood pressure bellow 80mm Hg
  • Skin cool, pale, cyanotic
  • Confusion (due to poor cerebral perfusion)
  • Talks in single words only

Large Pulmonary Embolism:

Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism). PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung.

Symptoms of pulmonary embolism include difficulty breathing, chest pain, and palpitations. In Severe cases of PE can lead to collapse, abnormally low blood pressure, and sudden death.

Dissection of Aorta:

Aortic dissection is a medical emergency and can quickly lead to death, even with optimal treatment. If the dissection tears the aorta completely open (through all three layers), massive and rapid blood loss occurs. 72 to 80% of individuals who present with an aortic dissection have a previous history of hypertension in an age between 50 to 70 years. Aortic dissection present with severe pain that had a sudden onset.

 

If not taken immediate care what complication may arise??

If not taken immediate care all of these Cardiac emergencies clinically in a well-equipped Cardiac center, these may lead to permanent damage of Heart muscle and in severe case can cause Sudden Cardiac Death.

 

What is Sudden Cardiac arrest or death?

Cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the end of normal circulation of the blood due to failure of the heart to contract effectively.

Cardiac arrest is a medical emergency that, in certain situations, is potentially reversible if treated early. Unexpected cardiac arrest sometimes leads to death almost immediately; this is called sudden cardiac death (SCD). The treatment for cardiac arrest is cardiopulmonary resuscitation (CPR) to provide circulatory support, followed by defibrillation (restore normal contractions through the use of an electric shock).

** If symptoms of any of these cardiac events last longer than a few minutes there is reason to suspect a cardiac emergency and in any case, prompt medical attention should be sought. Rush to a nearby hospital without wasting time.

 

Who is vulnerable to a cardiac emergency?

A person who has already suffered a heart attack, or who has had episodes of angina (chest pain that lasts for several minutes triggered by exercise, emotional upset, or other causes), is particularly vulnerable to a cardiac emergency.

A number of factors are associated with increased risk of a heart attack or other cardiac emergency.

Some are uncontrollable, like family history; Others are controllable for example, the effect of obesity or high blood pressure on overall risk can be eliminated by maintaining an ideal body weight and keeping blood pressure at normal levels.

 

What action is required to address the emergency situation??

The least you could do in such a situation is not to panic. Take the patient to the nearest specialty hospital or call NMC Emergency - call (971) 2 633 2255. Taking the patient within 30 - 60 minutes to the nearest hospital can save his life. If you are aware of providing Basic Life Support, please help by giving CPR (cardiopulmonary resuscitation) to the patient before taking him to the hospital.

 

What is the “Golden Hour”??

A heart attack occurs when a narrowing in the arteries and /or a sudden blockage from a blood clot cuts off the nutrients and oxygen supply to the heart muscle. The Golden Hour is a critical time because the heart muscle starts to die within 80-90 minutes after it stops getting blood, and within six hours, almost all the affected parts of the heart could be irreversibly damaged.

So, the faster normal blood flow is re-established, the lesser would be the damage to the heart.

 

Cardiac emergency and CCU services at NMC

NMC Emergency care team works hand-in-hand with our team of Cardiac care, making it the finest emergency and critical care specialty in the privet hospital sector in UAE.
NMC Cardiac emergency services features advanced diagnostic equipment’s, expert clinicians and dedicated cardiac care unit at Emergency set-up.

  • NMC emergency and critical care is modeled on Global line with Round the clock Emergency specialists, Intensivists, Interventional Cardiologist, trained Paramedics and skilled nurses.
  • The chest pain observation unit alongside with emergency has the right skill, team, technology and point-of-care tests
  • The Critical Care (CCU) facility is augmented with Hi-tech facilities like 64 slice CT scan, MRI, state-of-art monitors, ventilators, PACS software along with round the clock Radiology Dept.
  • Experts can help to prevent or even reverse muscle damage of your heart
  • ECG/ECHO/BIOMARKER/64 SLICE CT Scan help in Faster diagnostics and rapid cardiac intervention
  • Rapid “Door-to-balloon” heart attack care in emergency situation, be it just ‘thrombolyting’ the patient or undertake a primary angioplasty
  • Management of life threatening Arrhythmias with facilities for emergency pacing and Cardio version.

NMC Specialty Hospital - Abu Dhabi

Dr. Paul Stanley Thoppil

Dr. Paul Stanley Thoppil

Interventional cardiologist,
Abu Dhabi

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NMC Specialty Hospital - Dubai

Dr. Kais Mrabet

Dr. Kais Mrabet

Interventional cardiologist,
Dubai

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Dr. Upendra Jayantilal Shah

Dr. Upendra Jayantilal Shah

Specialist interventional cardiologist,
Dubai

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NMC Specialty Hospital - Al Ain

Dr. Austin Mohan Komaranchath

Dr. Austin Mohan Komaranchath

Specialist interventional cardiologist,
Al Ain

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NMC Royal Hospital, Khalifa City - Abu Dhabi

Dr. Wissam Al Sahli

Dr. Wissam Al Sahli

Consultant interventional cardiologist,
Abu Dhabi

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