The First 60 Minutes of a Heart Attack: The Golden Hour

Have you wondered what causes a heart attack? Three coronary arteries supply blood to the heart. When one of these arteries becomes completely blocked by a blood clot, it results in a heart attack, also known as MI (Myocardial infarction).

The accumulation of cholesterol, foam cells, fibrous tissue, and calcium mainly causes the narrowing of coronary arteries. This process is age-related and more common in individuals above 50-60 years old.

However, recent studies have observed that people below 40 are also experiencing heart attacks due to high blood pressure, cholesterol, diabetes, smoking, obesity, a sedentary lifestyle, and social and mental stress.

So, how do you recognize a heart attack? When a person experiences a heart attack or myocardial infarction, they may feel chest pain and other symptoms in different parts of their body. And the death risk associated with heart risk makes it crucial to recognize the early signs of a heart attack and seek prompt medical attention to save a person’s life.

This article delves into heart attack symptoms, golden hour, treatment & prevention.

Myocardial infarction Symptoms

Recognizing the signs of a heart attack before seeking medical attention is vital. The sooner you identify the symptoms, the quicker you can take action.

The most common indicator of a heart attack is chest pain, but other symptoms may also occur, such as:

• Restlessness
• Profuse sweating
• Persistent discomfort or pain in the jaw, left arm, and back
• A feeling of crushing or heaviness in the chest, heartburn or indigestion, nausea, and sometimes vomiting
• A clammy and sweaty feeling, shortness of breath, and lightheadedness or dizziness
• In some cases, anxiety may feel similar to a panic attack
• Coughing or wheezing may occur if fluid builds up in the lungs
• Hypoxemia that leads to low oxygen levels in the blood
• Pulmonary Edema in which fluid accumulates in and around the lungs
• Sudden drops in blood pressure (cardiogenic shock) due to the heart’s inability to supply enough blood for the body to function correctly.

It’s essential for those at risk of coronary artery disease to be aware of the following symptoms. However, if the signs are not clear or severe, the patient may not respond quickly.

In such situations, getting timely medical check-ups can be helpful. In addition to that, the Golden Hour during a heart attack is the most crucial.

The Golden Hour post the Myocardial infarction (MI)

It is a matter of great concern that 50% of individuals experiencing an acute heart attack pass away before reaching the hospital. Therefore, it is crucial to know about the warning signs and immediately seek assistance from emergency services.

The first hour after the onset of a heart attack is commonly known as the golden hour because taking prompt action within this timeframe can help reverse the damaging effects of a heart attack.

If the person receives timely treatment during this critical period, they can expect a near-complete recovery. It is imperative to act swiftly when faced with such a medical emergency to ensure the best possible outcome.

Damage to the unattended heart in the first few hours

The heart muscles begin to die within 80-90 minutes of being deprived of blood. Because of the same, during the first 2 hours, there may be significant fluctuations in heart rate. This is when the heart muscles contract rapidly without actively pumping blood from the heart.

Given the above scenario, the initial 4 hours are of utmost importance. If prompt attention isn’t provided to the patient, each passing hour can further damage the heart muscles, increasing the risk to one’s life.

In fact, within 6 hours, most of the affected areas of the heart may be completely damaged. This indicates that restoring normal blood circulation as quickly as possible will result in less damage.

The abnormal heart rhythms can further lead to death because of ventricular tachycardia and ventricular fibrillation. As a result, an ECG monitor is attached to the patient immediately upon arrival at the hospital to assess their heart rhythm and provide appropriate treatment in the event of an abnormal rhythm.

Besides, the latest innovations in the health tech sector, like Wellnest ECG Pro 2, enable doctors to conduct ECG within minutes through the auto-placement of Electrodes in times of such emergencies!

These issues can only be addressed in an ICCU (Intensive Coronary Care Unit) setting, where temporary pacemakers and defibrillators are available. Therefore, seeking early admission to the ICCU is the initial step toward addressing such problems.

When patients receive treatment within 2 to 4 hours, surgeons can prevent damage to most permanent muscles. However, if there is a delay of more than 5 to 6 hours in treatment, a significant portion of the heart muscles may become damaged. And after approximately 12 hours, the damage is mostly irreversible.

Myocardial infarction Treatments

If the patient passes out, follow the steps below:

• Immediately lie down, and the patient lies down on their back.
• Listen to their heartbeat by placing your ear over their chest.
• Check for breathing by placing your finger near their nose to feel their breath.
• If the patient is not breathing, quickly administer CPR using the following instructions:

1. Lay the individual on their back and ensure that their airway is clear and open.

To assist a person who may be having difficulty breathing, carefully place them on their back and kneel beside their chest. Gently tilt their head back by lifting their chin to help open their airway.

Check their mouth for blockages, such as food or vomit, and remove them if stuck. Avoid pushing any loose blockages further into the airway by being cautious when removing them.

2. Make sure the person is breathing.

To check if someone needs CPR, place your ear near their mouth and listen for no more than 10 seconds. If you don’t hear any breathing or only hear occasional gasps, begin CPR immediately.

However, do not perform CPR if the person is unconscious but still breathing. Instead, carefully place them in the recovery position, ensuring they have no spinal injuries. Keep a close eye on their breathing; if they stop breathing, start performing CPR.

3. Perform chest compressions 30 times.

To perform chest compressions in an emergency, place one hand on the other and clasp them together. Keep your elbows straight and use the heel of your hands to push down firmly and quickly at the center of the chest, just below the nipples.

Make sure to compress the chest at least 2 inches deep, and do so at least 100 times per minute. Allow the chest to rise between each compression to ensure proper circulation fully.

4. Perform rescue breaths twice.

Ensure their mouth is open, tuck their chin up, and slightly angle their head. Put your mouth entirely over theirs, pinch their nose shut, and exhale to expand their chest.

You should tilt their head again if their trunk does not lift with the initial breath. Then if the person’s chest doesn’t rise after the second breath, too, there’s a possibility they might be choking.

5. Repeat

Until the person begins breathing on their own or until aid arrives, repeat the cycle of 30 chest compressions and two rescue breaths.

Request an ambulance, then move the patient to a nearby medical facility.

Medical and Surgical Treatment in a Heart Attack

An MI occurs when a blood clot entirely obstructs a blood artery in the heart. The primary goal is to remove the clot as soon as feasible; else, that section of the heart would perish.

Even if there is a remote possibility that the symptoms are those of a heart attack, make the patient chew a 300/325 mg aspirin tablet right away to help break the clot. Aspirin is an antiplatelet medication that instantly begins dissolving platelet-rich thrombi.

Once the patient reaches the hospital, the doctors will attempt to remove the clot using either a potent clot buster medicine [thrombolytic medicines] or a surgery known as primary angioplasty.

Coronary angiography is performed under local anesthesia using the right arm without any cuts. A completely blocked artery is located, a wire is inserted through it, the clot is sucked, the narrowing is widened with a balloon, and then a stent (stainless steel wire mesh) is placed to maintain consistent flow.

Although both techniques have advantages and limitations, primary angioplasty is the chosen therapy in most cases. Diagnostic coronary angiography is conducted immediately after primary angioplasty to determine the site of the blockage. Then angioplasty is performed, and a medical device called a stent (metallic scaffold) is deployed in the artery to open the blood flow.

The only requirement is that it can be performed only in facilities with a cardiac catheterization laboratory and well-versed clinicians in this operation. In addition, additional forms of supportive therapy are undertaken simultaneously.

Suppose there is a delay in reaching a cardiac cath-lab-equipped hospital. In that case, the second best option is to use clot-dissolving drugs known as intravenous thrombolytic agents, followed by coronary angioplasty and stenting within 6 to 24 hours, depending on the patient’s condition. This is known as a pharmaco-invasive approach.

Prevention

While certain risk factors associated with heart risks, such as age, sex, race, ethnicity & family history, can’t be changed, you can take plenty of other preventive measures.

Keep an eye on blood pressure. It is critical to check your blood pressure regularly - at least once a year for most individuals- and more frequently if you have high blood pressure.

Maintain healthy cholesterol and triglyceride levels. High cholesterol levels can clog your arteries, increasing the risk of coronary artery disease and heart attack. You can reduce your cholesterol levels through changes in lifestyle and medications (if necessary).

Triglycerides are another fatty substance found in the blood. High triglyceride levels may also increase your risk of coronary artery disease, particularly in women.

Maintain a healthy weight. Obesity or being overweight can increase the risk of heart disease. This is primarily because of obesity’s connection to other heart disease risk factors such as diabetes, high blood pressure, triglyceride, and cholesterol levels. Keeping your healthy weight as per your BMI will lessen the risks.

Maintain a nutritious diet. Limit intake of saturated fats, sodium-rich foods, and added sweets. Instead, you can consume healthy foods like fruits, vegetables, and whole grains. The DASH diet is an example of an eating plan that can assist in lowering your blood pressure and cholesterol, both of which can reduce the risk of heart disease.

Get some exercise regularly. Exercise offers numerous advantages, including strengthening the heart and improving circulation. It can also aid you in maintaining a healthy weight as well as the reduction of cholesterol and blood pressure.

Consume alcohol in moderation. Too much alcohol might lead to a rise in your blood pressure. It also adds calories, which may lead to weight gain. Both of them increase the chances of developing heart disease. Men should not consume more than two alcoholic beverages daily; women should consume no more than one.

Do not smoke. Cigarette smoking elevates blood pressure and increases your heart attack and stroke risk. If you wish to quit smoking, you seek advice from your doctor.

Control stress. In numerous ways, stress is linked to heart disease. For example, it can elevate your blood pressure. Besides, excessive stress can also act as a “trigger” for a heart attack. Furthermore, frequent stress-relieving behaviors, such as overeating, heavy drinking, and smoking, also harm your heart. Exercise, listening to music, focusing on something calm or serene, therapy, and meditation are all techniques to help you manage your stress.

Manage diabetes. Diabetes increases the risk of diabetic heart disease by a factor of two. Diabetes high blood sugar levels can slowly harm your blood vessels and the nerves that control the heart and blood vessels over time. As a result, you must get checked for diabetes and, if diagnosed, keep it under control.

Make sure to get adequate sleep. Not getting enough sleep can increase your chances of developing high blood pressure, obesity, and diabetes. And these three factors cumulatively increase your risk of developing heart disease. Most adults require 7 to 9 hours of sleep per night. In case of recurrent sleep issues, connect with your doctor.

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