If home is where the heart is, it's also where the heart attacks and cardiac arrests are — up to three-quarters of them happen at home. Yet family members of those at high risk tend to be unprepared for these devastating emergencies.
You can help change this by resolving to learn what to do if someone has a heart attack. This entails learning CPR, learning how to use an automated external defibrillator, and making an emergency plan.
Remember, there are two types of heart attack. A myocardial infarction is the slower-moving type, caused by a clot blocking a coronary artery. The second type, cardiac arrest, tends to come on faster, though it can be foreshadowed by chest pain and other symptoms. Collapse and unconsciousness follow, with death a few minutes behind unless resuscitation is started.
Call for help
The first step in responding to any kind of cardiac emergency is calling 911 or your local emergency number. In addition to summoning help and lifesaving equipment, it puts you in touch with professionals who can coach you through CPR or other helpful actions while the emergency team is en route.
If you are witnessing a cardiac arrest and there is someone else with you, send him or her to look for a defibrillator. They are commonly found in airports, stores, schools, and other public places. If you are alone, stick with the victim and start CPR.
Press, press, press
Doing CPR on someone who has collapsed is simpler than you might think. Put one hand on the center of the person's chest. Put your other hand on top of it. Press down firmly, using your weight if necessary, to push the chest inward. Relax only long enough to let the chest spring back, and do it again. Keep repeating the press-relax cycle about twice a second (the ideal is 100 per minute). Don't worry about doing it wrong — poorly performed CPR is better than none at all.
A person who collapses with a cardiac arrest usually has enough oxygen in his or her bloodstream to nourish the brain for several minutes. So it's best to focus on rapid but steady chest compressions for a minute or two before stopping to give two quick breaths every 30 seconds or so. If there is someone with you, switch every minute or so to keep from tiring out.
During a cardiac arrest, CPR only buys time. It can't restore a healthy heart rhythm. That's up to the automated external defibrillator. It can shock the heart out of a deadly quivering rhythm — or none at all — and into a normal one.
Automated defibrillators are surprisingly easy to use. You attach the pads of the device to a cardiac arrest victim's bare chest. The machine analyzes his or her heart rhythm. If it's the kind that can be fixed by a shock, the machine tells you to stand clear and hit the "Shock" button.
Once available only to trained emergency crews, these lunchbox-size devices can now be had by anyone. The FDA has approved one model — the Philips HeartStart — for home use, and you don't even need a prescription to buy it. Whether it's worth the $1,200 or so price tag is an open question.
Although automated defibrillators may be easy to use, they are sophisticated machines subject to the same kinds of updates and recalls that affect pacemakers and implantable cardioverter/defibrillators. If you have one at home, it's important to register it with the manufacturer and keep your contact information up to date so you can be advised of any problems.
A plan won't stop a heart attack or make a cardiac arrest any less frightening and confusing. But it can save precious time. Here are four key steps for pre-attack planning:
- Know the warning signs of a heart attack. Go over them with family and friends.
- Decide who would take care of children, an ailing spouse, or other dependents.
- Make sure your house or apartment building has a number that is clearly visible from the street.
- Make emergency envelopes that include information about which family members or friends to call in case of an emergency, your doctor's phone number, a list of medications you are taking and those you are allergic to, and, if you have it, a copy of your latest electrocardiogram. Keep one envelope at home, one at work, and another in the car.
There's no predicting who will have a cardiac emergency, or when or where it might happen. What we do know is that they are common — striking more than one million Americans each year — and that the majority of them happen at home.
March 2007 Update