Heart attack: The Golden Hour

The first hour after the onset of heart attack is called the golden hour.
 Appropriate action within first 60 minutes of a heart attack can reverse its effects.

This concept is extremely important to understand because most deaths 
and cardiac arrests occur during this period. However, if the person 
reaches the hospital and gets treated within this period s/he can expect 
near-complete recovery.

Window of opportunity:

The Golden Hour is a window of opportunity that impacts a patient’s 
survival and quality of life following a heart attack. It is a critical time and 
time, is a muscle. This is because the heart muscle starts to die within 
80-90 minutes after it stops getting blood, and within six hours, almost all 
the affected parts of the heart could be irreversibly damaged. So, the 
faster normal blood flow is re-established, the lesser would be the 
damage to the heart.

To reduce the damage, it is important to get to the hospital as soon as 
possible. Other than the consequences of a damaged heart muscle, the 
most common killer in the early period are abnormal heart rhythms 
called ventricular tachycardia and ventricular fibrillation where the heart 
muscles contract at a rapid rate, but no effective pumping of blood from 
the heart takes place. This is why once the person reaches a medical 
facility (ambulance or hospital), they are immediately put on an ECG 
monitor to assess the heart rhythm, so that they can be given prompt 
treatment in case of an abnormal rhythm, which could be delivering a 
shock (Cardioversion) or administering certain medication. 

Steps to be taken:

· Recognise the symptoms

· Call for help immediately

· Reach the hospital promptly.

Watch out for these signs: 

· Heaviness or pressure or burning sensation over the chest while at rest 
or minimal exertion, associated with restlessness, perspiration, radiation 
of pain to jaw, back, left arm.

· Breathlessness without any chest discomfort, especially in diabetics.

· Abdominal pain and bloating are usually acidity-related problems, but if 
the symptoms are more than usual in severity or are associated with 
other symptoms, take them seriously.

What’s wrong and how to fix it?

Heart attack is caused when a clot completely blocks a blood vessel in 
the heart. The primary aim is to get rid of this clot as soon as possible; 
otherwise, that part of the heart dies.

Even if there is a slight suspicion that the symptoms could be of a heart 
attack, chew a 300/325mg of aspirin tablet immediately; it helps dissolve 
the clot. Once you are at the hospital, the doctors will try to get rid of the 
clot, either with the help of a very powerful clot buster medicine 
[thrombolytic medicines] or with a procedure called primary angioplasty.

Although both modalities have advantages and disadvantages, primary 
angioplasty is the preferred therapy in most scenarios. In primary 
angioplasty, a diagnostic coronary angiogram is performed immediately 
to identify the site of blockage and angioplasty is performed and a stent 
(metallic scaffold) is deployed in the artery to open up the blood flow. 

The only prerequisite is that it can be done only in hospitals where 
a cardiac catheterisation laboratory and doctors well versed with this 
procedure are available. Apart from this, other supportive therapy also 
gets initiated simultaneously.

Be prepared:

· Always keep the contact numbers of ambulances and nearby hospitals 
stored in your cell phone, so that you can call them in case of need. 

· Try to reach the nearest hospital which has cardiac care facilities…as 
early as possible. 

· Try to go by ambulance. Do not drive yourself as you could harm 
yourself as well as others. 

· Call the hospital helpline; so that the system can be activated even 
before the patient reaches the hospital.

Prevent the attack:

It’s always best to prevent such an event from happening. For that, 
leading a heart healthy life style is important. All the risk factors for heart 
disease like high blood pressure, diabetes, high cholesterol, obesity, 
sedentary lifestyle, smoking, are silent killers as they do not produce 
uncomfortable symptoms and are hence neglected by most of us. 
Getting yourself checked by an expert cardiologist at regular intervals is 
critical.

What to do if a person suddenly collapses?

Follow these pointers diligently:

· Make the patient lie down on his/her back immediately

· Listen to the heart beat by keeping your ear over the chest

· Check if the person is breathing by keeping your finger near the persons’ 
nose to feel their breath. If the patient is not breathing, start giving chest 
compression and intermittent mouth-to-mouth respiration if possible.

· Call for an ambulance and shift the patient to a nearby hospital.

Blog by

Dr.Deepak Krishnamurthy 
MD, DNB Senior Consultant,
Department of Interventional Cardiology