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When a Loved One Has a Heart Attack: How to Be the Best Health Advocate

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You don’t want to be paralyzed with fear should a loved one have a heart attack. To be the best advocate, you need to know what to expect and what to do. Treatment moves quickly, and every minute counts.

WHAT’S HAPPENING

A heart attack signals a complete blockage of a coronary artery causing sudden chest pain that does not go away. (Reminder: Other symptoms of a heart attack can include pain in the arms, jaw, neck or back…shortness of breath…cold sweats and nausea.)

The medical term for this type of heart attack is ST-elevation myocardial infarctionor, or STEMI (“ST-elevation” stands for a specific pattern seen on an electrocardiogram or EKG). When it happens, heart muscle will start to die quickly. That’s why today’s heart attack treatment is focused on getting your loved one to a hospital with a cardiac catheterization lab (cath lab), where a stent can be placed to restore blood flow.

What you should do first: Call 911 right away. The most important thing to know is not to drive your loved one to the hospital. Why? Paramedics can perform preliminary steps as soon as your loved one is in the ambulance and en route to the hospital. Also, if your loved one’s heart stops, one of the EMTs can attempt cardiac resuscitation through defibrillation while the ambulance is still moving. Although you could pull over to perform CPR, you wouldn’t be able to perform defibrillation—you would have to call an ambulance on the road to save his/her life. Studies show that about half of people having heart attacks do not call 911. Do not make this mistake.

While waiting for paramedics, it’s a good idea to give your loved one a full-strength aspirin—that’s 325 mg. Have him chew it and swallow it. (If there’s a choice, give non-enteric coated aspirin.) This may restore some blood flow. If you already have a list of all your loved one’s medications, grab it. If not and you have the time, gather up his pill bottles so that you can show them to the paramedics and the hospital staff.

WHEN THE AMBULANCE ARRIVES

The paramedics will put cardiac monitors on your loved one, check vital signs and start an IV and may also give him oxygen. They will do an EKG and send it to the nearest hospital with a cardiac cath lab. If it shows the distinctive ST-elevation pattern, the cath lab team will be activated. Nurses, doctors and technicians will get the cath lab ready for your loved one immediately.

During the ambulance ride, medications may be started. Most commonly, these include aspirin, a prescription blood thinner and an antiplatelet agent—a medication that prevents clotting. If your loved one’s heart stops in the ambulance, the paramedics will attempt resuscitation.

What you should do: Let the paramedics make the decision about which hospital to go to—it will be the nearest one with a cath lab. There may be room for one family member or friend to go in the ambulance to the hospital with your loved one, but follow along in your car instead if instructed by paramedics. All the attention in the ambulance should be on your loved one, plus you won’t be stranded at the hospital later on.

IN THE EMERGENCY DEPARTMENT

There may be a quick stop in the ER to stabilize and evaluate your loved one. Blood tests may be done to look for heart damage.

What you should do: Be there to offer support to your loved one. You might also answer providers’ questions if your loved one can’t. Give information about his health history and medication list and answer any insurance questions that may be asked.

WHEN IN THE CATH LAB

As soon as possible, the hospital staff will move your loved one to the cath lab and start IV sedation. During cardiac catheterization, a long, thin, flexible tube will be inserted into a blood vessel that goes to the heart and advanced to the blocked artery. The artery will be opened and, in nearly all STEMI cases, a stent put in place to keep blood flowing. This is the most common STEMI treatment and is successful in more than 95% of patients.

What you should do: This can be the most stressful time for you, but try to use it to call for support for yourself from friends or family. You might also alert your loved one’s primary care provider of what has happened.

IN CARDIAC INTENSIVE CARE

Most heart attack patients will stay in a specialized intensive care unit for about 24 hours.

What you should do: During this time, you will be able to visit your loved one. At some point, you might want to go home and get things he needs for his hospital stay. This is your first chance since the heart attack started to take a deep breath—be sure to do that.

THE HOSPITAL STAY

Expect your loved one to be in the hospital for about two to five days. During this time, he will have many blood tests and imaging studies and receive various medications.

What you should do: Once your loved one is moved to a regular hospital room, he  will be told to get up and start walking. You can help by encouraging this activity.

Talk to your loved ones’ doctors about test results and new medications. Most patients will be sent home taking between four and seven medications such as aspirin, an antiplatelet, a beta-blocker to lower blood pressure, a statin drug to lower cholesterol and/or an ACE inhibitor to open blood vessels for better blood flow and to help protect the heart. Speak with providers, and then help your loved one understand the role of each of these drugs and the side effects to watch out for.

AT HOME AFTER DISCHARGE

What you should do: Your work as an advocate kicks into high gear now. Help your loved one return to normal activities and participate in a cardiac rehab program when given the go-ahead. In rehab, topics covered include how to exercise safely and make healthful dietary changes and get guidance on losing weight if needed.

It’s also vital to make sure your loved one doesn’t return to a smoking habit and does take all medications as directed. Having a heart attack is a big shock to the system with emotional consequences, so also watch out for signs of depression, especially if having had a heart attack impacts returning to a job.

Finally, being a caregiver can be physically and emotionally draining, so also remember to take good care of yourself.

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Source: Umesh N. Khot, MD, vice chairman of cardiovascular medicine and chief quality officer, Heart and Vascular Institution, Cleveland Clinic, Ohio. Date: December 25, 2018 Publication: Bottom Line Health
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