HEART ATTACK - THE EVENT

My mother has been told that she is 'at high risk' of a heart attack. I am her carer and am worried about her. What should I do if I think she is having a heart attack?

Your mother should rest completely in a comfortable position, preferably lying flat with her feet slightly raised. Make her avoid any exertion: if you are at home, the floor is best, not the bed if stairs are involved. Call the ambulance immediately (dial 999) and tell them that you think that your mother is having a heart attack. Make sure that you stay on the line long enough to tell them precisely where she is. If you know her doctor's name, contact the surgery immediately: the doctor may be able to start treatment before the ambulance arrives. If your mother has been given glyceryl trinitrate tablets or sprays for angina, then one or two tablets or sprays should be given. She should also chew 300 mg aspirin, or dissolve and swallow it, unless she is allergic to it or she has a recently (inside 1 month) proven stomach ulcer; if in doubt, give it anyway - the benefit is greater than the risk.

Why do we have to say 'heart attack' when calling an ambulance?

Some areas have specially equipped ambulances which can give immediate care to coronary patients - these are known as 'coronary ambulances'. The staff - often paramedics - are coronary trained and can deal with the situation and its problems with a great deal of expertise and skill.

We live in the country and fortunately have a very good local hospital. However, it does not have a coronary care unit like the general hospital 40 minutes away. Our doctor has advised us to go to the coronary care unit in the event of my husband having a heart attack. Why?

In the early hours after a heart attack, the build-up of chemicals can irritate the heart and upset the electrical system that controls the heartbeat. A very irregular rhythm known as ventricular fibrillation (VF) can occur. In effect, it is as if the heart has stopped; all that is happening is that the heart muscle (ventricle) is chaotically wriggling like a bag of worms (fibrillating), and there is no blood leaving the heart as a result. This can be corrected by prompt medical treatment so that normal heartbeats can be restored. Prompt treatment means being in the hands of the experts in a coronary care unit who can keep an eye on your husband hour by hour until the risk settles, usually after 24 hours.

Coronary care units employ highly trained nurses who deal with pain, monitor the heart and supervise specific treatments designed to minimise complications and speed recovery.

My partner is very stubborn and simply refuses to go to hospital. He is getting on now and not strong. He has been a life-long smoker. I do not want to upset him by making him go to hospital if he had a heart attack. Would he be able to stay at home?

Some doctors believe it is safe for people to stay at home provided that suitable facilities and care are available. The danger period is usually within the first 12 hours; if this time has passed already and there are no problems, it is probably as safe to be at home. Older people like your partner may be happier at home also. Home care involves the family, district nurses and family doctor, and its quality will depend on their availability and workload.

It is unwise to be at home alone following a heart attack. If the heart attack has just happened, it is better to be in hospital, where everything is immediately to hand. This applies to young and old people of both sexes. There is clear evidence that otherwise fit people in their eighties benefit from thrombolysis (clot buster medication) and angioplasty (balloon treatment) where needed - and that means going to hospital.