When the heart stops beating - and how you've noticed it before. This is the topic we will address in today's article in the Nursing ABCs.

Around 41% of Austrians die from a heart attack or stroke every year. Around 34,000 Austrians suffer a heart attack every year - and one in three is fatal.

People over the age of 65 are particularly at risk of suffering a heart attack. The risk is particularly high for men and for those under 35. It is important for us to know that everyone who dies of a heart attack has not experienced 28 days between infarction and death. This means that treatment was simply given too late. That's why it's important for us to know that you must react immediately with life-saving measures if you suspect a heart attack.

What are the causes of a heart attack ?

Our heart is surrounded by blood vessels, technically known as coronary vessels or coronary arteries. These vessels supply the heart with blood and oxygen. The heart needs 5 - 20 percent of the oxygen required by the entire organism, depending on how physically active and fit we are.

The heart is a muscle that works involuntarily, which means that we don't have to consciously give ourselves the command to contract either from the brain like we do with the biceps. The heart muscle does this automatically throughout our lives. In order to contract about 70 times per minute, this muscle must be supplied with one liter of blood per minute through the coronary arteries. Over the years, calcification can form on the walls of the heart arteries. The medical term for this is Arteriosclerosis. If this arteriosclerosis leads to a narrowing within a vessel, less blood can flow into the heart muscle. This reduces cardiac output.

These deposits, which develop and grow in batches, are dangerous. We also refer to these deposits in technical terms as "plaques". The contents of these plaques are small solid substances, like tiny little chips. A deposit therefore contains these tiny little substances and can suddenly break open at any time. These small chip-like substances then enter the bloodstream, which in turn can cause a blood clot. If this clot is small, we may not even notice this process because the fasciae, which are built around the organs and wrap around them like pockets, immediately go into the healing process and dissolve the clot again without us noticing. This can happen because there are tiny little sensors in the fasciae, known as mechanoreceptors, which detect when something is wrong in the body and immediately get to work repairing it.

What happens in the event of a heart attack?

Let's get back to the clot. If it is large enough, it can obstruct or even block a large part of the vessel. This results in either a Cardiac arrhythmia, to a heart attack or - in case of severe circulatory disorder - to sudden cardiac death. What happens after a heart attack? We have learned that the sudden cessation of blood flow causes the heart muscle cells to go into a kind of shock. If the blood flow can be restored quickly, the heart muscle cells can recover.

If not - the cells die and a scar forms. The coexistence of healthy and damaged cells in the heart muscle often leads to  cardiac arrhythmias in acute myocardial infarction. If these disturbances in the heart rhythm are very severe, the heart stops pumping. Instead of the normal heartbeat, there are disorderly twitches, and this in turn leads to a Cardiac arrest. If it cannot be eliminated by delivering an electric shock, this standstill will result in death within a few minutes.

How should you behave during a heart attack ?

Since the beginning of the suspected cardiac arrest you have been usingemergency number 112 or 144 you have to go through the Heart Pressure Massage in the context of resuscitation to bridge the time until the rescuing electric shock (defibrillation) is delivered.

We now know that blood flow is disrupted when there is a large clot in the vessel. This can cause severe chest pain, known as "angina pectoris". This is always an alarm sign and you must call an ambulance immediately. Sometimes a so-called "silent" heart attack also occurs. It is called silent because the patient does not even recognize it. This is most likely to happen in people who suffer from diabetes (Diabetes) suffer.  However, most sufferers experience very severe pain. There is also a feeling of restlessness, which can even lead to fear of death. The patient has outbreaks of sweating, whereby the sweat feels cold.

All of these symptoms can subside after seconds or minutes. This is so fatal because we could then wrongly assess the signs as a temporary phenomenon. Who would want to be responsible for the death of a patient simply because the signs were not interpreted correctly? If these typical symptoms also occur at rest, then everything points to angina pectoris (Latin for constriction of the chest). Then there is a danger to life!

What are the symptoms?

A heart attack can manifest itself through the following symptoms and pain:

• Heavy, long-lasting chest pain radiating into both arms, the abdomen, between the shoulder blades and into the lower jaw
• Often a burning sensation is felt in the chest, also can
• pain occurs in the throat or upper abdomen
• Strong feeling of tightness, burning or sharp pain in the chest
• In addition to chest pain vomiting
• In women, shortness of breath, nausea and vomiting are often the only alarm signs
• Pale, sallow complexion and cold sweat, the face expresses immediate threat and is often altered to the point of strangeness
• Distress, forcing you to suddenly sit down or lie down
• Sudden circulatory collapse (collapse with and without unconsciousness)

Do men and women have the same signs before a heart attack?

No, the fatal thing is that women often misjudge the signs. Formerly a typical male disease, the number of heart attacks among women has been rising for several years.

• Smoking in combination with obesity
• high cholesterol
• Hypertension
• too little movement
• Stress

These are favorable factors. Women rarely experience the described tightness or pain in the chest.

Instead, they feel:

• extreme fatigue,
• have trouble sleeping,
• experience a dip in performance,
• are short-winded,
• have vertigo,
• pain in the upper abdomen or between the shoulder blades and
• have no appetite,
• vomiting or nausea

But even completely atypical symptoms such as frequent sweating or feelings of anxiety can be signs of a heart attack.

In the end, they even drive themselves to the hospital or if they are care recipients, they dismiss the pain. After all, they don't want to cause any more trouble. Many women have already died in this way. That is why it is particularly important to pay attention to the above signs. It is also alarming that two thirds of those affected have never complained of heart problems before.

What can you do if a patient or relative suffers a heart attack?

At the first signs of a heart attack, call the emergency services immediately via the Europe-wide emergency number 112, the ambulance on 144 or the emergency doctor as soon as you notice even one of the above symptoms.

Measures by relatives / assistants:

Even medically untrained people should recognize the typical signs and take immediate action. After making the above emergency call, various first aid measures should be carried out depending on whether the person concerned is conscious or not.

The person is conscious:

Position the upper body high so that the backflow of blood is somewhat reduced and thus relieves the heart. Reduce stress: first calm yourself down. In an emergency, the body is usually so alert that we automatically calm down. If not - at least don't let your fear show to the person affected in order to help them. Talk to them reassuringly. Open constricting items of clothing, undo your belt and shirt buttons... In the event of sudden respiratory arrest, start resuscitation immediately.

The person concerned is unconscious:

• Speak aloud to the patient
• Set pain stimuli, for example by pinching her or him
• Control your breathing: stretch your head, listen, look, feel your breath for at least ten seconds.

If breathing is present, place the patient in the stable lateral position and continue to monitor your breathing. Then perform chest compressions 30 times by finding the pressure point. To do this, feel the upper and lower end of the sternum, press four to five centimetres deep in the middle of it at a frequency of at least 100 times per minute. Then beat twice.

Actions taken by the emergency physician:

The emergency physician or paramedic performs a rapid emergency examination:

• consciousness
• Pulse rate
• Breathing
• bloodprint
• Oxygen saturation in the blood

After this, if a heart attack is suspected, an ECG is immediately performed, which is crucial for the further therapeutic procedure. The emergency doctor will insert an IV into the vein so that treatment can be started immediately. As soon as the patient can be transported, they are driven to the nearest hospital as quickly as possible. The emergency medical team continuously monitors all circulatory parameters. The emergency doctor must always be prepared for a deterioration or even respiratory arrest - after all, a heart attack has a high complication rate.

In the meantime, inform the hospital. The decision as to which hospital is approached depends on the

• Hospital type (major hospital with cardiac catheterization lab, primary care hospital without cardiac catheterization lab),
• the Removal and
• the patient's condition

If necessary, the so-called Reperfusion Therapy be started.

NORA'S TIP

The first minutes to two hours are crucial for the prognosis. The earlier you initiate treatment, the less coronary brain tissue dies. This significantly increases the chance of survival. You must therefore ensure that it takes less than 2 hours from the emergency call to the reopening of the coronary arteries in order to save your loved ones and those in need of care. Don't let them put you off either, but act immediately, that's what I urge you to do

Yours, Nora

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