Cardiac arrest, often fatal, is becoming increasingly commonplace. Here's what you need to know and how you can help
Like our brothers and sisters all over the world, we Thais are great at making New Year resolutions and promptly breaking them just a few days later.
This year, like other years, many of us will head into 2018 determined to eat healthier food, exercise more and generally take better care of ourselves. Perhaps we will stick to these worthy resolutions, though more likely we will quickly slide into old habits before January is more than just a few days old. Yet we would all do well to stop for a minute and reflect on the number of people we have lost this year to heart attacks. Yes, they happened to other people, but an unhealthy lifestyle means one could happen to us too.
Among the people in the news who collapsed and died from cardiac arrest were Thanat “Jo Boyscout” Chimtuam, a pop idol from the 1990s whose heart gave out while he was performing on stage, and veteran politician and statesman Dr Surin Pitsuwan, who suffered chest pain at home but died despite being rushed to hospital. And then there were the not-so-famous people who collapsed while working out in the gym or running a marathon.
None had apparently suffered any warning signs of symptoms. Or were the signs there and a lack of knowledge meant they went unrecognised?
Current statistics show that two people die in Thailand of a heart attack every hour. They are by no means always elderly or in obvious bad health though almost all will be suffering from what is known as coronary artery disease.
Cardiac arrest occurs when blood flow that brings oxygen to the heart muscle is reduced or cut off. This oxygen-rich blood is provided by the arteries. But those arteries become narrow and blood cannot flow as well as it should. Fatty matter, calcium, proteins and inflammatory cells build up within the arteries to form plaques of different sizes and when a plaque breaks, a blood clot forms around it. This clot can block the blood flow through the heart muscle, and the muscle cannot get oxygen, so the damage or death of part of the heart muscle occurs. This is called a heart attack or myocardial infarction (MI).
While some heart attacks are what the experts call “silent”, that is without symptoms, there are usually warning signs even if those all too often these go ignored.
Dr Apichai Pongpatananurak, a cardiologist from Samitivej Sukhumvit Hospital, stresses that sudden and fatal heart attacks don’t happen for no reason. Most sufferers will have had some problems with their health prior to the attack and will have brushed them off as being inconsequential.
They probably had chest pain, were short of breath, or felt dizzy or light-headed. They also likely had high cholesterol (Jo Boyscout’s cholesterol was measured at 300 mg/dL: less than 200mg/dL is considered desirable for adults), diabetes, hypertension and a history of smoking, alcohol or obesity.
In broad terms, causes of heart attack can be divided by age: below and higher than 35 years. Heart disease and heart attack commonly discovered in the below-35s is generally the result of hypertrophic cardiomyopathy, an inherited condition in which the heart muscle cells enlarge and cause the walls of the ventricles to thicken, blocking the blood flow, The vast majority of the 35 years and over cases are due to coronary artery disease.
But it’s not all gloom and doom. As Dr Apichai points out, we can all take charge of our own health and be aware of the risk factors. For example, if you are planning to start a course of heavy exercise – and this is particularly important for diabetics – have a check up first. That check-up will include running on a treadmill while you're hooked up to an EKG.
We all need to clean up our dietary habits. That means cutting back on fast foods and fried foods and adding plenty more vegetables and fruit to our daily intake. And while it is tempting to down alcohol over the festive season, show consideration to your heart and down a glass of water in between those glasses of beer.
Perhaps even more importantly, we should also all learn how to give cardiopulmonary resuscitation (CPR) and ideally this should be taught at school, as it is in many European countries. Sadly, the majority of people have no idea how to come to the aid of someone having a heart attack. What happened to Jo Boyscout is a case in point. His band members did not provide immediate help after he collapsed but kept joking as they thought Thanat was only acting out. It was only several minutes later when they realised his condition was serious that they called for an ambulance from a rescue foundation, which took about half an hour to reach the scene. During this time, no first aid or CPR was given to the singer and he died.
When a person has suffered a heart attack, CPR or chest compression given with both hands must be started within four minutes and 1669 called to dispatch an emergency team to help. The CPR-giver should first use his/her fingers to locate the end of the person's breastbone, where the ribs come together, place two fingers at the tip of the breastbone and the heel of the other hand right above the fingers (on the side closest to the person's face). Both hands should be used to give chest compressions, with the other being put on top of the first and the fingers laced together. The chest should be pressed 5 to 6cms down 100 to 120 times per minute until the emergency medical team arrives or until the patient is revived. If the venue has an automated external defibrilliator (AED), it should be used on the patient.
A member of Boyscout’s back-up band, singer Chanit “Ta Boyscout” Yaisamer, later told interviewers that he was afraid to give CPR after a previous experience with a friend who died.
Dr Apichai says this reaction is understandable, but adds, “The fact is if you won’t help, they will die.”
Many organisations are now running CPR workshops and AEDs are slowly but surely being installed at many places including BTS Skytrain stations, condominiums and housing estates.
So even if you don’t want to commit to New Year resolutions in 2018, do try and make one – and keep it.
Learn about sudden heart attacks and how to give CPR.
You could save a life.