Mistakes That Can Lead to Death after a Heart Attack

Every 34 seconds someone has a cardiovascular event, and every minute 1 American dies of one. Every year heart diseases take lives of 787,650 Americans¹ and 17.7 million people globally. Every 5^th patient who has suffered a heart attack faces the risk of having myocardial infarction or stroke or even die from cardiovascular complications during 3 years of follow-up. So, what mistakes can lead to death after a heart attack? What depends on doctors and what on patients themselves?

During a myocardial infarction the blood vessel which supplies the heart with blood is blocked by a clot or a plaque buildup. This deprives the heart of oxygen and the muscle begins to die. If the obstruction is not resolved and the blood flow is not restored quickly, there appears heart arrhythmia, acute heart failure and potential death.

Symptoms may begin slowly and persist for hours, days or even weeks before the attack. The person may experience chest pain, shortness of breath, or feel tired days or weeks before the attack. They may also experience pain in the arms, back, jaw or even stomach, mistaking it for heartburn. The heart continues to beat, but because of blockage, it is not receiving enough oxygen-rich blood it requires. There may appear restlessness, heavy pounding heart, bluish lips, hands and feet. All this can be treated and prevented, but:

Patients hesitate to call immediate medical emergency and wait until the symptoms will resolve on their own.

Chest tightness is often attributed to food poisoning, degenerative spine disease or abrupt change in the weather. As a result, 40-50% of people suffering a heart attack die at home without getting medical attention. So, if you suspect the development of acute coronary syndrome, it is vital to call emergency to start heart attack treatment as soon as possible. When the person is timely taken to the emergency and immediate care institution, most of the life-threatening consequences of this state can be averted.

Ambulance doesn’t arrive on time or do not transport the patient to hospital for assessment.

The most efficient heart attack treatment is to restore the blood flow with stenting. But this can be done only a few hours after the cardiovascular accident and only in specialized hospitals, such as center for cardiovascular surgery. Doctors, patients and their close ones must understand that every minute counts. The ambulance must arrive within average time of 7-10 minutes² and, if it is possible to reach a cardiovascular surgery center within 120 minutes, they must transport the patient there.

The patient starts feeling better and stops the prescribed treatment after leaving hospital.

If everything mentioned above works out, the patient has got coronary intervention and his blood flow has been restored, he is released from hospital with assigned therapy, which usually involves medications and regular exercise. However, most patients do not follow their treatment plan once they’ve started feeling better.

It is important to understand that myocardial infarction is a continuum process which started before the cardiovascular accident and unfortunately continues after it. It is linked to two processes that take place in the heart – atherosclerosis and thrombosis. Atherosclerosis can be slowed down by medications, for example, statins that can lower cholesterol levels. Thrombosis can be prevented by anti-platelet therapy and drugs, such as aspirin, which should be taken lifelong.

The thing is that all the medications prescribed after the attack work unnoticed. When a person has high blood pressure, he takes a pill for it and his pressure returns to normal. But the patient doesn’t see or feel how a pill for blood coagulability or cholesterol works. Therefore, they refuse or forget to take the prescribed medications.

The doctor doesn’t explain to their patient the importance of taking medications and leading a healthy lifestyle.

Sometimes, the doctor who supervises the patient after the heart attack can limit himself to general recommendations or just prescribing medications. However, it is necessary to explain the importance of receiving those medications and why those medications are prescribed. Only if the patient understands it, they will take drugs correctly, even in spite of their feeling good.

It is also important for the doctor to explain the role of unhealthy habits, such as smoking and alcohol consumption, which not only prevent full recovery after the attack, but can trigger heart failure.³

References:

1. Emelia J. Benjamin , Salim S. Virani, et.al. “Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association”. Circulation. 137:e67–e492. Originally published: January 31, 2018. https://www.ahajournals.org/doi/10.1161/CIR.0000000000000558

2. Jill P Pell, Jane M Sirel, et.al. “Effect of reducing ambulance response times on deaths from out of hospital cardiac arrest: cohort study”. BMJ. 322(7299): 1385–1388. Published: June 9, 2001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC32251

3. Luc Djoussé, J. Michael Gaziano. “Alcohol Consumption and Heart Failure”. Current Atherosclerosis Reports. 10(2): 117–120. Published in final edited: April, 2008. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2365733