By Dr. K. Javeed Nayeem, MD

In my two earlier articles I have told you all about why Sudden Cardiac Deaths (SCDs) occur and what you should know about this deadly problem. Today I will be telling you about what you can do to prevent such deaths and how best you can deal with the situation if you do happen to encounter it as you go about your daily life.

Knowing what to do is more important for all of us as Sudden Cardiac Death is one medical condition where the intervention and quick and appropriate reaction of bystanders rather than any medical help which is very often the main element that is more likely to save the victim’s life.

I say this because the first rescue efforts which can be administered on the spot and also during the transit to a hospital are the ones that can keep the patient alive till he or she reaches a medical facility. If this is achieved successfully during the most risky and critical first few minutes, the chances of the patient surviving after reaching the hospital are very good. 

But as the age-old adage says, ‘prevention is better than a cure’ and this is perhaps nowhere truer than in the case of heart attacks or SCDs. So, I’ll talk about prevention first.

As I said in my very first article, nearly eighty percent of SCDs herald their arrival nearly a month before striking with some ominous signs or symptoms that should not be ignored. And, therefore the most important first step is not to ignore or brush away those symptoms as trivial especially when one has associated risk factors like obesity, high blood pressure, diabetes, high blood lipid levels and a family history of heart disease.

People who lead sedentary lives, smoke or consume alcohol or lead stressful lives, working hard and losing sleep, to achieve their self-set or job-related goals are the ones who should modify their lifestyles before it is too late. Too late here does not mean till they start experiencing the signs and symptoms because by then the damage would have been done and their bodies would be poised on the verge of going over the cliff. So, earlier is always better.  So, signs like fatigue, palpitation, shortness of breath or chest pain and discomfort while walking uphill or on climbing stairs, should be taken seriously and a medical opinion sought to rule out serious problems.

Very often the symptoms of serious heart problems can mimic the symptoms of gastritis or hyper-acidity which is very common. So, most people continue to consume over the counter medications on their own and avoid going for a cardiac check-up. Very often it is the fear of what these check-ups can reveal, which dissuades a great many of them from seeking medical help.

While it is true that hyperacidity and gastritis can mimic a heart problem it is also very true that many all too real cardiac problems can masquerade as simple acidity and that is what makes it dangerous to ignore the problem. It must be noted that while dealing with what seems like acidity and gastritis it is always safer to rule out an underlying cardiac cause than to overlook it.

The verdict should come from the horse’s mouth and here the best horse to bet on is none other than your friendly, neighbourhood cardiologist! I say this because these days, with the rapid growth of our healthcare system and transport facilities a cardiac care centre is available just a stone’s throw away for most of us. In most towns and cities every other house now has a car and our free ambulance services serving even remote village are pretty good and they have been saving lives very effectively over the past few years. So, seeking medical help to establish a diagnosis before the problem strikes can save lives.

Now I’ll tell you what you can do if you do find somebody falling down unconscious on the pavement or at the workplace and I’ll keep it very simple. You have to first see if the person has a good and steady pulse and to do this you need to first learn where to locate it. And this is something that you should learn to do immediately after you finish reading this article!

The pulse tells you if the person’s heart is beating steadily and it is best felt on the inside of the wrist. The best way to locate it is to move your entire thumb and locate the point where this movement starts. You will most certainly find the pulse throbbing                                                            somewhere in its immediate vicinity but if you are in doubt a doctor or nurse you know can help you immensely in this matter. It is worthwhile to feel your own pulse now and then, not only to remain adept at this very vital skill but also to reassure yourself that you are alive!

Even as you are kneeling down to help the fallen person you should request someone around to call for medical help. So, another thing you should become good at is to memorise a couple of emergency help numbers like the national ambulance service, the Police Control Room and a good cardiac care hospital. If you find the pulse steady and bounding and the patient breathing, he or she is safe for the moment. You can wait till the medics arrive.

But if you find that the person is not breathing or the pulse is absent or very weak and irregular, you need to react without wasting any time. If the pulse is weak, you should raise the legs of the person so that you can divert whatever blood that is flowing out of his or her heart to the brain to keep it alive till help arrives.

But if you find the pulse absent in both wrists, you should thump the patient’s chest hard once or twice with your fist and see if the pulse returns and remains beating. This action can very often start a heart that has stopped. But if this does not happen, it is time to start a cardiac massage. And though we all use the term ‘massage’ it is almost a misnomer because just massaging the chest does not help at all!

What you need to do is place the person supine on a firm surface and with both your palms placed one above the other on the centre of the chest, press down firmly and rhythmically, depressing it sharply by at least an inch and a half so that the heart underneath is compressed sufficiently to pump out the blood inside as it does on its own normally.

This is again a skill that a doctor or para-medic or even the videos available on the internet can teach you very well. You have to keep doing this manoeuvre continuously either till the heart starts beating or till medical help arrives or you yourself manage to get the patient to a hospital where the medical team can take over.

But there is another thing you have to ensure before the victim is safe and that is to ensure that his or her lungs get the air to keep him or her alive. That is where knowing the art of artificial respiration comes in handy. But that will have to wait until next week because I do not want to give you an overdose of my medicine all at once! So please hold your breath for now and please stay tuned!

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