Replacement of Heart Valve

Introduction

In heart the blood flows between different chambers of heart must flow through a heart valve. The blood which flows out of heart into large arteries must also flow through a heart valve. All heart valves open up enough so that blood can flow through in a specific manner. The heart valves then close to keep blood from flowing backward. There are four valves in the heart: Aortic valve, Mitral valve, Tricuspid valve, Pulmonic valve. Replacement of heart valve is used to repair or replace malfunctioning heart valves. Out of the four heart valves the aortic valve is the most common valve to be replaced, the mitral valve is the most common valve to be repaired. In rare cases the tricuspid valve or the pulmonic valve needed to get repaired or replaced.

Replacement of heart valves has gone through a long journey of test and trials for last many decades. Replacement of heart valves is not any more an operation that is exclusively approached through a simple sternotomy using only sutured prostheses. Now a day’s surgical valve replacement can be performed through many of minimally invasive ways employing conventional mechanical or bioprostheses (tissue valves). In both cases, the direct surgical access allows a clear inspection of the valve, complete excision of the effected leaflets, and debridement of the annulus in a clear and detailed way under a visual system. Which is a better manner employed to treat not only valve pathologies of all natures but also aetiologies. When the process is compared with transcatheter valves in patients for risk it is found that a high or intermediate preoperative predictive risk, conventional surgery has not been shown to be inferior to transcatheter valve implants. To understand the comparison of sutureless valves and their practical applicability with the minimally invasive surgery advances, the trauma of surgery and invasiveness can be reduced and we can get better results.

Replacement valves durability and performance

Before replacement of heart valves an evolution is always done regarding all the possibilities to cure the heart. If there is a possibility the surgeon can repair heart valve, the ring annuloplasty is performed. In this process the surgeon repairs the ring-like part around the faulty valve by sewing a ring of cloth, plastic or tissue around the valve. In the process of repair the surgeon shapes, trims or rebuilds the defected leaflets of the valve. The flaps that open and close the valve are called leaflets.

Replacement is usually needed in case of the aortic valve which is not generally repaired. If the valve is too damaged, the replacement is needed. This process is called valve replacement surgery. The surgeon will remove the damaged valve and replace it with a new one. Mainly there are two types of valves used for replacement. One is Mechanical valve made of man-made materials, such as metal (stainless steel or titanium) or ceramic. These mechanical valves have the longest durability. The person will have to be on medicine support system (blood-thinning medicine) for the rest of the life to get the optimum performance. The second one is Biological or Bioprosthetic- made of human or animal tissue. The bioprosthetic valves has a comparatively less durability. It last 12 to 15 years, but the person may not need to take medicine support (blood thinners) for life. In some cases, surgeons can use patient’s own pulmonic valve to replace the damaged aortic valve. In such cases the pulmonic valve is then replaced with an artificial valve (this is called the Ross Procedure). This procedure may be useful for people who do not want to depend on blood thinners for the rest of life. In this process the new aortic valve does not last very long and may need to be replaced again after a period of time by either a mechanical or a biologic valve.

Replacement valves risks and medication requirement

Replacement of heart valve is a decision taken after having a thorough investigation and consideration of all risk factors. The main question for the patient is whether a mechanical or bioprosthetic valve should be used keeping in view the risk and benefits of the two options mechanical or bioprosthetic valves. In case of mechanical valve because of thrombogenicity of materials used a high shear stress is generated around the hinge points and backflow jets which results in damaging blood and activate clotting-pathways, in such cases patients require lifelong anticoagulation therapy (blood thinning medicines such as warfarin or aspirin) to avoid blood clotting. Even with the use of anticoagulation this risk is apparent like spontaneous bleeding (e.g. gastrointestinal bleeding) or trauma-related bleedings (e.g. subdural hematoma), which cause considerable mortality and morbidity.

Bioprosthetic valves (tissue valves) are made of either porcine aortic valves or bovine pericardium, in some cases it may also be produced from equine or porcine pericardium. The main benefit of bioprosthetic valves is that they do not require support of medicine for life-long. But as we use tissue it does introduce the possibility of degeneration of the valve, which is virtually non-existent in mechanical valves. The main risk with bioprosthetic valves is reoperation for structural valve deterioration (SVD) due to the limited durability of bioprosthetic valves. The average lifespan of a bioprosthetic valve is estimated at 15 years in elderly patients, but this risk is higher in younger patients in whom SVD is accelerated due to a more pronounced immunologic response to the valve and enhanced calcification of the valve In addition, elderly patients generally have a shorter life expectancy during which they are at risk for requiring replacement of a deteriorated bioprosthetic valve and thus less often require reoperation. The most common reason for reoperation is SVD. Risk of non-SVD is considered to be equally low to that of mechanical valves. Particularly important is the risk of prosthetic valve endocarditis that has a similar incidence in mechanical and bioprosthetic valves and is a devastating diagnosis that often requires the need for reoperation.

Types of Replacement Heart valves

Replacement of heart valve is an effective way to treat problem valves. This procedure has been performed for last many decades. Generally it is safe and effective procedure that can help many patients to live healthy and active life. There are mainly two types of Heart valves used in replacement procedure. In case of patients with significant heart valve disease, when valve replacement is performed, the valve is chosen by considering many parameters of the patient’s condition, medical history, age etc. The selection of the type of valve is important to ensure the safety, durability and better health after the surgery for as long as it could be. Both the type of valve has different characteristics and own advantages and disadvantages.

  1. Mechanical valve– Mechanical valves are made up of man-made materials. Mechanical valve is made up of metal (stainless steel or titanium) or ceramic. They usually consist of one or two leaflets and a metal ring surrounded by a ring of knitted fabric, which is used to sew onto the heart in place of the original faulty valve. Mechanical valves bring revolution in the heart valve replacement for the person with faulty valves. In due course of time the professionals faces many challenges in respect of proper functioning of mechanical valves and along with other new health related issues caused by the valves. Many studies were done to overcome the challenges and after many intensive researches many types of mechanical valves were invented. Each type of mechanical valve was even better and improved than the previous one. The revolution in this field is still going on to make it the best. There are mainly three types of mechanical valves  used till date.
  2. Caged ball Valve – Caged ball valve is the very first mechanical valve successfully implanted. Caged ball valve consists of a silastic ball with a circular sewing ring and a cage formed by three metal arches. These are no longer used for replacement of heart valves. There are still several thousands of patients have caged ball valves implanted, and these patients require a regular follow-up. The first implantation of an aortic valve substitute was performed in 1960 with a caged-ball valve. It consists of a silastic ball encaged by Stellite-21 (alloy of cobalt, chromium, molybdenum and nickel) arches and a Teflon sewing ring. Some studies report > 40 years of proper functioning of this type of valve in some patients. In this type of design, the blood flow is partially obstructed by the ball and has to flow around it. Due to the obstruction in the flow of blood generates a large energy loss. The ball also causes blood cell damage and blood stasis due to flow separation, which further causes clotting of blood known as thrombosis. Even though it has a  good durability but the caged-ball valve provides a poor hemodynamic performance with a much high risk of thrombosis. Due to so many complications caged ball valve’s use is discontinued after the discovery of tilting disc valve.
  3. Tilting disc valve – The tilting disc valve was made keeping view of the complications in the performance of caged ball valve. It is made in such a way to overcome all the drawbacks. In tilting disc valve the ball is replaced by a circular carbon-coated or pyrolytic carbon disk (mono-leaflet) fixed to a rigid ring by metal struts and rotating with an opening angle ranging from 60 to 80 degrees. In tilting disc valve the blood flows through two orifices of different sizes when the valve is open, the blood flows in such a manner creating a semi-circular flow jet through two orifices the large one and another through the smaller one. In this type of valve due to the angular opening the damage to the blood cells is reduced but still causes slight energy loss and turbulence, especially through the larger orifice. The thrombosis is still a big challenge in tilting disc valve also and the patient has to use blood thinner medicine for the rest of the life. For the safety side highly durable materials for the disk and the rigid ring are used. Even with all improvement in some cases of struts disruption due to fatigue and fracture have been reported due to fabrication defect of the outlet strut causing the malfunctioning of the valve. It is again a search of a new type of valve has begin resulting even a better option bileaflet valve.
  4. Bileaflet valve– Bileaflet valve is the new discovery in the process of search for a better mechanical valve after tilting disk valve. Bileaflet valve is made of two semilunar disks attached to a rigid valve ring by small hinges. In  bileaflet valve the opening angle of the leaflets relative to the annulus plane ranges from 75° to 90°. In bileaflet valve the open valve consists of 3 orifices: a small slit-like central orifice between the 2 open leaflets and 2 larger semicircular orifices laterally. When the valve is open, the resulting transvalvular flow is thus symmetrical and makes bileaflet valves less obstructive mechanical valves (with the largest effective orifice areas). The material used for the leaflets also makes it a much better choice. The material used to make bileaflet valve are – solid pyrolytic carbon or graphite coated with pyrolytic carbon. It provides adequate biocompatibility, strength and durability. It also provide better thrombo resistance as well than other mechanical valves. However, hinges can be a source of blood stagnation and subsequent thrombus formation. Keeping in view of such problems, all mechanical valves have a built-in normal small backflow allowing blood wash-out. Bileaflet prostheses have the highest regurgitant fraction (10%). The professionals are making constant efforts to enhance this washing-effect by modifying the hinges’ design (butterfly geometry, convex open pivots). All these improvements makes it a better choice but still have many drawbacks like high leakage flow velocities, turbulent flow, vortex structures and viscous shearing. Such drawbacks may in turn cause damage to blood cells. Bileaflet valve is more widely used mechanical valve all over the world. The major issue with bileaflet valve is the inherent thrombogenicity (resulting from potential blood stasis) and hemolytic risk (due to viscous shearing). Patients with mechanical valves require a life-long anticoagulation therapy which  increases the risk of bleedings. These valves should be avoided in women of child-bearing age, or pregnant women as warfarin is not safe for use in pregnancy, and those with a high risk of falls or bleeding. In the process of improvements many measures taken to reduce the thrombosis issue of bileaflet mechanical valves, like new surface coating with hydrophilic polymers and improved designs to get closer to the native valve and provide a better physiological flow. Even with all improvements bileaflet valve is the better choice and used widely but certain drawbacks are still there. Keeping in view one more new valve is in the process of development the triflo valve, a trileaflet valve with pyrolytic carbon leaflets has been developed (not yet in clinical use) and it provides a large effective orifice area with soft closure, reduced flow separation and regurgitation (when the valve doesn’t close all the way and blood flows backward into the heart). There are many improvements made like the ability of the valve to rotate within the sewing ring to improve to the flow or supra-annular designs to provide larger valve orifice areas. These improvements resulted in good hemodynamics and excellent durability. It could be proved a better choice for future.

Advantage of Mechanical Valve

The mechanical valve has one very important advantage which is their durability. In case of an elderly person or a fully grown patient the mechanical valve have been known to work more than 40 years. Mechanical valve in general less likely to have a reoperation or resurgery. Mechanical Valve is safe for the person who have overactive parathyroid gland (affecting blood calcium levels).

Disadvantage of Mechanical valve

The mechanical valve has many disadvantages like causing blood damage, life time blood thinning medicine to be consumed rest of the life, cavitation, noise issue, fluid mechanics etc. We will discuss few of them in detail.

Blood Damage– The blood flow and its specific constituents are the very important for normal functioning of our body. Our heart controls the regular blood flow in our body. The smooth blood flow has specific role in maintaining basic constituents of the blood like blood platelets. The complex blood flow phenomena caused by the mechanical prosthesis are responsible to induce serious thromboembolic complications. Many studies shows the models realistic sized suspended platelets for assessing potential blood damage in flow through Mechanical valve due to the nature of the materials and the design hemodynamics. The patients implanted mechanical valve are at a higher risk for clotting and therefore cause embolism. Even though many improvements made in the mechanical valves but high leakage flow velocities, turbulent flow, vortex structures and viscous shearing are the few side effects may be expected. All such effects may in turn cause damage to blood cells. The only possible way to overcome it up to certain levels is taking appropriate medicines throughout life. The medication improves some complications but equally creates the new one like excessive bleeding issues etc. 

Noise– Some people hear a ticking sound. It’s the valve leaflets opening and closing sound. But it is not necessarily shown in all people.

Cavitation– Cavitation is known to be the rapid formation of vaporous microbubbles in a fluid due to a local drop of pressure below the vaporization pressure at a given temperature. Cavitation in the blood can be a major cause to mechanical heart valve failure, so cavitation testing is consider as an essential part of the valve design verification process. In the mid 1980s after a series of valve failures observed and as a results it is correlated with a direct association of cavitation. The damages when tested were found to be due to cavitation. Many studies showed the bubble formation and collapse of cavitation at mechanical heart valves. It was concluded that the cause of damage to the formed elements of blood could be cavitation and as a result enhance the risk of thromboembolic complications seen in mechanical heart valve patients.

The mechanical heart valve’s quality is quite high, and implantation has become a routine clinical procedure with a low operative mortality (< 5%). Most of the patients still face the risks of blood cell damage, thromboembolic complications and material failure of the prosthetic device. It is found that cavitation has been responsible by visualization causing of high frequency pressure fluctuations (HFPF).The tilting disc valves are found to be with higher cavitations risk than bileaflet valves because of higher closing velocities. But the thromboembolic potential seems to be the same in both valves. More studies are therefore needed to investigate the cavitation potential of bileaflet valves in vivo. The post processing of HFPF have shown difficulties when seen on bileaflet valves because of asynchronous closure of the two leaflets.

Fluid mechanics– The blood circulation system in the body works on fluid mechanics. Human heart performs a series of task to maintain the blood flow in the whole body. Heart valves have a major role in maintaining the proper flow of blood that to at a certain pressure. Heart valve help to maintain unidirectional seamless blood flow through the heart and to open and close the valves like door at the right time and close tightly to avoide backward flow. Mechanical valve has the issue of blood flow disturbances. It is found that many of the complications of mechanical heart valves can be explained through fluid mechanics. In studies we came to know blood clot formation is a side effect of high shear stresses created by the design of the valves. If we look the pressure phenomenon used by an ideal heart valve would produce minimal pressure drops, have small regurgitation volumes, minimize turbulence, reduce prevalence of high stresses, and never create flow separations in the safety of the valve. Even though many improvements makes in the mechanical valves but high leakage flow velocities, turbulent flow, vortex structures and viscous shearing may in turn cause damage to basic structure of blood cells.

2.    Bioprosthetic valve- Bioprosthetic valve is a step towards the natural solution of the heart valve problem. Bioprosthetic valves (tissue valves) are made up of either natural tissues porcine aortic valves or bovine pericardium, in some cases it may also be produced from equine or porcine pericardium. Bioprosthetic valve is in general made in two types – stented or stentless bioprotheses. Stented Bioprostheses –The stented bioprostheses is made in such a way to mimic the native aortic valve. In porcine bioprosthetic valves 3 porcine aortic valve leaflets cross-linked and mounted on a metallic or polymer supporting stent hence it is called stented. Pericardial valves are made from sheets of bovine pericardium and mounted inside or outside a supporting stent. Stentless Bioprostheses – It a more improved version with better hemodynamics and durability of the valve. Many versions of stentless bioprosthetic valves have been developed. Stentless bioprostheses are created from whole porcine aortic valves or fabricated from bovine pericardium. Percutaneous Bioprostheses – There are patients with symptomatic aortic stenosis (when the opening of the valve gets too narrow and not enough blood flows out) considered to be at high or prohibitive operative risk and in such cases Percutaneous aortic valve implantation is usinging as an substitute to standard aortic valve replacement (AVR). Usually a percutaneous transfemoral approach is used to implant the valve. To reduce the issues of vascular access and associated complications, a transapical approach through a small thoracotomy may also be used sometime. The procedure appears promising at present. The percutaneous bioprostheses remains experimental and is currently undergoing further investigation.

Advantage of Bioprosthetic Valve

The advantage of Bioprosthetic valve (tissue valves) is that the patients usually do not require long-term blood thinner therapy (e.g. warfarin) for the rest of their life. These medications has reduce the blood clotting in the system which can cause stroke or embolism. In the long term these medicine creates an increase in risk of bleeding. However, approximately 1/3 of patients with a tissue valve need a blood thinner requirement for other heart or vascular conditions. Bioprosthetic valve is used in case of pregnant women or planning to have children as warfarin cannot be used in pregnancy due to the risk of causing fetal malformations. In increasing age the bioprosthetic valves are suggested keeping in view of higher risk of bleedinmg related issues.

Disadvantage of Bioprosthetic valve

The main disadvantage of tissue valves is their less durability. The bioprosthetic valve is made up of tissues which gets damaged with time and conditions. As the tissue get damaged and require replacement, especially in patients ≤ 65 years old.The durability of tissue valves depends on the patient’s age at the time of the valve replacement surgery takes place. In case of patients less than 65 years old, some aortic tissue valves begin to fail after only 5 years and some mitral tissue valves begin to fail as early as 4 years after the surgery. In some cases tissue valves fail after 7 to 10 years. The risk factors that may increase the possibilities of failure include poor life style of the patient, several conditions affecting calcium metabolism or when calcium containing chronic drug therapies are used, including children, adolescents, young adults and patients on maintenance hemodialysis. The patients with bioprosthetic valves are more likely to get reoperation or repeat replacement surgery. Bioprosthetic valves tend to deteriorate more quickly in younger patients.

Tissue engineered valves

Tissue engineered heart valves (TEHV) is step towards a new revolution in the replacement of heart valves. It is uniquely designed valve which proposed treatment by creating a living heart valve for people who are in need. In present scenario a huge number of prosthetic hearts are implanted in a year all around the world which is expected to be triple or more in the coming next fifty years. 

Our today’s treatment system offers only two provisions such as mechanical valves or biological valves. It’s a hard fact that both are not properly supporting to one’s health, both have limitations like in mechanical valves the lifelong use of anticoagulants is must causing several health issues while biological valves are having durability issue like structural degradation and leads to reoperation. Heart valve disease is major cause of high cardiovascular morbidity and mortality rate in the world. Thus, there is a great need of Tissue engineered heart valve.

Tissue engineering of heart valves is a novel approach that explores the use creating a living heart valve composed of the host’s own cells that is capable of growing, adapting, and interacting within the human body’s natural system. In these models natural and synthetic polymers mimic the extra cellular matrix. Tissue engineering heart valve is a method providing new horizon of hope for constructing both valve replacements and valvular disease models. Tissue-engineered heart valve replacements help us to go beyond the limitations of mechanical and bioprosthetic valves, as they are made up of living tissues capable of active remodeling and self-repair.

Many tissue-engineered valve replacements have got promising results in large-animal trials. Tissue-engineered disease models also provide a scalable way for investigating the pathobiology of valvular diseases like aortic stenosis. These various reviews provide an overview of recent developments, current challenges, and future directions in the field of heart valve tissue engineering.

Research has not yet reached the stage of clinical trials.

Conclusion

Human heart is a very complicated as well as very sensitive organ. Human heart provides nutrition and other support system to all body through the blood flowing through it. Heart has four valves which maintain the regular flow of blood towards the body from the heart and vice-versa. Taking care of is Human heart is very challenging not only today but always. The medical researchers accept the challenges and invent the best possible solution to various problems. Replacement of heart valve was one of the most challenging tasks for the medical professionals.

The journey of replacement of heart valves from early time to modern world shows many ups and downs. Every time from the very first replacement of mechanical heart valve till today the long journey was full of hurdles but every time a new mile stone is created. The development of mechanical valves from caged ball valve to bileaflet valve shows the serious concern and commitment of the medical community. Mechanical valve and bioprosthetic valve prove to be of very useful step in treatment of Heart valve replacement but due to the limitation of both the options a challenge remains always. Heart valve disease is major cause of high cardiovascular morbidity and mortality rate in the world. . Thus, there is a great need of Tissue engineered heart valve.

Tissue engineering of heart valves is a research that explores the creation and use of a living heart valve composed of the host’s own cells which are capable of growing, adapting, and interacting within the human body’s natural system. Tissue enginnered heart valve is the most revolutionized step towards the future of replacement of heart valve. Tissue engineered heart valve will surely overcome all the limitation of both mechanical and bioprosthetic valves. Tissue engineered heart valve is the future of Replacement heart valve. Many tissue-engineered valve replacements have got promising results in large-animal trials.

Research has not yet reached the stage of clinical trials. But Hoping for a better future of tissue engineered valve.

FAQ

Q1. What is a heart valve?

Ans. Human heart has four valves: the mitral valve and the aortic valve on the left side of the heart and the tricuspid valve and the pulmonic valve on the right side of the heart. In order for blood to move properly through the heart, each of these valves must open and close properly as the heart beats. The valves are usually referred to as leaflets or cusps. This leaflets comes together to close the valve, preventing blood from improperly mixing in the heart’s four chambers (right and left atrium and right and left ventricle)

Q2. When do the heart valve open and close?

Ans. It could be notice that the beating of the heart makes a “lubb-dubb, lubb-dubb” sound. This sound corresponds to the opening and closing of the valves in the heart. The first “lubb” sound is softer than the second; this is the sound of the mitral and tricuspid valves closing after the ventricles have filled with blood. As the mitral and tricuspid valves close, the aortic and pulmonic valves open to allow blood to flow from the contracting ventricles. The blood collected in the left ventricle is pumped through the aortic valve to the rest of the body, while blood cloocted in the right ventricle goes through the pulmonic valve on to the lungs. The second “dubb,” which is much louder, is the sound of the aortic and pulmonic valves closing after releasing the blood.

Q3. How often do the heart valves open and close ?

Ans. The average human heart beats 100,000 times per day. In the whole life span an average person 70-year-old, that means over 2.5 billion heart beats/life.

Q4. How big are the heart ?

Ans. The heart is about the size of the two hands clasped together.

Q5. How can the heart valve be replaced?

Ans. If the heart valve cannot be repaired, the consultant may decide to replace the native valve with a prosthetic valve. The prosthetic valves are usually of two types: a mechanical valve or a tissue valve. A mechanical valve is made from synthetic (manmade) materials and a tissue valve is usually made from the animal/human tissues. Valve replacement can be performed with a full open-chest or through less invasive or minimal incision approaches as well.

Q6. Are there any complications or other risks with heart valve surgery that should be known?

Ans. Serious complications, sometimes leading to re-operation or death, may be associated with heart valve surgery. It is important to discuss the particular situation with the consultant to understand the possible risks, benefits, and complications associated with the surgery.

Q7. How do valve should be taken care of ?

Ans. Be sure the dentist and general consultant know that heart valve surgery is done. Ask the dentist and general consultant about taking antibiotics before dental or surgical procedures or endoscopy to help prevent valve infection. Always follow The consutant’s instructions carefully.

Q8. How long after heart valve repair or replacement surgery “normal” levels of activity could be resumed?

Ans. After a valve replaced or repaired, the normal recovery period is four to eight weeks. The ability to return to the normal daily activities depends on several factors, including the type of valve repair/replacement one had, how well the incision is healing, and the advice of the consultant. A supervised cardiac rehabilitation program under the guidance of the consultant is always helpful to regain energy and ensure overall good health.

Q9. What are the type of mechanical valves?

Ans. There are mainly three types of mechanical valves

  1. Caged ball valve
  2. Tilting disc valve
  3. Bieleaflet valve

Q10. What is tissue engineered valve?

Ans. Tissue engineered heart valves (TEHV) is step towards a new revolution in the replacement of heart valves. It is uniquely designed valve which proposed treatment by creating a living heart valve for people who are in need. Tissue engineering of heart valves is a novel approach that explores the use creating a living heart valve composed of the host’s own cells that is capable of growing, adapting, and interacting within the human body’s natural system. In these models natural and synthetic polymers mimic the extra cellular matrix.

Cardiopulmonary Resuscitation (CPR)

Introduction

Useful in emergency situations like heart attack or near drowning, as a life-saving technique, Cardiopulmonary Resuscitation (CPR) helps revive a person whose breathing or heartbeat has stopped. As recommended by the American Heart Association, everyone and anyone, including untrained bystanders or qualified medical practitioners, can perform the basic steps of CPR along with chest compressions.

In situations when someone stops breathing, every second counts as otherwise it can lead to permanent brain damage or even death. If one knows how to perform CPR, a life can be saved, until medical help arrives on the spot.

It is possible to perform hands-only CPR even if you haven’t undergone a professional training. Using the pressure created with chest compressions, CPR helps keep the blood circulating until emergency help arrives. Trained person can go a step further and perform the complete procedure starting from chest compressions, clearing the airway and doing the rescue breathing, which ensures the lungs receive oxygen supply.

Practicing CPR is essential to keep your skills sharp and hence must be performed every two years. Even if you are not confident of your skills to perform live CPR on a suffering person, it is important to carry out the action instead of standing and watching like a dummy and doing nothing.

Steps Involved in CPR

The person who performs the CPR is called the rescuer and has to follow three main steps, known as C-A-B:

C – Do Chest Compressions

In this step, the rescuer press the patient’s chest many times in a row to move blood out of the heart which has stopped breathing.

A – Check the Airway

The rescuer, after doing the 30 chest compressions, checks the airway by listening and looking to see if the person is breathing or not.

B – Do Rescue Breathing

The rescuer’s breathing helps move oxygen in the lungs down below in a person who is not breathing. You have to give TWO rescue breaths if the person is not breathing.

Why CPR?

CPR is important as it helps in keeping the blood flow active, even if it is partial during the emergency situation of blockage of blood flow and oxygen when a person’s heart and breathing have stopped. It extends the opportunity for a successful resuscitation once the trained the medical staff arrives on the site.

If the CPR is performed within the first six minutes of the heart stopping, it helps to keep someone alive until medical help arrives. Although CPR is unlikely to restart the heart, it restores partial flow of oxygenated blood to the brain and the heart. The motive is to delay tissue death and extend the opportunity for successful resuscitation without permanent brain damage or even death. Once an electric shock is administered, known as defibrillation, it is usually required to restore viable heart rhythm.

CPR will lead to inducing back the heart rhythm and hence should be continued until the patient starts breathing or is declared dead. In case no CPR is performed, it only takes three to four minutes for the person to become brain dead due to lack of oxygen.

CPR helps in circulating the blood so it can provide oxygen and helps the brain and other organs to stay alive even as you wait for the ambulance. Although the blood has enough oxygen to keep the brain and other organs alive for few more minutes, the oxygen wouldn’t circulate unless someone performs a CPR.

In case you are unsure if the patient is in a state of cardiac arrest, you should begin CPR nevertheless, even if not required as the person may respond to your attempts. CPR by no means is harmful to the patient even if they are not in a state of cardiac arrest.

Awareness on CPR in India

According to experts and research reports, approximately 98% of Indians are not aware about CPR. For thousands of Indians, cardiopulmonary resuscitation is pretty difficult to understand, let alone practice it or perform it live on a patient. CPR is presented as a mouth-to-mouth breathing, invoking humour or romance in movies.

This hampers the context of the life-saving medical help, and the technical nature of performing the act goes for a toss. However, this is the maximum sensibility which can be expected from celluloid.

CPR has much more to offer, as it not only saves a drowning victim but also when performed at the right time on the patient having a sudden cardiac arrest, it can even save lives. Despite being the capital of cardiac diseases, obesity and diabetes, printed information is not available in India. A surprising indifference towards cardiac health awareness means simply pushing each of us on road to a cardiac epidemic.

It is this indifference towards this life-saving support which has resulted in the appalling lack of campaigns in India. It is this gap between the academic knowledge and implementation which is preventing efficient implementation.

Around 98 per cent Indians are not trained in CPR which is to be provided when the sudden cardiac arrest occurs.

Before you begin

Preparation for CPR

Before you begin to give CPR, it is important to correctly assess the situation. The following factors are important to be analysed:

  • Is the person in a safe environment?
  • Is the person conscious or unconscious?
  • If the person appears unconscious, check by tapping or shaking their shoulder and ask out loud, “Are You Okay?”.
  • If the person doesn’t give an answer and two people are available, ask one person to call the emergency medical help. In case only one person is available, ask them to call and you can start performing the CPR.
  • In case you are alone, it is better to call for medical help before beginning the CPR.

How to perform CPR?

In order to ensure the patient’s condition is not deteriorating, it is important to perform the CPR in the right manner. Based on the patient’s condition, location, help and medical facilities available, along with their age, performing CPR demands certain rules which must be followed. Let us take a look at what are the methods to be kept in mind, steps and stages to be followed and critical things to be kept in mind when handling patients of different age brackets:

  1. On Adults

The age group being covered here is from puberty to adulthood. The overall condition must be assessed properly before beginning the CPR. In case a second rescuer is available, ask them to call for medical help and get the desired equipment or tools. You should also check the pulse for not more than 10 seconds while you look for normal breathing. There would be either of the two conditions – no breathing, or no normal breathing and no breathing or only gasping.

  1. Compressions: Restore blood circulation

Once you start the compressions, the blood circulation begins to restore to normal rate and hence one must continue to perform the action as per the guidelines. At least 100/120 minute on the lower half of the breastbone is the ideal rate of compressions. The depth of the compressions should be strictly between 2 inches (5cm) and 2.4 inches. While performing the compressions, the chest wall recoil must also be noted. Allow complete recoil between compressions and one must rotate compressors every 2 minutes to reduce the fatigue caused due to CPR. Another important aspect to be taken into consideration is to minimize the interruptions in the chest compressions, and an attempt must be made to minimize or limit the interruptions to <10 seconds.

  1. Airway: Open the airway

In order to ensure the airway passage is not blocked and the patient is able to inhale and exhale through a clean and clear airway, it is important to check the functioning of the same. One of the best ways one can do it is to tilt the head, lift the chin and avoid excessive ventilation. The compression ventilation ratio must be kept in mind at all times. A ratio of 30 compressions with two ventilations is suggested when there is only one or two rescuer available.

  1. Breathing: Breathe for the person

Once the above mentioned steps have been performed, it is suggested to carry out the following steps which involve ventilation with advanced airway. Under this method, one breadth should be given every 6 seconds. Asynchronous with chest compressions, (at least 100/120 min) should be given. This has to be followed by about 1 second per breadth with a visible chest rise.

Attach and use the Automated External Defibrillator (AED) as soon as possible. Minimize interruptions in the chest compressions before and after the shock. You should then resume CPR by beginning with the compressions immediately after each shock.

  • On ChildsCompressions: Restore blood circulation

Once you start the compressions, the blood circulation begins to restore to normal rate and hence one must continue to perform the action as per the guidelines. At least 100/120 minute on the lower half of the breastbone is the ideal rate of compressions.

Compression must be at least 1/3 AP diameter, and about 2 inches (5cm). While performing the compressions, the chest wall recoil must also be noted. Allow complete recoil between compressions and one must rotate compressors every 2 minutes to reduce the fatigue caused due to CPR. Another important aspect to be taken into consideration is to minimize the interruptions in the chest compressions, and an attempt must be made to minimize or limit the interruptions to <10 seconds.

  1. Airway: Open the airway

In order to ensure the airway passage is not blocked and the patient is able to inhale and exhale through a clean and clear airway, it is important to check the functioning of the same. One of the best ways one can do it is to tilt the head, lift the chin and avoid excessive ventilation. The compression ventilation ratio must be kept in mind at all times. A ratio of 30 compressions with two ventilations is suggested when there is only one rescuer available. In case there are two rescuers available, a ratio of 15:2, meaning 15 compressions followed by two breaths.

  1. Breathing: Breathe for the child

Once the above mentioned steps have been performed, it is suggested to carry out the following steps which involve ventilation with advanced airway. Under this method, one breadth should be given every 6 seconds. Asynchronous with chest compressions, (at least 100/120 min) should be given. This has to be followed by about 1 second per breadth with a visible chest rise.

Attach and use the Automated External Defibrillator (AED) as soon as possible. Minimize interruptions in the chest compressions before and after the shock. You should then resume CPR by beginning with the compressions immediately after each shock.

  • On Baby of 4 weeks or olderCompressions: Restore blood circulation

Once you start the compressions, the blood circulation begins to restore to normal rate and hence one must continue to perform the action as per the guidelines. At least 100/120 minute on the lower half of the breastbone is the ideal rate of compressions.

Compression must be at least 1/3 AP diameter, and about 1.5 inches (4 cm). While performing the compressions, the chest wall recoil must also be noted. Allow complete recoil between compressions and one must rotate compressors every 2 minutes to reduce the fatigue caused due to CPR. Another important aspect to be taken into consideration is to minimize the interruptions in the chest compressions, and an attempt must be made to minimize or limit the interruptions to <10 seconds.

  1. Airway: Open the airway

In order to ensure the airway passage is not blocked and the patient is able to inhale and exhale through a clean and clear airway, it is important to check the functioning of the same. One of the best ways one can do it is to tilt the head, lift the chin and avoid excessive ventilation. The compression ventilation ratio must be kept in mind at all times. A ratio of 30 compressions with two ventilations is suggested when there is only one rescuer available. In case there are two rescuers available, a ratio of 15:2, meaning 15 compressions followed by two breaths.

  1. Breathing: Breathe for the child

Once the above mentioned steps have been performed, it is suggested to carry out the following steps which involve ventilation with advanced airway. Under this method, one breadth should be given every 6 seconds. Asynchronous with chest compressions, (at least 100/120 min) should be given. This has to be followed by about 1 second per breadth with a visible chest rise.

Attach and use the Automated External Defibrillator (AED) as soon as possible. Minimize interruptions in the chest compressions before and after the shock. You should then resume CPR by beginning with the compressions immediately after each shock.

Conclusion

 The role of training in learning CPR and to perform it properly is by far the most aspect of this entire process. Chest compressions-only CPR is very attractive because it is easier to teach than the conventional CPR and is still beneficial to the victim. There are online courses available, and instructor-led courses will often include training on delivery of airways and breathing maneuvers which may be extremely crucial for the patient, depending on their condition. Instructor led-courses usually provide feedback devices like the use of a mini mannequin which helps in practicing with more clarity.

Within a span of 3-6 months, skills related to CPR begin to deteriorate and therefore refresher training is strongly recommended. The training intervals of 12 to 24 months are not adequate and hence the refresher courses may be required every 6 months to stay updated and sharpen the skills.

FAQs

  1. What is the duration for which CPR should ideally be performed?

Paediatric Cardiopulmonary Resuscitation (CPR) for >20 minutes has been considered as not beneficial after the paediatric in-hospital cardiac arrests. The concept has been recently questioned, although the effect of CPR duration on the outcome has not recently been described. The main aim is to determine the relation between CPR duration and outcome after the paediatric in-hospital cardiac arrests.

  • What are the key skills that one needs to learn in order to perform CPR properly?

A short form for Cardiopulmonary Resuscitation is a well-known emergency technique used for helping someone suffering from a cardiac arrest, a condition where in the heart suddenly stops functioning or beating. Cardiac arrest can cause brain damage or even death within minutes if a person doesn’t receive immediate help.

You should immediately start CPR if someone is lying on ground and is not responsive or do not have a pulse. It may work in favour and help save someone’s life. When you perform hands-on CPR on someone, it involves manually compressing the chest to pump the blood to vital organs even though the heart has stopped. Contrary to what is shown on the television, effective CPR does not require mouth-to-mouth (rescue breaths) and instead prioritizes consistent, repeated chest compressions. Although rescue breaths are also important, most important is circulating the blood. As the blood circulates, some amount of passive air exchange takes place in the lungs.

The basics of knowing the correct method of CPR involves 100 to 120 compressions per minute. There are guidelines for depth as well – you have to compress at least 2 inches into the adult chest.

  • When do the results of CPR begin to show?

Prolonged CPR can produce favourable results when carried out promptly and effectively, by utilizing all the available resources including intra-arrest PCI and ECMO. When CPR is performed for a shorter duration, the neurological outcome is better in survivors of cardiac arrest however a cut-off beyond which resuscitation is likely to lead to unfavourable outcomes could not be determined and is unlikely to exist.

  • How does one know if CPR is to be performed or not?

When someone is unconscious or is lying lifeless, there is a high chance they may need help. There could be number of medical issues which could be at play, and CPR may not be the only reason or solution. Breathing and pulse are the two key factors in determining in case someone needs CPR or not. The warning signs of heart attack, stroke and cardiac arrest must be taken into consideration as every second counts.

If the person has suddenly collapsed, it is important to check for the breathing and the pulse. You should try to wake the person and if unsuccessful, it is important to check for the breathing and the pulse. Trouble with breathing in terms of no breathing or breathing problems may call for CPR. In case a pulse cannot be felt, the heart may have stopped working in which case a CPR may be needed. If the pulse of the person cannot be felt, it is sign CPR is immediately required.

In case you witness the patient has been electrocuted, try and not touch the victim. Try and remove the source of the power or remove the victim from the electrical contact. However, it is important to ensure that you use something which doesn’t conduct electricity, like a wooden broom or stick.

The person may have been under the influence of drugs, smoke, inhalants or may have drowned. In which case, it is important to check for breathing and pulse. This may require a combination of rescue breathing and chest compressions.

  • Are there any side effects of CPR?

The common CPR side effects include aspiration and vomiting which is dangerous for the victim. As the victim is unconscious, he is not able to clear the vomit from the mouth and is likely to inhale the same into the lungs, blocking the airway and leading to possible infection.

The force of chest compressions is likely to break the ribs. In case of elderly, this is significantly common due to the brittleness and weakness of the bones. Broken ribs present the dangers as a broken rib could possibly puncture or lacerate a lung, spleen or liver.

Internal brain injuries could be possible as CPR leaves the brain receiving 5% less oxygen than normal. The brain damage takes place within 4 to 6 minutes from the time the brain is deprived of oxygen, and post 10 minutes can lead to long term side effects.

As a result of the air being forced into the lungs, the abdomen usually becomes bloated and full of air during CPR. This makes ventilation more difficult and an increased chance of vomiting.

The result of the vomit and foreign objects like a person’s own teeth, being inhaled into the lungs etc. can lead to aspiration pneumonia, which can be very dangerous to a victim’s health.

Myocardial Infarction

One of the essential internal organs of the body, the heart not only helps in pumping blood to all parts of the body through the help of the circulatory system but also helps in supplying oxygen. It also provides nutrients to the tissues, removes carbon dioxide and other impurities from the body. Thus, it becomes highly imperative to take care of one’s heart to maintain a healthy body.

What is a Myocardial Infarction or a Heart Attack?

The human heart requires a good supply of blood to stay healthy and perform all the vital functions smoothly. However, when there is a partial blockage or complete blockage of an artery, which supplies blood to the heart, a heart attack can occur. As a person grows older, the inner arteries of the heart can become narrow, or can get damaged to due fatty build-up or plague and may result in blood clots. When these blood clots completely block your blood flow to the heart or even severely reduce it, leading to unbearable pain in the chest cavity. This resulting condition is commonly known as a heart attack.

Coronary Artery Disease

The heart contains a network of blood vessels known as arteries on its surface, which helps in providing oxygen to the heart. However, sometimes, these coronary arteries that are responsible for supplying oxygen to the heart become too narrow or constrained as a result of excessive cholesterol or fat build up in the artery walls. This, in turn, increases the chances of formation of plaque. Sometimes these plague build-ups can result in breakage that may result in blood cells and blood particulars to stick on it, leading to a blood clot like formation. This is one of the main culprits in narrowing your arteries, and thus disrupting blood flow to the heart.  In a situation like this, the heart is unable to get ample oxygenated blood, especially while physical activity is being performed. This may initially result in a Coronary Heart Disease (CHD), or a Coronary Artery Disease, eventually leading to a heart attack.

What happens during a heart attack?

Heart attack, also known as Myocardial Infarction (MI), where ‘Myo’ refers to heart and ‘infraction’ refers to permanent damage or death of the tissue due to the disrupted flow of blood into the heart. The human heart is a muscle that requires a regular and uninterrupted supply of oxygen and nutrients to function correctly. Coronary arteries, which are a network of blood vessels, supply the heart with the much-needed oxygen and nutrients. When these arteries get clogged or blocked, it can lead to sudden decrease or blockage of blood flow to the heart, resulting in a heart attack. While certain heart attacks can begin slowly starting with mild discomfort and pain in the chest, others may occur all of a sudden with great intensity causing intense pain.

The seriousness of a heart attack is judged on the severity of the damage that may get caused to the heart muscle.

A cardiologist is someone who assesses the condition and establishes the damage through the process of echocardiography- an ultrasound scan of the heart. An echocardiography can help a cardiologist to not only understand the severity of the attack but also know about the type of heart attack for recommending the correct course of treatment.

Types of Heart Attacks

A heart attack can be classified into the following categories:

STEMI

A STEMI or ST-Elevation Myocardial Infarction is a very severe type of heart attack. During this kind of an attack, the coronary artery gets completely blocked, which means a significant portion of the heart gets deprived of oxygen. When a person undergoes this kind of a heart attack, it is crucial to seek immediate medical intervention because emergency and immediate revascularization may help in restoring the blood to the heart.

Revascularization can be done in two ways- while the first type can be done through thrombolytic drugs which are given intravenously, the second technique involves mechanical procedures like angioplasty that uses very thin tubes known as catheters, which are inserted in the arteries to open the blockage.

NSTEMI

An NSTEMI or Non-ST Elevation Myocardial Infarction is a different kind of heart attack which may not lead to severe damages to the patient’s heart, unlike a STEMI that causes severe damage to the heart. During an NSTEMI, the blockage to the heart is temporary or partial. The diagnosis is made on the basis of the presence of troponin- a type of protein that is released when any kind of damage is caused to the heart.

The treatment usually consists of medication; however, the right course of treatment may depend on the severity of the blockage. Sometimes cardiologists may suggest an angioplasty or a cardiac bypass graft surgery.

Coronary Artery Spasm

Also, known as a silent heart attack, a coronary spasm or unstable angina, a Coronary Artery Spasm is a occurs when the arteries tighten up, leading to a drastic decrease or a complete stoppage of blood flow to the heart. This type of a heart attack is a bit difficult to diagnose because it may not get identified during an angiogram – the test that is used to check for blockage in the arteries. Also, a Coronary Artery Spasm can reoccur since it does not result from a clot or a plaque build-up in the artery. The treatment of coronary artery spasms can be done through medication.

Demand Ischemia

A Demand Ischemia can occur when the heart requires more oxygen than the body can provide. This usually occurs in patients with anaemia, other infections or tachyarrhythmia. These heart attacks can be detected through blood tests since the presence of certain enzymes in the blood can help to establish any damage to the heart.

Symptoms of a Heart Attack

It is important to seek medical help under any condition pertaining to the heart. While sometimes certain symptoms of a heart attack are evident, in other instances, it becomes important to exercise extra caution. Here is a list of heart attack symptoms that cannot be overlooked under any circumstances.

  • Chest pain or discomfort: One of the most common and prominent signs of a heart attack is experiencing pressure, tightness or severe pain in the chest. Every person may experience this pain or discomfort in a different manner- while for some it may seem like a sharp shooting pain, for some it may appear as if a heavy object has been placed on the chest.
  • Indigestion, stomach pain, heartburn or nausea: Some people may experience early symptoms of indigestion that may include, ache in the tummy, heartburns and vomiting. Though most of the times, the symptoms are associated with indigestion itself; however, if in case of other associated instances of chest pain, immediate medical consultation is suggested.
  • Pain in the chest that travels to the arm: One of the most common symptoms of a heart attack is the pain that radiates from the chest to the left arm. Most of the times, people mistake heart attacks to be a common pain in the arm.
  • Pain in the throat or jaw: Often pain in the throat or in the jaw is related to sinusitis. However, if the pain radiates from the chest and reaches up to the throat and jaw, it may be indicative of a heart attack

Other symptoms of a Heart Attack

  • Light-headedness or dizziness: While dizziness may result from multiple causes like standing up all of a sudden, or due to lack of proper nutrition; however, sudden unexplained and unsteady dizziness or light-headedness could be one of the symptoms of a heart attack. This may occur from a sudden decrease in blood pressure due to disrupted blood flow to the heart.
  • Sudden exhaustion: In case of sudden changes in health conditions during any kind of physical activity including climbing stairs or carry heavyweights, which could be done without any hassle earlier, gives a good enough reason to visit a doctor and get symptoms of a heart attack, deduced.  
  • A chronic cough that won’t go: Cough, in general, is not associated with a heart condition. However, if there’s an unexplained cough is persistent that refuses to go and it accompanied by pink or white mucus, it may be one of the symptoms of heart failure.
  • Excessive sweating: Sweating profusely for no evident reason is a very prominent symptom of a heart attack that certainly should not be ignored. Therefore, in cases of excessive sweating out of no reason, along with other associative heart attack symptoms, medical attention is recommended at once.
  • Irregular heart rhythm or beat:  While a racing or an irregular heartbeat is common during any physical activity; in case this phenomenon is experienced more often, one should get in touch with their doctor immediately.

Symptoms of a Heart Attack in women

Most common symptoms of a heart attack in women may include sudden chest pain or discomfort, shortness of breath, nausea, vomiting, back pain or jaw pain.

Major Causes of a Heart Attack

One of the main reasons that may result in heart attacks or coronary heart diseases is when one of the major arteries gets blocked due to fatty deposits of cholesterol. The blood clot of plague may rupture in the artery leading to a drastic reduction in the blood supply to the heart – thus causing a heart attack.

Though the step-by-step process that can lead to a heart attack has not completely been established, however, here are some dietary reasons or lifestyle causes that may make a person susceptible to having a heart attack.

  • A high-fat diet: A diet that contains more than the required amounts of fat may lead to an increase in the cholesterol levels of the body. Increased cholesterol can lead to excessive fat build-up in the arteries leading to a heart attack.
  • Diabetes: Diabetes can cause a heart attack in certain cases. If the blood sugar levels are high for a long period of time, then it may lead to damage in the blood vessels and nerves of the heart.
  • Smoking: Smoking is dangerous for the heart since it can damage the lining of the arteries that may end up in fat build-up, which eventually may lead to narrowing of the arteries. This can lead to a heart attack or a stroke.
  • Obesity and being over-weight: Obesity is one of the main culprits of a heart attack. Excess amount of weight means more pressure on the heart to pump excess blood. This extra pumping often exerts an additional strain on the heart, sometimes leading to a heart attack.
  • High cholesterol: High amounts of cholesterol can lead to fatty deposits in the blood vessels. Sometimes these deposits can grow considerably in size, making it difficult for the blood to flow in the arteries. And at times these deposits can rupture suddenly, forming a clot that can cause a heart attack.  
  • High blood pressure: A condition of hypertension or high blood pressure may put extra stress on the heart and may lead to narrowing of blood vessels and fat build-up, thus making a person more prone to this condition.
  • Genetics: One of the major reasons one may have this condition is because of their genes. This means people who have a family history of heart ailments are a good amount of chance of having a heart attack.

Other causes of a Heart Attack

The above mentioned are common causes that may result in a heart attack; however, there are some lesser common reasons too that can result in one.

  • Hypoxia or insufficient oxygen in the blood: If a person experiences any a loss of lung functioning or decreased levels of oxygen in the blood due to carbon monoxide poisoning, the heart does not get ample oxygenated blood. This condition may damage the heart muscles and cause a heart attack.
  • Drug Misuse: Consumption of stimulant drugs such as methamphetamines, amphetamines, cocaine, and more can sometimes result in narrowing the coronary artery. This stops or reduces the blood flow to the heart to serious levels, causing a heart attack.

Risk factors

Wondering what can put one at an increased risk of having a heart attack? While some risk factors can be avoided, others may not be easy to evade. Also, there are certain people who are at more risk than others, and it majorly depends on your risk factors. Here are various factors that may put a person at an increased risk of having a heart attack.

  • Age factor: Men who have crossed the threshold of 45 years of age, or women who are more than 55 years of age, there lays an increased chance of the risk of having a heart attack.
  • Family history: If anyone in the family has had a heart condition, especially before the age of 55, then there is always an increased risk of having this condition.
  • Past record of coronary disease: People who have experienced any coronary heart diseases or a heart attack in the past; it increases their chances of having a heart attack to a considerable extent.

Other risk factors that can be controlled

  • People suffering from any kind of diabetes, such as Type 1 or Type 2, it is important that they keep their blood glucose levels under check, since higher glucose levels may damage the arteries and increase the risk of a heart attack.
  • Lack of any kind of physical activity that not only increases one’s chances of obesity but also puts them at risk of developing other health conditions such as hypertension, high cholesterol, diabetes, and more, are indirectly linked to increasing the chances of a heart attack.
  • Having high amounts of cholesterol in the blood can lead to fat deposits in the arteries that cause narrowing of arteries leading to a sudden decrease or blockage of blood flow. People suffering from high amounts of cholesterol, should always keep them under check and consult a doctor at regular intervals.
  • Smoking is one of the self-inflicted conditions that put a person at a higher risk of having a heart attack since the nicotine in the cigarette causes the coronary arteries of a person to become narrow.
  • Excess pressure in the blood known as high blood pressure or a condition of hypertension is something that can damage the arteries and lead to a heart attack.

Complications during a Heart Attack

While experiencing a heart attack, sometimes the concerned person may develop other complications too. Some of the common complications that may arise are:

Sudden cardiac arrest

This is a condition in which certain electrical disturbances can occur in the heart, which can lead to disruption of the heartbeat altogether. This condition can be fatal, and therefore, immediate medical intervention is required.

Abnormal heart rhythm

Arrhythmia or abnormal heart rhythm is a condition when the heartbeat is irregular, which means it is either slower or faster than the normal rate. Such a condition can quickly turn fatal because the blood can pool up, leading to clots. These clots are dangerous and may sometimes travel to the lungs causing pulmonary embolism or even travel to the brain, causing a stroke.  

Heart failure

A heart attack can damage the way in which the heart functions, and sometimes it may affect the pumping function of the heart by making it weaker. This condition disrupts the regular heart functions due to which the heart fails to pump ample blood required to meet the body’s needs.

Valve problems

The heart comprises of four valves, which help in pumping the blood to all parts of the body. A heart attack can sometimes damage one of these valves. This can lead to further problems in the valve functioning, including shortness of breath, dizziness, fatigue, swelling of the feet or ankles, and more.

May cause depression

Suffering from a heart attack can not only take a toll on one’s physical health, but it can also make them emotionally weak, leading to depression. It is seen that nearly 33% of people who have suffered a heart attack are most likely to suffer depression because of their ailment. Depression may sometimes get difficult to identify, however, if there are considerable changes in appetite, sleeping schedules or habits, social activities and other lifestyle changes post a heart attack, it is advisable to get in touch with a doctor.

It is advisable to keep a check on the blood sugar levels, blood pressure, cholesterol, and other such factors while also maintaining essential lifestyle choices to remain healthy.  

Diagnosis of a Heart Attack

A Myocardial Infarction, or in more simple terms, a heart attack, arises out of several symptoms. While some people are more susceptible to cardiac issues than others, the truth is that anyone could suffer a heart attack, due to any number of causes. Myocardial infarctions could be caused by anything, from genetics, to stress, to obesity and being overweight, to other underlying causes that may not have been spotted.

So, how does one spot a heart attack, after suspecting it?

While the timely intervention of a cardiologist is key here, there are a couple of tests and procedures that one needs to undergo to diagnose a heart attack.

12 Lead ECG

What may sound like a very technical term; a 12-Lead ECG is something most people have come across.

The 12-Lead ECG is a medical test which uses to record the heart’s electrical activity using a series of electrodes that self-adhere. Usually used with some type of conducting gel, these electrodes are attached to several parts of the body, primarily across the chest. These measure definitively the electrical impulses and signals of the heart, and then note these signals down on graphing paper, that then proceeds to print it out. These ECGs are then analysed by cardiac specialists, who measure and examine the causes of the patient’s discomfort. In case of additional symptoms of a heart attack, such as shortness of breath, discomfort, dizziness, nausea and more, a 12-lead ECG helps to establish the root cause and identify the risk factors for the patient.

A 12-lead ECG also identifies if the heart chamber walls are too thick, check the functioning of implanted mechanical devices like pacemakers, or understand if medicines are working fine or the patient is at risk of side effects.

Blood Studies

Today, in addition to a traditional ECG that uses electrodes placed at strategic spots on the body, blood tests can also establish any heart issues someone might have. Using what is described as a high sensitivity troponin test, cardiac specialists may help to decide whether someone’s symptoms are symptomatic of heart issues, or completely unrelated.

Additionally, blood tests can help identify if there is a higher-than-usual level of proteins in one’s bloodstream; something that may eventually lead to a heart attack. Apart from the Troponin Test, other blood studies for heart attacks include the CK or CK-MB tests and Serum Myoglobin Tests. Often, blood tests are repeated after a certain period to check if one is at risk of heart disease.

In some cases, patients with cardiac issues do not necessarily present classic symptoms on an ECG, but might still be having to deal with symptoms of a heart attack; in which case a blood test is considered useful. Those subjected to the blood test with levels of the hormone troponin elevated in their blood are considered as having cardiac issues.

Echocardiogram

An echocardiogram or ECG is the primary way of finding out if someone has either suffered a Myocardial Infarction or is in any way, at risk of one. The most standard procedure of checking for heart ailments, the primary ECG or echocardiogram uses an ultrasound that is very similar in concept to what is used for conducting scans in pregnant women.

An ECG uses sound waves to produce images of the heart, which is then studied by a cardiologist to understand the patient’s heartbeat and if the heart is pumping blood regularly. The ultrasound waves in an ECG also help in assessing the functioning of the cardiac muscles, as well as the valves of the heart.

The standard kind of ECG used to diagnose Myocardial Infarctions uses a hand-held device that is similar to the one used in sonograms as well. Known as a transducer, this device transmits waves of sound through the chest. These sound waves reflect or reverberate off the cardiac muscles and valves and record the sound wave echoes from one’s heart. These echoes are then converted into moving images on a computer to show if the structures are all normal, or if there are any structural issues.

Cardiac catheterization

A cardiac catheterization measures the effectiveness of the blood vessels in terms of supplying blood to and from the heart. It is a diagnostic procedure that involves invasive methods to gather information about the health and functioning of the heart. During a cardiac catheterization, a catheter – a long, narrow tube is placed within the leg or arm. While an ECG uses soundwaves, this procedure uses more obvious visual cues. During cardiac catheterization, a special coloured dye is injected into the patient and directed towards the heart muscle. The coloured dye thus injected is known as a contrast dye, and easily shows up on X-rays and other scans.

The technique of taking X-rays of the heart arteries is called coronary angiography or arteriography, and the images deduced are termed at coronary angiograms or arteriograms.

Management and Treatment of a Heart Attack

There are several ways to not only identify but also effectively treat heart issues. Particularly, if these issues are identified in their early stages, their efficacy is much more. In an ideal situation, preventative action is far more helpful and can be achieved by a couple of factors as listed below.

Medications

Medication, in fact, may come across as a difficult way to keep track and deal with potential heart issues. However, medication is often the most effective course of action that can be used as a preventive measure against heart attack.

There are a number of medications available to tackle each specific heart-related issue, tending to everything ranging from high blood pressure to an irregular heartbeat. There might also be issues stemming from arterial disease, where the walls of the arteries sometimes prevent effective blood flow. When taken regularly and timely, medication can not only help one deal with existing heart issues but potentially help prevent any larger ones from occurring in the future.

A common medication to prevent heart attacks can include anti-clotting medicines like Aspirin, anti-platelet medicines like Clopidogrel, anti-coagulant medicines like Warfarin, anti-anginal medicines like Nitrates and other blood-pressure and cholesterol medicines.

Door to Balloon Time

Door-to-balloon time or D2B, as known in the medical community, is described as the time from which emergency services are at the door of a patient who has suffered a Myocardial Infarction, till the time that a catheter guide wire has been inserted as part of the cardiac catheterization procedure. This means that doctors, and emergency technicians, consider the time from which the patient has been brought in or tended to, till the time that a catheter has been utilised to unblock the offending artery and minimise damage to the cardiac muscles. The longer this takes, the higher the risk of damage to the cardiac muscles. D2B is typically given as 90 minutes, in order to decrease any lasting damage from the Myocardial Infarction someone has suffered from.

Interventional Procedures

An interventional procedure is made to increase the strength of the blood flowing through the body in the event of a heart attack. Once a cardiac catheter has been placed, one of many interventional procedures can be performed on a patient.

One of the most common interventional procedures is a Balloon Angioplasty, which involves the use of a balloon to increase the width of arteries so that blood can flow into the heart more easily. The expansion of the balloon expands the arteries for this exact purpose.

Sometimes, the Balloon Angioplasty is done in combination with a stent, which is a device that is placed within the artery. A tube made of meshed metal, the stent takes on the shape and form of the artery that it is placed in, thus opening it up and expanding it. The artery then begins its healing process around the stent.

There is also a procedure known as a drug-eluting stent, when a stent has a light coating of medication that is slowly released into the coronary arteries to block cell proliferation, or reduce any other medical risks generally associated with the heart, or the post-care of a Myocardial Infarction.

Coronary Artery Bypass Surgery

The arteries that supply blood to the heart are called coronary arteries. Blockage in any blood vessel is bad news but is particularly significant if coronary arteries, which keep the heart tissue alive, are blocked. Coronary Artery Bypass Surgery, or CABG, more commonly known in India as Bypass Surgery, is ideal for patients who have obstructive heart issues, or if they have had a serious heart attack earlier.

CABG works in an interesting way, where blood vessels from healthier parts of the body are taken and reconnected to those around the blocked coronary artery, which is what the procedure is named after. The other blood vessels involve the use of arm and leg veins, and patients who have had a CABG are usually made to undergo severe lifestyle changes after their surgery.

Prevention of Heart Attacks

It is far easier and better to take preventive measures to combat a heart attack or a Myocardial Infarction than deal with the much larger, more significant consequences at a later time. While certain risk factors related to age or family history cannot be changed, there are certain conscious lifestyle choices one can adopt to help reduce the risk of heart disease.

Of course, this is not to say that everyone who suffers a heart attack is following an unhealthy lifestyle. Many people who lead healthy lifestyles exercise at regular intervals, eat healthily, still suffer heart attacks, often quite suddenly; this could be due to a number of genetic or external factors.  However, here are a couple of preventive measures against heart attacks.

Medication to combat genetic risk

People who are at risk of having a heart attack can seek medical assistance by consulting a doctor, who can put them on the relevant medication. For example, either low or high blood pressure, kept untreated for a long time, could contribute to heart issues. Preventive medication can help stem these issues before they occur, saving health, time and money as a result.

Additionally, Type 2 diabetes screening, especially for people with a family history of diabetes, are advised to get themselves retested at three-year intervals.

Lifestyle changes

Leading an active, healthy lifestyle goes a long way in preventing heart attacks. According to research, those who walked briskly for a minimum of 30 minutes a day had a 20% lowered risk of suffering from a potential heart attack.

Apart from ensuring sound physical health, mental health, goes a long way in helping prevent a heart attack. Minimising day-to-day stress in whatever way possible goes a long way in cardiac disease prevention since stress is one of the major causes of a heart attack. For example, even a few minutes of mindfulness or meditation each day can help to destress. Taking time out for oneself, family, or simply pursuing pastimes or hobbies is also helpful in dealing with stress, and preventing heart attacks in turn.

Also, a healthy diet goes a long way in ensuring a healthy heart while also keeping blood pressure, diabetes and cholesterol levels in check. It is recommended to include green vegetables, lean meat and fish, fat-free dairy, whole grains and olive oil in one’s diet. Intake of salt, processed carbohydrates, sugar, alcohol and saturated fat should be limited.

Avoiding smoking and limiting alcohol is also one of the preventive measures of heart attacks. Smokers, both active and passive, are at high risk of a heart attack as compared to a non-smoker. Also, too much alcohol consumption can lead to multiple diseases, including high blood pressure, irregular heartbeats, or sudden stroke.

Conclusion- Heart Attacks

There is no hard and fast rule as to when, or how a heart attack will strike, or whom; indeed it will strike. Of course, some people are at a higher risk either due to physical health issues, or genetic factors, or lifestyle choices. However, there are ways to deal with heart attacks when they happen, depending on the patient, the issues that have caused the heart attack, their overall health, their viability for operation – and more. Heart attacks, depending on their severity, might need stents or implants, or might need surgery; all of which are subjective to the doctor’s recommendations.

While theoretically, anyone could suffer a Myocardial Infarction, there are preventive measures; both medical and non-medical, which mostly involve switching to a more conscious and healthy lifestyle, that could prevent one. Consulting with a physician or a cardiac specialist to assess one’s heart health, ensure early detection of risk factors and take preventive measures is an excellent way to start.

Adequate knowledge about the signs and symptoms of a heart attack is always useful. Sharing knowledge amongst friends and family members about the initial or warning signs of a heart attack, common do’s, and don’ts will also help raise awareness and act as a preventive measure.

FAQs: Heart Attacks

  1. What are some of the dietary changes one can make to prevent a heart attack?

For those who are at high risk of a heart attack, or have already had one, it is generally recommended to incorporate more vegetables and fruits into their diet. Whole grains, pulses, and healthy vegetables are filling, deliver more nutrients to the body, and contribute to overall health. For meat-eaters, cutting down on red and fatty meats, and switching to leaner options like chicken, turkey and other poultry is proven to contribute to overall health.

  • Are women at a higher risk of heart attacks than men?

Males or females, anyone can suffer a Myocardial Infarction. However, the risk factors change for men and women. Men are affected by heart issues younger than women are, but women are less likely to survive a major heart attack. Women, however, are advised not to ignore the slightest symptoms of a heart attack.

  • How is smoking related to heart disease?

There is a strong correlation between smoking and heart diseases. Statistics say that 20% of all heart attacks are brought on by smoking. The nicotine present in cigarettes constricts blood flow to the heart, increases blood pressure, and even diminishes the oxygen in the blood. Smoking also leads to blood clots, which again can be a big factor in a heart attack. Second-hand smoke too can cause heart attacks – so quitting smoking can even protect your loved ones.

  • Do lifestyle habits or genetics impact the general health of the heart?

Both. There are a number of lifestyle changes that can drastically improve the quality of life, even if one has already suffered a heart attack. One might also, as a result of genetics, be at an elevated risk of suffering a heart attack. Then, it becomes even more important to prevent the other underlying causes that could spur on a heart attack.

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