Episode 5: Heart Attacks and Cardiac Arrests

Welcome to Episode Five of First Aid Unboxed

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Mark: Hi, and welcome to episode five of First Aid Unboxed. We are episode five already. I cannot believe it.
Mark: This is with Louise Madeley for Madeleys First Aid Plus. Tell us a bit about yourself. People who've only just come to the podcast, why are you such an expert?
Louise: Good question. I've spent 30 years in the NHS working in A&E and ITU. I initially did my nurse training 30 years ago, something like that, and worked in London, then in France, then over back to Shropshire, and worked in hospitals around here.
Louise: So I've got a long history of medical terminologies and debunking them, so to speak. But I also left that side of things to go into advanced clinical practice, so have a master's in that. And I was used to diagnosing and treating and prescribing and making people feel better.
Mark: You've got lots of letters after your name as well, haven't you?
Louise: I can honestly say I've got more letters after my name than in my name now.
Mark: What do all those letters mean?
Louise: Goodness knows. They're just the medical qualifications, basically.
Mark: Now, Madeleys First Aid Plus has got a new live website. We will talk a little bit more about that at the end, but if people want to have a quick look at it now while they're listening to this, what's the website address?
Louise: It's www.madeleysfirstaidplus.co.uk. That's M-A-D-E-L-E-Y-S, First Aid Plus.
Mark: Okay, there's lots of new stuff on that, which we will talk about at the end of the podcast so that people will have an idea. But go and have a look at it now while you're listening to us now. That's probably the best thing to do.

Understanding Heart Attacks vs. Cardiac Arrests

Mark: This episode's subject, heart attacks and cardiac arrests. Now, in my layman's terms, these are the same thing, but they absolutely aren't, are they?
Louise: No.
Mark: Okay, well, let's first of all, let's do the difference between what is a cardiac arrest and what's a heart attack.
Louise: Okay, so a heart attack, the proper term for it is a myocardial infarction. Big word. All it means is myo is muscle, cardial is your heart, and infarction is death of.
Louise: It's another Latin term. So it's death of heart muscle. You get a blockage.
Louise: So we're talking again about your plumbing. So your heart is the pump. You've got your vessels there.
Louise: Blood flow will normally go round it with great ease. Not a problem. However, if you find that you get a narrowed artery, buildup of plaque, things like this, buildup of debris in your bloodstream, basically, you can get a heart attack.
Louise: So it's a blockage within your pump.
Louise: And cardiac arrest.
Louise: Cardiac arrest is your electrics, pure and simple. Sudden loss of heart function, causing the heart to stop beating effectively. So it's not necessarily that your heart isn't beating at all.
Louise: It's that it has stopped beating effectively. So it's not pumping that blood around. It's a sudden collapse.
Louise: You are on the floor immediately.
Mark: Oh, right. So you will literally fall down with a cardiac arrest.
Louise: Yeah. And that's the big difference when you see somebody have either a heart attack or a cardiac arrest. Cardiac arrest, they're on the floor instantly.
Louise: They're standing one second, on the floor the next. Bang. A heart attack, you can have a heart attack for minutes, days.
Louise: You know, it's an ongoing thing. It's a blockage, but it doesn't mean that your heart has stopped and you're on the floor.

Symptoms and Risk Factors of Heart Attacks

Mark: So the symptoms of a heart attack, what are the things that people should think, oh, I need to look out for that? And who is susceptible as well? Is it just anybody or is there certain people who are more susceptible to heart attacks?
Louise: Yeah, anybody is susceptible. However, the bigger risk factors are people who are overweight, who have diabetes. A lot of it is down to lifestyle, as well as genetic factors.
Louise: So it could be that it's inherited from another family member. There are lots of different reasons, but then you've got higher risk groups than others. In which case, if you think you are in a higher risk group, go to your GP, go and find out what the chances are that you may be at risk of having a heart attack.

Lifestyle Factors and the Importance of Exercise

Mark: So as far as lifestyle is concerned, obviously trying to lose a bit of weight, is exercise important for things like that as well?
Louise: Absolutely. Exercise, as every medic will tell you, is good for absolutely every aspect of your life.
Louise: Whether it's blood pressure or diabetes or heart or anything at all.
Louise: Psychological, you name it. Yeah.
Mark: Yes, I know that's very much a thing at the moment, isn't it? Maybe we'll do that in a future episode.
Louise: Yeah.
Mark: About the psychological benefits of doing exercise.
Louise: Yeah.

Recognising Cardiac Arrest and Real-Life Example

Mark: And cardiac arrest. Obviously, the symptoms are, you collapse.
Louise: You collapse, full stop.
Louise: Simple as that. And it's not something that you realize is happening until it happens.
Louise: Yeah. And this happened to a friend of mine recently, a chap, they had just been out. He was only 29.
Louise: He's 29 years old, fit and healthy. No previous medical history that they were aware of. He suddenly collapsed in front of them.
Louise: And thankfully, one of the people that was with them recognized it as cardiac arrest and was on that chest in less than a minute. He's alive and well. In fact, he came back to do a first aid training course with me a couple of weeks ago.
Louise: And it was the most privileged experience I've had, to be honest, to be able to teach those that were there and him himself and explain a little bit about what experience he may have been going through at the time from a nurse's point of view as opposed to his point of view. So, you know, we had, it was a long conversation.
Louise: We were talking about CPR before we started this episode in our little preamble conversation. And Louise has decided she's going to do an entire episode about CPR. It's far too important just to tag on to something else.

Detailed Explanation of Heart Function and Cardiac Events

Mark: So, when you have a heart attack, what is actually happening?
Louise: So, there's different degrees of a heart attack, if you like, and it can happen in different parts of the heart and around the different parts of the heart.
Mark: Describe the heart then. What's actually in there? What does your heart look like?
Louise: You know, she has a little model of a heart here. Which is no good, because we're not recording this on video.
Mark: I know.
Mark: So, yeah, what's, you know, can you describe the different parts of it and how it works?
Louise: Yeah, I mean, basically, you've got four chambers, two small ones at the top, two large ones at the bottom. So what's happening is the blood is going into one of the ones at the top, it's then going down into the bottom ones by pumping. When you hear it go da-dum, da-dum, what's actually happening is that it's being pushed.
Louise: You're getting a contraction of muscle when you hear the dum. And it sounds quieter than the second dum, purely because it's in the top atrium, which is the chamber at the top, then gets pushed down to the other one. And the idea is that it gets pushed out.
Louise: So the second noise, the dum, is the second heartbeat, if you like. It's all one heartbeat, but it's the second sound that you hear. So you get da dum, da dum, da dum.
Louise: When somebody has a cardiac arrest, it doesn't, it fibrillates generally. There's some other things, but the most common is fibrillate, which just means it goes like jelly, literally. And it's just a brrrr sort of noise.
Louise: So it's not effective. It's not doing that boom and pushing it out. And then it circulates around the body.
Louise: With a heart attack, what's happening is you have a blockage in one of these big vessels that goes into the heart. And as a result, it's not effectively pumping, but at the same time, it's extremely painful and it can lead to a cardiac arrest.
Mark: So a blockage like a blood clot or something like that?
Louise: It can be a blood clot. It can actually be a lot of things. Debris, so fatty deposits, for example, in the bloodstream.
Louise: After a while of these being passed around the bloodstream, they congeal, they get blocked together, and they become a blockage. So it could be something like that. There's lots of reasons for blockages, but that's why we always say lifestyle factor is a huge part of it, because these fatty deposits build up over time.
Louise: So when you're getting a blockage, a blood clot forms in a narrowed artery, typically caused by a buildup of plaque, which is making things go narrow. And if you remember talking before about a hosepipe, thinking of a hosepipe that's a really thin hosepipe, fine-bore hosepipe, you'll have a much higher pressure than if it's a large-bore, healthy hosepipe, where the pressure is less so. So hence, you get high blood pressures and low blood pressures.
Louise: So these narrow arteries cause a buildup of plaque. The other term for it is atherosclerosis. That's the technical term for it.
Louise: But basically, all it is is a narrowing of these arteries. And anything that is narrow is more likely to get blocked up. That's just how it is.
Louise: Hence, you end up having a heart attack.
Mark: So the heart is literally the engine room of the body, then? It does all the work.
Louise: It is, yeah, absolutely. And the healthier you are, the less work you have to do. So the less work the pump has to do, if you are healthy and if your vessels are in a good state of health, then your heart doesn't need to work as hard.
Mark: Can it be tiring then? Can it actually physically tire you out?
Louise: Yes.

Recognising Symptoms of a Heart Attack

Mark: So if you're having a heart attack, there are symptoms to look out for, aren't there?
Louise: Absolutely. And actually, the experience of a heart attack can be different between men and women. And we're going to touch on CPR with the disparities with men and women at some point.
Louise: But yeah, the symptoms can be different based on gender. And also somebody who's diabetic may not experience pain in the same way through something called neuropathies. So it's something that you need to be aware of if you have diabetes.
Louise: But generally, symptoms, you're talking about chest pain. So if you experience chest pain or somebody with you experiences chest pain, it's a 999. It may be a heart attack.
Louise: And it's very easy for people to pass it off as a bit of wind indigestion. But actually, if you're getting chest pain, you need a medical person to check it out. Do an ECG, which is like a trace of the heart.
Louise: Looking at the electrics to see whether or not you are having a heart attack and get that ruled out. So pain, but it could be discomfort, not necessarily agonizing pain. Shortness of breath, nausea, so feeling quite sicky.
Louise: People going into a cold sweat, you know, that sort of clammy experience that you get. And pain and discomfort in other higher end of your body, arms, back, neck, jaw, stomach. That's why people tend to mistake it for indigestion.
Louise: It could be that you're getting a pain in your stomach and it's actually a heart attack. So it's about recognizing several symptoms as well. It doesn't mean run to your GP immediately if you get a bit of a tummy ache or anything.
Louise: It's an overwhelming experience. Also, the feeling of impending doom is actually a symptom of a heart attack. Sounds odd, sounds bizarre, but research shows again and again that people who have experienced a heart attack often describe that feeling of intense impending doom.
Louise: It's known as, and that's literally how they feel when they're having it.
Mark: That does sound quite scary, to be honest. I've never heard of that one before. I do hear this stuff about people get a pain in their left arm or something like that, and that's quite a common symptom.
Louise: Yeah, can do. Generally they get pain in the chest and then it radiates down the arm. But again, this can be very different between men and women.
Louise: Women are less likely to get that particular symptom. The symptoms for women can sometimes be lighter, not necessarily as crushing pain in the same way. And again, it depends on how severe the heart attack is, how severe the blockage is, and how well the heart's functioning whilst having that heart attack.
Mark: So what are the main differences between the symptoms for a man and the symptoms for a woman?
Louise: They tend to be a lighter symptom, so not necessarily that crushing feeling in the chest.

Immediate Actions to Take During a Heart Attack

Mark: So if these symptoms do present themselves, next step?
Louise: Next step is 999, full stop. So immediately call an ambulance. It does reduce the damage to the heart if you get treated as quickly as possible.
Louise: So treatments could include certain types of medication, something called an angioplasty, where they go in through an artery and fix the problem, a stent which holds it open, it acts a bit like a bridge in the artery and holds it open, bypass surgery, this sort of thing. But either way, it's a 999, it's straight to the hospital. The other thing you can do is, from a first aid point of view, we put them in what we call the W position.
Louise: So sitting down with their back up against a wall and their legs bent, that's the W position, because their body looks like a W when they do it.
Louise: And what does that do?
Louise: It relieves the symptoms. It also means that they're on the floor and much easier to deal if they do end up having a cardiac arrest as well. It keeps the head raised and keeps them in the optimal position for their heart to function whilst having a heart attack in a nutshell.
Louise: So it's the W position, back up against the wall, head upwards and legs bent, best position. Also having 300 milligrams of aspirin, regardless of whether they take aspirin every day, doesn't make any difference. You still give the 300.
Louise: So as a first aid, we don't give medication. What we can do is say to them, I think you may be having a heart attack. Do you have any aspirin?
Louise: I would advise that you take 300 milligrams. Normally, if you take it every day, it's 75 milligrams. That's what you'll find in your cupboard.
Louise: So it would be four of those.
Louise: So you take four aspirin tablets basically of the standard size.
Louise: As long as it's 75 milligrams.
Mark: Right, okay. I don't think I've got any aspirin in the house at all. I need to look at that, make sure I've got something as an emergency.
Louise: Yeah, and it's not kept standard as it used to, like paracetamol and Ibuprofen can be. It's not part of your stock drug anymore, if you like. You take home medications that you've got in the house.
Louise: Aspirin isn't used for a headache like it used to. So yeah, it's about having some to hand just in case, particularly if you're in a high risk group.

Recovery and Long-Term Effects of Heart Attacks

Mark: And with heart attacks, people talk about, oh, they've had a mild heart attack or a severe heart attack. Will the heart recover? Will it get better again?
Mark: Can it get back to the stage it was at before? Or will there be a certain amount of permanent damage involved?
Louise: Yeah, well, again, myocardial infarction. Muscle, heart, death of. That's the point.
Louise: So if you get somebody who is having a heart attack at that moment and you get them to hospital quickly and they are treated quickly, then the chances are that they may make a full recovery. So it doesn't mean that the heart is going to be irreversibly damaged. However, the longer it takes to get them treatment, the more damage that's going to be caused, just based on the fact that they still have that blockage there that hasn't been treated.
Louise: And as a result, they're going to end up with death of that muscle. So if there is death to the muscle, it's not going to be as effective afterwards as it was pre-heart attack. So it's all about time.
Louise: It's time-sensitive. Get them in as quickly as possible.

Responding to Cardiac Arrest

Mark: So cardiac arrest, what do we do in that situation? So if someone has obviously literally collapsed, what's your next move there?
Louise: And this chap was a perfect example. All he experienced a few minutes before that, he said he had what he referred to as possible palpitations in his chest. So like a butterfly feeling in his chest, skipped heartbeat.
Louise: And actually, we all have palpitations from time to time. Perfectly normal. Hence, his friend didn't think anything of it.
Louise: He just thought, well, you've just had one beer. Maybe that's the cause. Don't know.
Louise: And left it at that. Because he had said that, and then suddenly his friend fell to the floor and was clearly out cold. He knew that was a cardiac arrest.
Louise: Also, the look of somebody when they collapse, they have no pulse. There is no effective pulse. So their heart has technically stopped beating effectively.
Louise: Yeah, it's literally straight down onto the floor. They're technically dead at this point until you start CPR.
Louise: And are those some of the things we've seen like on the football pitches recently, where people have been... They said they were dead for 30 minutes or whatever. But the CPR has kept their blood flowing around their body.
Louise: Precisely. Yeah, even that hands-only CPR, where you are just pressing down on the chest, it's keeping that heartbeat going, keeping the flow around the body, stopping all the muscles, et cetera, and all the organs from not receiving oxygen.
Louise: Yeah, because it's all about oxygen starvation in the end, isn't it?
Louise: Absolutely. And the longer it takes somebody to start CPR, the greater the chance of something called hypoxic brain injury, where the brain doesn't receive enough oxygen, and people can end up with brain damage after a cardiac arrest.
Louise: So it's a CPR 999 situation immediately.
Louise: Get on that chest immediately.
Louise: Immediately.
Louise: And don't stop for anything else for more than 10 seconds.
Mark: What if the person becomes conscious again?
Louise: In 30 years? Well, no. I mean, when you're talking about the chain of survival, for example, it's about early recognition, early intervention, but at the end of that, it's also about post-resuscitation care.
Louise: So somebody who's had a cardiac arrest isn't going to sit up like they do in the movies and ask for a cup of tea. They'll say, oh, what happened there? They will still be unconscious, chances are, or at least very, very confused and drowsy, and off in the ambulance, and then they receive the post-resuscitation treatment and care and so on.
Louise: And that is what makes the massive difference of survival rates, et cetera. But it all starts with get on that chest within the first minute, if at all possible. The thing to remember, I suppose, is that when it comes to a heart attack, it's a circulation problem, so it's your plumbing, whereas a cardiac arrest is an electrical problem, and your heart still is beating effectively.
Louise: So one can be very painful and go on for a while, although it's absolutely an emergency, and that person needs 999, as opposed to a cardiac arrest where they are on the floor, technically dead at that moment, CPR instantly.

Teaser for the Next Episode on CPR

Mark: You've described the symptoms and what happens and what we can do. In the next episode, we're going to talk about CPR, aren't we? And you're going to explain how and the best way to do this, and not to be afraid of doing it, basically.
Louise: Absolutely. You've got to remember that when somebody has a cardiac arrest, that is the worst possible scenario. Nothing you do is going to be worse than the fact that...
Louise: They are already dead by the time they hit the floor.
Louise: Absolutely. So you can only do good. You can't make anything any worse.
Louise: And there are regulations out there now, bystander law, etc. stating very clearly you are not going to get into trouble for doing CPR and doing the best you can to help that person survive. The top priority is that people do that rather than worry about the risk of being sued.
Mark: As I said in the next episode, so remember to subscribe and follow us if you do want to make sure you hear the next episode, which will be out at some point in the new year, I think. Louise will be describing CPR, how to do it, what to do and go through the whole procedure. She'll also be talking about some interesting statistics to do with male and female survival rates through CPR.
Mark: But we'll leave that for that, because it's very, very interesting indeed. Moving on to your new website I think we need to talk about now. It's been coming quite a while.
Mark: We've had the new website is coming conversation. It is now live, it is now with us. Tell us a little bit more about it.Louise: What's the difference between the old website and the new website?
Louise: The functionality, as much as anything. Before it used to take quite a bit to get to look at the courses and look at what it is that I do. Now it's very functional, extremely functional.
Louise: Very quick and easy to use both mobile and desktop. It doesn't have my blog on it yet. That's to come.
Louise: So by the new year, it will have the new blog on there. Unfortunately, because I've stopped the old website, all my blogs from there are archived, so to speak. So I'll need to put those onto the new website, but also the new blogs that I've been doing are ready to come out.
Louise: I just need to get them live on the website.
Louise: So via the new website, people can book individual classes, classes with groups of people that you run, corporate classes.
Mark: Absolutely. If anybody wants to do a corporate class, then they're probably better sending me an email on inquiries at madeleysfirstaidplus.co.uk because it can be more cost effective, if you like, if you've got 8 to 12 people doing it, as opposed to booking straight online. If it's a small number of people, then absolutely online, very simple to use.
Louise: It'll take you straight through to the booking system, and the dates are all there for you to see.
Mark: So if anybody's got any questions about what we've been talking about today, what's the best way to get in contact with you?
Louise: Either go on to my website, www.madeleysfirstaidplus.co.uk or email me on inquiries at inquiries@madeleysfirstaidplus.co.uk. That's M-A-D-E-L-E-Y-S.

Key Takeaways from Today's Episode

Mark: And is there a takeaway from today's?
Louise: Recognising a heart attack quickly, so somebody who has chest pain, somebody who suddenly goes very grey, complaining of a feeling of doom, and that's the best description of it, and everybody says the same thing, who experiences it, but that it can go on for a long period of time. Make sure that you get them to medical help immediately. On the other hand, a cardiac arrest, it's your electrics, and you are down on the floor in a moment, and it's CPR, full stop, straight on CPR.
Louise: Use a defib. We'll go through it next time.
Louise: Absolutely. We will definitely go through that in the next episode. So we'll be doing CPR and defibrillation as well, yeah?
Mark: Yes.
Mark: Lovely, okay. Because I think people are quite scared of those sort of things as well. It would frighten me, to be honest.
Louise: Understandably, yeah. They do look fairly inoffensive, I must admit, the way they're built now. I mean, I come from the days of the big, big machines that you do-dum, you know, like you see in movies.
Louise: And where they've come from those days to now is phenomenal. I mean, you don't need to know anything about any medical issues whatsoever. What heart rhythm is going on, nothing.
Louise: All you need to know is to press that button on and stick the pads in the right place. Once that's done, it will tell you everything. It is your best friend during a cardiac arrest.
Louise: It will tell you everything, the exact moment when to do everything. And you'll also, because you've put the phone on speakerphone, when you're speaking to the paramedics, they will be listening to it as well, and they'll be telling you what to do. So you've got two very good best friends there whilst performing CPR.
Louise: You're not alone.
Louise: Because you see defibrillators all over the place these days, the little boxes on the side of various buildings.
Louise: Because you need to get there quickly and get it attached to somebody as quickly as you possibly can, we need them everywhere, so people do not have to run very far to get one.
Mark: Okay. Well, we'll talk a lot more about that in the next episode. And the whole defibrillator thing, because I know there's a whole thing about servicing them as well.
Mark: That is brilliant. Thank you very much for that. Again, I've learnt stuff.
Louise: I always learn stuff. Like a lot of people, I always thought that cardiac arrest and heart attacks were the same thing, and they're completely different. And we'll talk about CPR.
Mark: As I said a number of times already, we'll talk about CPR in the next episode, which will be out in the new year. Until then, we hope you all have a lovely Christmas and a lovely new year.
Louise: Yes. Merry Christmas. Have a lovely new year, and I'll see you in the new year.
Mark: Thank you very much, Louise. Lovely talking to you again. As I said, the next one will be out in the new year.
Mark: So subscribe and follow us for that. You can also listen to any past episodes by subscribing or for searching for First Aid Unboxed on your preferred podcast platform. Or you can go to 1386audio.com/forward/have-a-listen, and they're all on there as well.
Mark: So until the new year, thank you very much for listening, and we'll speak to you soon. Bye bye.
Mark: This is a 1386 audio production.

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