More Heart Attacks

I've mentioned before about the superb care the people of London get in respect to heart attacks. They get diagnosed in the ambulance by a twelve-lead ECG, they will then get taken to a specialist centre for the gold standard treatment of an angioplasty. It is excellent and I love it, it improves the patient's outcome and gives us ambulance crews a warm fuzzy feeling to have done something other than pick up a drunkard.

I've had two such cases recently – both of them men in their early forties, both of them not recognising what was happening to them. Neither of them had any sort of medical history, it had just struck out of the blue. Both of them waited before they got treatment.

The first was an Eastern European chap who'd had pain in his chest since the morning, he'd gone to work and feeling unwell waited until his work was finished before walking to the hospital. It was only when the nurses there did the ECG that it became apparent that he was having a heart attack. We were called to 'blue light' transfer the patient to the angioplasty centre. He'd already been transferred to the CCU, so we also had a nurse coming with us. Like all CCU nurses she was excellent with the patient's care, all the paperwork was up to date, she kept explaining things to the patient to keep him informed and she treated us like professionals.

All throughout the patient didn't want to 'be a problem', he'd agree to anything, offered to help us (including walking to the ambulance!) and when he reached the angioplasty centre he told the doctor that they could 'do whatever they want with him'. He kept apologising that his English wasn't too good, but we muddled along fine.

The Consultant who performed the operation told us that once a patient had been through an angioplasty they normally gave up the smoking that nearly killed them. As this was the only risk factor the patient had, and as he was a really pleasant chap, I hoped he would find the strength to give up.

A really nice job.

The second job was picked up from the patient's place of work. Our FRU was already there and as soon as he saw us he shouted across that the patient would need a stretcher. As soon as you laid eyes on him it was obvious that the patient was having a big heart attack. He was sweating, he was clutching at his chest and he was scared that he was going to die. It was a perfect 'Hollywood heart attack'.

We wheeled him onto the ambulance where a very rapid ECG showed a big heart attack. My crewmate put the pedal to the floor while I tried to gather as much information as possible. The chest pain had started a few hours earlier, but the patient had ignored it and driven to work. He also had a phobia about needles, but the angioplasty centre managed to get the required needles into him through a combination of persuasion and brute force.

It's amazing to watch the screens as you see the blood flow return to the heart when the blockage is cleared. To know that the patient's chance of recovery is very good makes you feel that you have done a 'proper' job.

Both of these patients had a 'widowmaker' – a Left Anterior Descending Myocardial Infarction. These are the sorts of heart attack that can cause you to suddenly drop dead. Both were very lucky, despite their waiting to get treatment.

Both of these lives have been saved – but their outcome would probably be better if they had called an ambulance when they first got the symptoms.

Seriously – don't hang around with chest pain. If it's not obviously a pulled muscle (from lifting heavy objects or from coughing too much) then call an ambulance – the worst thing that can happen is that you get effective treatment quickly, the best thing is that you get a clean bill of health.

Oh – and quit smoking and/or taking cocaine.

As a public service announcement here is the British Heart Foundation description of the symptoms of a heart attack

“The most common symptoms of a heart attack tend to be pain in the centre of the chest which can spread to the neck, arm or jaw. It is often associated with nausea and shortness of breath.

“While women can experience the classic symptoms of a heart attack, they often present with more vague symptoms. These include a dull ache or heaviness in the chest, indigestion like pain, or feeling light headed with chest pain.”

You only have one heart, don't take it for granted.

I have the physical manuscript of the American version of Blood, Sweat and Tea – the one where they take out all the letter 'u's. Every page as a column of red copy-edit changes. I don't think that the copy-editor likes ellipsises much either…

What strikes me as amusing is that the American publishers sent me (by FedEx) the printed out manuscript and want me to send it back with my alterations on it. Wouldn't it have been much simpler, cheaper and kinder to the environment, to just email it to me? They want it back in nine days – for the next four 'days' I'm on night shifts. I'm tempted to just fire off an email saying that they can do whatever they want with it.

13 thoughts on “More Heart Attacks”

  1. At the age of 46 out of the blue I had Chest 'Ache' on exertion after being in denial for 3 days and fear and on point of collapse I went to the GP, had ECG confirmed Angina after angiogram was told had 2 narrowings, 6 weeks later I had extensive stenting (3 plus a further vessel that he could not put a stent in) I was 99% blocked and lucky not to have had a heart attack, It was a frightening time of my life, I was given great treatment, advice and support, and now after a year and a cocktail of drugs I carry on with a normal life I know i carry Heart disease for the rest of my life, and know to 'Listen to my body' We walk miles, and go to a local Heart support group monthly meetings and weekly exercise, I work in a care home and colleagues are aware of my condition, So basically dont delay going for advice and 'Listen to your body' The treatment of Heart disease is improving all the time, and there is support available to help you through it,joan

  2. don't you always find its the patients with 'proper' chest pains who wait before calling anyone and its normally the elderly, bless them!

  3. No, the worst that can happen is not simply treatment or a clean bill of health. You know the hideous mess that a lot of hospitals are in. Even leaving aside scare stories about c. diff. and MRSA and so on, it's really easy for someone to end up spending hours upon hours sat on a bed either lonely and bored to tears, or worrying about how their washing is out/windows are open/dog needs feeding/children need picking up from school, all the while wondering what exactly the matter might be.That's one thing if you're actually having a heart attack or similar Big Problem and need to be in a hospital, even if only for observation – but quite another if you don't need to be in hospital at all and the only reason you've spent close on 24 hours there is because the doctors have too much to do and took that long just to get around to you.Which is why one of my close relatives with a family history of heart disease will no longer call an ambulance for chest pain. Not even when she turns funny colours. This upsets me, but, you know, I can see her logic. She has better things to do than sit around in hospitals for a day at a time Just In Case, and she's quite certain the A&E departments have better things to do with their own highly limited resources too.

  4. An A&E department should be able to rule out a heart attack in under four hours.The situation might be different if you have a history of heart problems, where observation is needed. But for most people an ECG and a blood-test will rule out anything nasty.

    I'd rather have a bit of worry about my laundry rather than drop dead of a heart attack mind…

  5. I can appreciate why you say this, Tom, but if I trotted off to hospital every time I had chest / jaw / arm pain I'd be as well taking up residence in a caravan in the car park. I think I've been to my GP 3 times about it and the last one (a different bloke) took the trouble to explain WHY my symptoms were not those of a heart attack. I think they're largely triggered by stress and anxiety, certainly not smoking and coke! and I keep telling myself that, with some degree of conviction.But if you're prone to textbook symptoms and are not having the full blown 'Hollywood' attack you refer to, rather something more resembling the first guy's, how on earth do you know when it's for real?

  6. Agreed, and if I didn't think she'd get so upset with me, I would call an ambulance every time.Thing is, once the heart attack is ruled out, they don't just let you wander off. Once the tests are done and indicating an all-clear, you have to wait to be seen by the *glow*DOCTOR*/glow* before you can be discharged and you can be waiting a damn sight more than four hours. Even if all the doctor does is glance at your notes and tell you to make an appointment with your GP.

    Hence the approach of “well, I'll just skip the middleman and make a GP's appointment, that way I'm seen within 24 hours by a doctor who has my medical notes at their fingertips, and if I die in those 24 hours, so be it, at least I was in the comfort of my own home for the last day of my life rather than the hellhole that is (local hospital).” It scares the pants off me but I can see the logic.

  7. But if you're prone to textbook symptoms and are not having the full blown 'Hollywood' attack you refer to, rather something more resembling the first guy's, how on earth do you know when it's for real?Simply by having an ECG and possibly a blood test.

    Obviously in your case it wouldn't be right to call the doctor everytime, but for most people I'd say that they should at least get it checked out.

  8. I was quite touched when quite recently my dear husband was concerned that I might be having a heart attack. He knows there is a history of heart disease in my family and that I'm on meds for high cholesterol. He has taken the time to find out what the symptoms of a heart attack might be. Of course I ignored him and assured him it was just indigestion . . . Fortunately this time I was right.I did see a colleague one time insist on finishing his day of teaching before allowing his wife to drive him to the hospital – this despite having felt bad enough that he called (and emailed!) the school nurse from his classroom to tell her his symptoms. She said 'Head for the hospital now!' No idea why he contacted her and then ignored her advice. After having been worried about missing one or two classes he ended up being off work for weeks!

  9. Hear hear. Better to look slightly foolish than to be dead.My father died of a heart attack at the age of 52. He'd never had any signs of heart problems at all – was a slim built, active man – had given up smoking at least a decade before, drank sensibly, ate sensibly. The last person you'd expect to have heart problems.

    Unfortunately, his very first heart attack was also his last heart attack. Mum was away on a residential course and not at home, he felt ill. All we know is that he felt ill enough to phone his mother and she was concerned enough to get a taxi to go to check up on him. It was the taxi driver she chatted to on the way that picked up on the symptoms and radioed for an ambulance to meet them there. The ambulance crew (or police, I'm not sure which) had to smash in a window to get inside the house but they got there too late.

    I'll always wonder how different things would have been if he'd dialled 999 rather than my grandmother.

    I repeat. Better stupid than dead.

  10. batsgirl; has your relative been speaking to my relative?And should the relative need to leave hospital with medication, you can add another three hours waiting in the 'discharge lounge' (how did any one come up with such a revolting title, you wouldn't want to sit down, would you?) Whilst the pills and potions are tracked down.

    My relative says she is not going again, and gave me that rather stubborn look, and I can see where she is coming from. There will be trouble ahead.

  11. This is it! If you go in once and it turns out to be something genuine enough, but not in fact a heart attack or immediately life threatening (such as Tom's own incident two weeks ago) and you don't happen to be on first name/colleague terms with the A&E staff or have easy access to several transportation options… then it's not an experience you'd care to repeat for no good reason.Oh yes. The Stubborn Look. Best of luck.

  12. Can I add my congratulations to you for humane, entertaining and (mostly) sane dispatches from the front line of the NHS. My father was an ambulance driver and of course never looked after himself. I was present at a rather surreal incident when his colleagues piled up at our house to jump start him after years of carting people to and from hospital took their toll. He managed 20 more years of life and countless grandchildren after that brush with the grim reaper!I work in a different part of the public sector with strong links to the Police. I've started my own blog as therapy: Legitimate Tangent: Notes on the Lunacy of British Public Sector Life

    I wonder if you could take a few moments to look it over. Ian Hislop and Stephen Pollard of the Spectator think it's OK, it just could do with a bit of a lift from your many readers, for example. And perhaps, if you think it's any use, a place on your blogroll? Anyway, nice to make contact. I was able to say at my dad's funeral that one of the best things about him was that he was someone you could always rely on in a crisis. That was the job, that was.

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