Coping With Heart Troubles
ALL too often we hear about relatives, friends and acquaintances suffering a heart attack. In the United States alone heart attacks kill some 650,000 persons annually, more than a person every minute. About 350,000 die before they reach a hospital. But people in other countries, too, are affected. Nearly half the men in Western countries, as well as many women, are dying of this single ailment—heart attack!
What is particularly frightening is that so many of the victims are young—in their 30’s, 40’s and 50’s. Often their hearts are essentially healthy. Why do they die? What is the trouble?
Source of the Problem
The source of the problem is a lack of blood supply to the heart muscle. ‘But how can that be?’ you may ask. ‘Is the heart not literally bathed in blood? Do not tons of it pass through the heart daily?’
This is true. So to understand the nature of the problem, we must know a little about how the heart works. It is a hollow muscle, with four chambers, the right atrium and the right ventricle, and the left atrium and the left ventricle. Oxygenated blood from the lungs flows to the left atrium while the right atrium is filling with blood laden with carbon dioxide from the body. On contraction of the atria, the blood is forced through valves into the ventricles. Then the major pumping action of the heart occurs. The ventricles forcefully contract, simultaneously sending the oxygenated blood to the various body parts by way of the aorta and the oxygen deficient blood to the lungs by way of the pulmonary artery.
While the blood is traveling through these chambers, the heart muscle itself is not benefited by this life-sustaining fluid. A comparison can be made with a gasoline truck. The truck does not derive its power from the gasoline that it is delivering to a customer. Rather, it is powered by the fuel that it obtains when it stops at service stations. This fuel is channeled through the fuel line to the truck’s engine.
Similarly, it is not the blood passing through the heart chambers that delivers nourishment to the heart. No; but, rather, it is the blood that is pumped out from the heart and delivered back again by another route that feeds the heart. The key to the problem of heart attacks lies in these ‘fuel lines,’ or blood-delivery routes to the heart.
Blood leaving the heart is pumped into the body’s huge artery, the aorta. However, almost immediately much of this blood is channeled off into the two coronary arteries. In this way oxygen and chemical nutrients are carried to all parts of this most important muscle of the body. What happens, though, if there is an interference of blood flow through the coronary arteries?
Clogging of Coronary Arteries
This might be illustrated by what happens when a great deal of rust builds up on the inside of a water pipe. When you pump water through that pipe, the flow is restricted. So what happens if a large amount of water is required in a short period of time? The pump pushing the water may malfunction under the extra stress and break down.
This gives you an idea of what is occurring within the hearts of millions of persons today. The coronary arteries are being narrowed by a buildup of fatty deposits. This condition is called atherosclerosis. What happens, then, when the heart needs more blood to meet some physical or emotional emergency?
Even when a small part of the heart is temporarily starved of blood, electrical patterns can somehow become disturbed, upsetting the beating rhythm. The heart then goes into what is called ventricular fibrillation—an unusual and serious complication in which it twitches chaotically and ineffectively, and stalls from the lack of a driving force. Death follows within a few minutes unless proper pumping action is restored.
Similarly, heart attacks are often precipitated by a clot, or thrombus, in a coronary artery. Atherosclerosis does not cause a uniform narrowing of the vessels. Rather, a buildup of deposits occurs intermittently along the blood vessel, while the diameter of the rest of the vessel may be normal. So the clot occurs at a narrowed part of a vessel, blocking the blood flow to a portion of the heart muscle. This blocking of a blood vessel in the heart is called a coronary thrombosis, or a coronary occlusion. The result of the blockage is referred to as a myocardial infarction*—a heart attack.
How can you tell when a person is suffering a heart attack?
Many heart attacks are difficult to recognize. In fact, heart specialists estimate that perhaps 20 percent of initial attacks occur without any awareness by the victims. This may be because a blood vessel in the heart is closed off gradually over a period of weeks or months, instead of abruptly.
Then, again, the symptoms may simply not be recognized as a heart attack. They may be mistaken, for example, as a severe attack of indigestion. Also, vomiting may occur, along with fatigue and an ashen appearance. Other signals may be sweating and shortness of breath. The most common symptom of a heart attack, however, is uncomfortable pressure, squeezing or fullness in the center of the chest. Or it may be a crushing chest pain, which is an almost sure signal of a heart attack.
In many cases, persons live long and full lives after a heart attack, perhaps without ever realizing that they had one. On the other hand, even a mild attack that does minimal damage to the heart can precipitate ventricular fibrillation, and the victim may become unconscious and die within minutes. But you could save the victim, if you knew how to do it.
Saving Victims of Heart Attacks
Many persons whose hearts have stopped for up to five minutes or so are now physically fit and able to do all the things that they did before their heart attack. Swift action by persons who were near at hand saved them. They knew what to do. Would you know? Could you save a life?
It is not as difficult as you may think. In some places many of the general public are being taught the very effective lifesaving procedure called cardiopulmonary resuscitation, or CPR for short. It is a combination of external heart massage and artificial respiration. If you have the opportunity, it would be fine to receive a course of instruction in this procedure. However, by carefully considering the directions provided here, you may be able to save the life of a heart-attack victim—perhaps someone you dearly love.
If you find a collapsed person, there are certain preliminary steps that you should follow before beginning CPR. But you should act quickly, because an unconscious person can live for only about four to six minutes without breathing.
First, you should determine if the person is really unconscious. It could be embarrassing to start lifesaving procedures on someone who is only sleeping! So gently shake the person’s shoulder and ask: “Are you OK?” If he does not answer, check to see if he is breathing, since he may have only fainted. Do this by placing your ear close to his mouth, with your face turned toward his chest. If he is breathing, you should be able to feel his breath in your ear, and perhaps observe chest movements.
If there is no indication of breathing, it is important to open his air passage. Sometimes the tongue of an unconscious person sags backward in the throat, cutting off this vital air passageway to the lungs. Opening the airway to the lungs may be all that is necessary to restore breathing, and this is usually not difficult.
With the unconscious person lying on his back, use one hand to lift up the back of his neck gently. This will cause the head to drop backward, extending the neck. Put your other hand on his forehead and roll his head back fully, until it will go no farther. You may be surprised how far back the head will go with full extension. Having done this, the chin will be pointing almost straight upward, with the crown of the head resting on the floor. In this position the jaw and the tongue are drawn forward and the airway in the throat is cleared.
If this quick clearing of the airway does not restore breathing, begin immediately to give artificial respiration. Using your hand that is on the victim’s forehead, pinch the victim’s nose shut while, at the same time, keeping the heel of the hand in place to help to maintain head tilt. Keep your other hand under the victim’s neck (or under his chin), lifting up. Then open your mouth wide and place it directly on the mouth of the victim, and give four quick, full breaths in rapid succession. You will see his chest rise as his lungs expand.
Next, quickly check for the victim’s pulse, which tells you whether his heart is beating. The best place to locate the pulse is in the carotid artery, the major artery in the neck. To find it, take your hand from the back of the neck and slide its index and middle fingers into the groove beside the voice box. If there is no pulse, the heart has stopped and, in addition to artificial respiration, you must also provide artificial circulation to save the victim.
Artificial circulation is accomplished by closed-heart massage. This is a relatively simple procedure of compressing the chest. These compressions actually force the heart to pump blood. This often prompts the heart to begin beating again on its own. But, of course, oxygen, too, must continue to be provided, since the circulating blood is useless if it is not picking up oxygen from the lungs.
Thus, what the rescuer must do is to carry on the vital functions of breathing for the victim and at the same time forcing his heart to pump his blood. Even if the heart does not start beating on its own, if you can keep up CPR until medical help arrives, the victim may be saved. There have been cases where the breathing and the pumping of blood has been carried on artificially for hours before the victim’s own system was prompted to take over these functions.
Besides being prepared to help heart-attack victims, what else can we do? Can the buildup of deposits in arteries—the principal cause of heart attacks—be prevented, or at least slowed?
It is generally agreed that cholesterol and fats (glycerides) are somehow involved in the buildup of these deposits. So it only makes sense to watch our diet and avoid putting on excess weight, since visible fat likely means that inside our body fatty deposits are accumulating in arteries, dangerously narrowing them. It may also be advisable to limit or exclude the eating of foods deep fried in animal fat. At the same time eat a generous amount of nutritional vegetables, fruits, melons and cereals.
Today’s high-speed, tension-producing way of life, too, seems to be another factor in accentuating the buildup of fatty deposits in the arteries. So, since those who struggle too incessantly to accomplish too many things in too little a space of time are prone to heart attacks, you will want to avoid this continual sense of time urgency.
Getting sufficient exercise is also an important means of offsetting the possible disastrous effects of a buildup of fatty deposits in our arteries. In fact, Dr. Wilhelm Raab, as director of Cardiovascular Research at the University of Vermont, said: “Lack of exercise is the major cause of coronary heart disease.” Why is this?
The heart is, as we know, a muscle, and muscles become weak when they are not exercised sufficiently. In fact, our whole circulatory system is adversely affected. The arteries supplying blood to our muscles become narrower in size, and many small vessels even disappear. On the other hand, regular exercise causes our arteries to become larger, so they can carry more blood. Also, more blood vessels open up in muscle tissue, providing new routes for delivering more oxygen, thus minimizing the possibility of a heart attack.
Regular physical activity, too, strengthens the pumping action of our heart. As a result, fewer strokes are necessary to accomplish the same amount of work. Thus, a physically fit heart does not have to strain to meet an emergency as does an unconditioned heart. So to protect your heart, make exercise a regular habit. Said one doctor: “Vigorous walking, if practiced from youth on, would in itself drastically reduce the disability and early deaths due to coronary heart disease.”
But not all heart troubles are precipitated by a buildup of fatty deposits that narrow the insides of coronary arteries. A malfunction in the heart’s electrical system is the source of some heart troubles.
As noted earlier, the heart has a complex system of specialized cells that initiate and conduct electrical impulses throughout the heart to trigger its rhythmic beating. A heart block is an abnormality in the transmission of these electrical impulses. The impulses do not get through properly, and the pumping action of the heart is adversely affected.
There are different degrees of heart block. A partial block may involve only a delay in transmission of impulses, and it may not result in any significant abnormality in heart function. But the trouble can be serious. The impulses from the atriums to the ventricles may be blocked completely, and so the heart chambers beat independently of each other. The result is ineffective heartbeats that fail to provide proper blood flow. If the heart block persists, and the inadequacy of blood flow is too great, the person may die.
Today, however, thousands of persons who would probably have died a few years ago are still living, and living practically normal lives. This is due to the development of artificial heart pacemakers. The first of these were implanted in patients around 1960. They have proved so successful that literally hundreds of thousands of persons today are walking around with these pacemakers in their bodies. You will find the following story about the tremendous changes a pacemaker made in one man’s life both informative and heartwarming.
“Myo” refers to muscle, “cardial” to heart, and “infarction” means the area of tissue that has died because of the interrupted blood flow.
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Exactly how should CPR be performed? A brochure from the American Heart Association gives the following concise directions:
“Kneel at the victim’s side near his chest. Locate the lowest portion of the sternum [the victim’s breastbone]. . . . Place the heel of one hand about 1 to 1 1⁄2 inches [2.5 to 4 centimeters] away from [that is, above] that tip. Place your other hand on top of the one that is in position. Be sure to keep your fingers off the chest wall. You may find it easier to do this if you interlock your fingers.
“Bring your shoulders directly over the victim’s sternum as you compress downward, keeping your arms straight. Depress the sternum about 1 1⁄2 to 2 inches [4 to 5 centimeters] for an adult victim. Relaxation must follow compression immediately and be of equal time. A rhythmical, rocking motion helps insure the proper length for the relaxation cycle. Remember, do not remove your hands from the victim’s sternum while allowing the chest to return to its normal position between compressions.
“If you are the only rescuer, you must provide both rescue breathing and cardiac compression. The proper ratio is 15 chest compressions to 2 quick breaths. You must compress at the rate of 80 times per minute when you are working alone since you will lose compressions when you take time to interpose these breaths.
“When there is another rescuer to help you, position yourselves on opposite sides of the victim. One of you should be responsible for interposing a breath after every fifth chest compression. The other rescuer, who compresses the chest, should use a rate of 60 compressions per minute.”