Heart attack
Initial treatments for heart attacks
The initial treatment of a heart attack at the time of these interviews (2004 and 2011) included pain relief, thrombolysis (clot busting) and other blood thinning drugs (e.g. aspirin), given by ambulance staff or at the hospital. Many of these treatments are still given in the same way.
On the way to the hospital, ambulance staff may give people oxygen if they have a low level of oxygen in their blood. To relieve pain they may give morphine intravenously (through a vein) and glyceryl trinitrate (GTN) as a tablet under the tongue or as a spray and an aspirin to chew to thin the blood.
Mervyn describes the treatments he received in the ambulance on his way to the hospital.
Mervyn describes the treatments he received in the ambulance on his way to the hospital.
She describes the series of tests she had done in the ambulance and in hospital.
She describes the series of tests she had done in the ambulance and in hospital.
In coronary care it was just, everything happened so fast and the team were, just working on you like from all directions, there's a doctor, there's nurses, you know, they're taking blood, they're doing this, they're doing that. So that all happened so, so fast and some of it was like a bit of a blur as well.
I can't really recall everything that happened while I was actually in coronary care. All I know is that they worked really fast to get me stable. So that's when, you know, they actually realised that I was having a heart attack and just spoke to me obviously to make sure that they were going to give me the correct drugs, just asked me a few questions and, basically, that's all I can remember there for a little while because then I was just in a daze.
It felt like I was drifting and I just recall people and, I didn't, I wasn't actually unconscious but I think I might have been drifting in and out while I was in coronary care. So, but then they got me stable and then, over the next few days in coronary care it was, obviously they just wanted me to rest and get better the best that I could.
They did an echo of my heart which, there was some slight damage to my heart but not a great deal of damage to my heart. And then, before they'd let me come home I had to go on a sort of like it was a stress test, they call it, where I just had to go on a treadmill and be all wired up and monitored up to, to see whether my heart got into any difficulty, which it did after so many minutes of doing exercise.
So they decided then that I'd have to have an angiogram and I had to wait a few months to have the angiogram and it, and when I had the angiogram they decided that because of one of my arteries was narrowed 90% that I would benefit from having an angioplasty and, and a stent.
People we talked to found it reassuring being in the ambulance and receiving treatment even before they arrived in hospital enabling healthcare staff to plan treatment before the person arrived at the hospital.
The ambulance crew did an ECG which was sent electronically to the hospital. On arrival, the doctor told James that they would like to do a primary angioplasty without delay.
The ambulance crew did an ECG which was sent electronically to the hospital. On arrival, the doctor told James that they would like to do a primary angioplasty without delay.
The cardiologist at the hospital told James that he needed primary angioplasty without delay to avoid further damage to his heart.
The cardiologist at the hospital told James that he needed primary angioplasty without delay to avoid further damage to his heart.
James explains primary angioplasty and the care he received after the operation.
James explains primary angioplasty and the care he received after the operation.
Other people we interviewed s describe the interventions they received when they got to hospital. Where diagnosis was not straightforward, it took a little longer for initial treatments to be given.
He felt much better after the initial treatments he was given in hospital.
He felt much better after the initial treatments he was given in hospital.
I stayed in under observation in A & E for about six hours and this was through the night. They called my wife who arrived with one of my daughters with her partner in the early hours of the morning and stayed with me for some while and were rather surprised to see me sitting up feeling quite bright and cheerful wondering what the hell all the panic was about. They went, I started pressing them about being discharged.
They said that in fact I'd had a major heart attack and it was probably as a result of my diabetes that I was not feeling any pain other than general discomfort. The following morning I was admitted to the cardiac ward.
Staff were unsure when his heart attack occurred so he had warfarin to thin the blood instead of thrombolysis.
Staff were unsure when his heart attack occurred so he had warfarin to thin the blood instead of thrombolysis.
Was it a chest pain?
Not really, it was as if there was a mouse running up my chest, it was a most peculiar feeling, as if there was something just going like that, up my chest. And it was just a little pain that ran up, most peculiar feeling, and that was really all I was getting and I didn't feel right, I didn't feel right at all.
So I was taken, my wife took me in the car this time to the hospital, went again to the Accident Unit and they were very good. As soon as I mentioned heart problems in the reception I was straight through to the doctors area. They did, they put the tests on me, they said 'yes, you're in trouble', and they took me through to the local CCU which is at that hospital. And they said, 'yes, you've had a heart attack'.
They weren't sure whether it was the first time or whether it was Wednesday or whether Wednesday was a prelim to it or whether it was three o'clock in the morning.
They said, 'unfortunately, because if it was three o'clock in the morning which they were beginning to think it was, I couldn't have this clot busting drug which everybody gets and you should have within the first hour or so. So I just stayed in the CCU, they put me on warfarin and all the usual sort of drugs and looked after me really.
Thrombolytic (clot buster) drugs help to dissolve the clot that is blocking the artery and are usually given immediately upon arrival in hospital. But in some parts of the country, people get them before they reach hospital, to speed up treatment. Ideally the injection should be given as soon as possible after the onset of symptoms of the heart attack. If the injection is delayed beyond six hours, the benefit is less and beyond 12 hours there is little or no benefit.
Explains what he was told and why he agreed to have the thrombolysis (clotbuster drug).
Explains what he was told and why he agreed to have the thrombolysis (clotbuster drug).
When he said I was having a heart attack, that the next few hours were crucial and what was really important, if possible, was to try and attack the clot that would be in my, the part of the heart that the clot would be in. I'm not physiologically terribly well tuned I'm afraid.
He explained, I mean I was very impressed actually because he squatted down and spoke to me at my level. He explained that there were risks attached to this process, which I think is called thrombolysis. There was a one percent risk of spontaneous bleeding, which I said is hardly, that I'm not really concerned about that.
He said there was also a one percent risk of stroke. But he obviously pointed out the risks of not taking this treatment were much more significant. And that if it could be effective early enough, it could minimise the long term damage to my heart muscle. So I clearly was happy to agree.
Explains why she chose not to have the thrombolysis (clotbuster drug).
Explains why she chose not to have the thrombolysis (clotbuster drug).
I asked what the risks were and he said you could haemorrhage because obviously it's going to thin your blood down and you could haemorrhage from your brain and I said, 'Well, what's the worst scenario?' and he said, 'Well, death.' [laughs] and I thought, 'well I don't really want a brain haemorrhage.'
I thought, 'I've had a heart attack, or I'm having a heart attack or whatever' and to me it didn't feel that bad because I didn't have the crushing pain. That's all I'd got to go by really, and nobody could make the decision, only me. That's what I decided.
After initial diagnosis and treatment, people were cared for in the hospital's coronary care unit (CCU), where further tests and decisions about treatment were made (see 'The coronary care unit'). Sometimes, people are transferred to another hospital for specialist treatment and care.
He was transferred within 24 hours to a regional cardiac centre because his condition was not stable.
He was transferred within 24 hours to a regional cardiac centre because his condition was not stable.
I understand by this time, I was totally unconscious. I understand from my wife that the medical staff were waiting at the door to take me in on to the stretcher and straight up the corridor and they did indicate to her, 'Don't, we'll be running up this corridor,' because that particular hospital had a very long incline passageway to the cardiac unit and said, 'don't run, we'll have to run.'
Apparently they had all of the equipment on there. Took me up to the ward and I knew nothing of this, this was what was related to me by my wife. The first thing I recall was the following morning, roughly about seven to half past, I couldn't say exactly.
I came round and I remember saying to my wife, 'You know I feel a wee bit better,' and at that time I was in a cubicle near to the nurses station and then my wife and my daughter appeared because my wife had stayed all night and then thought now we've got to get [my] daughter.
So she came down and they came in again and was standing just outside of the curtain and then they allowed them to come in again to see me because the doctors were there and they had come in to see me and just at that time when they came in, I said, 'I'm going to be sick.'
And I did, I vomited and immediately, as it happened the doctors were still there, virtually at the end of the bed, and they ushered my wife and my daughter out and then I lost conscious again.
Came round and by this time they were making arrangements to transfer me to a hospital [in the next county], on [in the next county] which specialises in heart conditions.
And of course off I went and between leaving the hospital and the [specialist] hospital, from time to time I came around a little bit. I can remember the driver making certain remarks about people being in his way [laughs] and then in to hospital. And as I say, I sort of lost consciousness from time to time, well most of the time actually on the journey.
I can remember being taken out and in to the hospital, going up the corridor and straight through from the ambulance, up the corridor and in to the operating theatre where they started to treat me. By this time I was sort of more unconscious than awake. I was in the theatre for three and a half hours.
Last reviewed June 2017.
Last updated June 2017.
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