Life Threatening Heart Emergencies

Cardiac ARREST (Sudden Stoppage of heart Activity)
  1. If you think, someone heart has stopped; immediate call emergency services (select your country)
  2. The Cardiopulmonary resuscitation (CPR), should be started as soon as possible.

The steps to follow are: (Video)

  1. Call for help
  2. Move the patient onto his back
  3. Interlock your fingers and position at the lower part of breast bone (sternum)
  4. Start giving chest compression
  5. Open the mouth (airway and give 2 breaths)
  6. The ratio of chest compression- breathing is; FOR every 30-chest compression, use 2 breaths (30:2).
  7. If no one for breathing, then continue chest compression, until ambulance people arrive.
  8. The ambulance people will decide regarding further management (usually heart attack).
  9. If no ambulance services available, Continue CPR and try to transfer patient to nearby hospital.

Note: If there is heart monitor /defibrillator available, then attach them to patient and follow as above or listed to the device (usually automated machines)

Video of CPR

Acute (Sudden) Heart Attack
How to diagnosis & Treat Heart Attack (Emergency)
  1. The Diagnostic steps and treatment might be different depending on the type of heart attack you are having (see types of heart attack)
  2. It is important to diagnose heart attack as soon as possible as it may put your life at risk.
  3. What to Do if You see someone might be having heart attack- Click Here

The Steps to Follow are:
  1. Step 1: Call for ambulance or Go to the nearest Hospital

  2. If you have the following symptoms:

    1. Chest pain or chest discomfort may be mild or severe. ( usually on the left side of upper chest/left arm or neck/jaw)
    2. May have Nausea, Shortness of breath, cold clammy and Sweating or Dizziness
    3. Some people may describe it as the “ The worst pain of my life”.
    4. Some people may have their heart stop immediately (sudden cardiac arrest)
  3. Step 2: Doctor in hospital will do:
    1. The doctor will take a detailed history of the symptoms of chest pains and do physical examination.
    2. Do and Urgent ECG/EKG
    3. Additional tests may be required (Bloods, Chest X-ray and/or Urgent Heart SCAN - Echocardiogram)
  4. Step 3: Doctor Will Make diagnosis and decide for treatment

  5. Once the doctor confirms the Heart attack, the aim is to:
    “Quickly restore the blood flow of the blocked artery in order to save the heart muscle from damage”

    The steps are as follows:

    1. Will be attached heart monitor/ Blood pressure monitor and ECG/EKG.
    2. You may be started on oxygen (Mask)
    3. Aspirin will be given ( usually given by ambulance- team)
    4. Pain relievers with morphine or other medications
    5. Blood-thinning medications called heparin.
      1. Heparin make your blood less "sticky" and stops clots formation.
      2. Heparin is given intravenously or by an injection under your skin
    6. Clot-preventing drugs: (Anti-platelet medications)
      1. Medications such as clopidogrel (Plavix) OR prasugrel (Effient) OR ticagrelor (Brilinta), will be used in addition to Aspirin. (The type of medications depends on your hospital availability)
  1. As it is very very important to open the complete blocked artery as soon as possible ( ideally within less than 2 hours of start of chest pains), the available treatments are:
  1. Coronary angioplasty also known as Primary Percutaneous Coronary intervention (PPCI). This is performed to treat the blockages in the vessels of the heart by stretching with balloon or implantation of STENT (steel metal). The doctors will perform this in a catheter lab ( X-ray Room) by inserting a tube (catheter) that's passed through an artery in your groin or wrist to a blocked artery in your heart.
  2. Emergency Coronary artery bypass (CABG) surgery: In some cases, doctors perform emergency bypass surgery at the time of a heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery.
  3. This is decided if after taking performing coronary angiogram (taking pictures) of your shows multiple blockages or as a complications of coronary angioplasty complication.
  4. Additional emergency procedures:
    You may need additional procedures depending on the status of your heart and risk to your life. These procedures are:
    1. Intubation: Put to sleep by putting a breathing tube in the mouth. This is needed if heart stops and needs breathing support.
    2. IABP: This is an insertion of special balloon in your leg to support the heart pumping.
    3. ECMO: This is an insertion of special tubes balloon in your legs to support the heart pumping.

If your doctors confirms that you have probably partially blocked artery of your heart, in addition to routing medications, you will need a coronary angiogram or coronary angioplasty (insertion of stents), but this can be performed within 1 to 3 days of admission in hospital.

Acute (Sudden) Attack of Angina

Angina attack is usually mild but in some cases may be severe.

The steps to follow are:

  1. Immediately stop the activity, what you are doing.
  2. Use your GTN medicine (spray or tablet): you must sit before you use. You may feel lightheaded or dizzy
  3. Take another dose of GTN after 5 minutes if the first one does not help.
  4. If no improvement in 5-10 minutes, call your emergency services.

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When to call for ambulance or go to nearby hospital
“Never drive if you are having angina pains”
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  1. If the pain is not improving after second GTN dose ( lasts longer than 15-20 minutes)
  2. If you think the pain is worse than before, on minimal exertion or at rest
  3. Frequent recurrence could be Unstable Angina
Acute (Sudden) Arrhythmias (Heart Rhythm Issue)

How to diagnosis an Acute arrhythmia (Emergency)
  1. The symptoms of acute heart Arrhythmia starts suddenly or abruptly. The symptoms of acute arrhythmia usually depends on the underlying heart problems. The acute heart attack, acute heart failure, and patients with previous heart attack or cardiomyopathy usually cause this
  2. The patient may present in various stage of un-stability including, severe Palpitations, Severe Breathlessness with or without low blood pressure or blackout.
  3. Some may present with Cardiogenic shock ( heart unable to pump blood) and the patient may need support for lungs ( Intubation)
Treatment of an Acute Arrhythmia

The steps to follow are:

  1. Step 1: Call for Ambulance or Go to the nearest Hospital
    If you have the following symptoms, which starts suddenly:
    1. Moderate to severe palpitations, Shortness of breath, Dizziness.
    2. Chest pain or chest discomfort may be mild or severe. ( if due to Heart attack) usually on the left side of upper chest/left arm or neck/jaw)
    3. Some people may have their heart stop immediately (sudden cardiac arrest)
  2. Step 2: Doctor in hospital will do:
    1. The doctor will take a detailed history of your symptoms and do physical examination.
    2. Do and Urgent ECG/EKG
    3. Additional tests may be required (Bloods, Chest X-ray, Urgent scan - Echocardiogram)
  3. Step 3: Doctor Will Make diagnosis and decide for treatment:
  4. Once the doctor confirms the acute arrhythmia, the aim is to:

    “Quickly restore the blood flow to the heart muscle (if Heart Attack) and remove the excessive fluids from lungs (pulmonary oedema), in order to save the heart muscle from damage”

    The steps are as follows:
    1. You will be attached to heart monitor/ Blood pressure monitor and ECG/EKG.
    2. Oxygen may be given via Mask OR pressurized machine.
    3. An IV line will be inserted for the use of medications and fluids.
    4. Pain relievers with Morphine or other medications.
    5. Special medication like Amiodarone, digoxin or Beta-blocker may be needed to reduce the heart rate.
    6. If patient unstable, may need small electric shock to the heart to restore normal rhythm.
    7. Blood-thinning medications called heparin may given.
      1. Heparin make your blood less "sticky" and stops clots formation.
      2. Heparin is given intravenously or by an injection under your skin
    8. Clot-preventing drugs. (Anti-platelet medications) - IF heart attack
    9. Furosemide: Medications to remove water from the lungs.
    10. Nitrates: Given to remove water from lungs. Given via IV line
    11. Inotropes: These are live saving medications given in severe heart failure in order to improve heart pumping function and maintain blood pressure.
    12. Heart Support Devices: If patient is unwell, may need additional heart devices including; Intra-Aortic Balloon Pump, ECMO, Impella Mechanical Support.
    13. If doctor confirms a heart attack then the doctor will follow the treatment.
  1. As it is very very important to open the complete blocked artery as soon as possible ( ideally within less than 2 hours of start of chest pains), the available treatments are:
  1. Coronary angioplasty also known as Primary Percutaneous Coronary intervention (PPCI). This is performed to treat the blockages in the vessels of the heart by stretching with balloon or implantation of STENT (steel metal). The doctors will perform this in a catheter lab ( X-ray Room) by inserting a tube (catheter) that's passed through an artery in your groin or wrist to a blocked artery in your heart.
  2. Emergency Coronary artery bypass (CABG) surgery: In some cases, doctors perform emergency bypass surgery at the time of a heart attack. Bypass surgery involves sewing veins or arteries in place beyond a blocked or narrowed coronary artery.
  3. This is decided if after taking performing coronary angiogram (taking pictures) of your shows multiple blockages or as a complications of coronary angioplasty complication.
  4. Additional emergency procedures:
    You may need additional procedures depending on the status of your heart and risk to your life. These procedures are:
    1. Intubation: Put to sleep by putting a breathing tube in the mouth. This is needed if heart stops and needs breathing support.
    2. IABP: This is an insertion of special balloon in your leg to support the heart pumping.
    3. ECMO: This is an insertion of special tubes balloon in your legs to support the heart pumping.

If your doctors confirms that you have probably partially blocked artery of your heart, in addition to routing medications, you will need a coronary angiogram or coronary angioplasty (insertion of stents), but this can be performed within 1 to 3 days of admission in hospital.

Hypertensive Crisis (Uncontrolled High Blood pressure)
What is Hypertensive Crisis?
  1. It is an extreme increase in blood pressure that can lead to a stroke.
  2. The BP is > 180/120. The systolic pressure of 180 millimeters of mercury (mm Hg) diastolic pressure of 120 mm Hg or higher
  3. The signs and symptoms may include:
    1. Severe Chest Pain
    2. Severe Headache
    3. Confusion and Blurred Vision
    4. Nausea and Vomiting
    5. Severe Anxiety
    6. Shortness of Breath
    7. Seizures
    8. Unresponsiveness
Treatment of Hypertensive crisis

The steps to follow are:

  1. Step 1: Call for ambulance or Go to the nearest Hospital
    If you have developed the symptoms of hypertensive crisis (as described before).
  2. Step 2: Doctor in hospital will do:
    1. The doctor will take a detailed history of your symptoms and do physical examination.
    2. Do and Urgent ECG/EKG
    3. Urgent blood tests
    4. Urgent blood Pressure
    5. Additional tests may be required (Bloods, Chest X-ray)
  3. Step 3: Doctor Will Make diagnosis and decide for treatment
    1. Once the doctor confirms the hypertensive crisis, the Urgency/speed of treatment depends on the damage to other organs of body (doctors will confirm with tests and history).
      1. If No damage noted: reduce blood pressure in next 24-48 hours ( quik reduction may cause problems)
      2. If Organ damage confirm, then reduce the blood pressure as soon as possible, in to limit and prevent further organ damage
    2. The doctor will decide about the type of medications, usually depends on the underlying cause for hypertensive crisis or the damage caused by it.
    3. The medications includes:
      1. Sodium Nitroprusside
      2. Labetalol
      3. Nicardipine
      4. Esmolol
      5. Produces a prompt, controlled reduction in blood pressure


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