Your best chance in a cardiac emergency? Timely action and ICU care!

As we mark World Heart Day 2024 with the theme “Use Heart for Action,” it reminds us all to take proactive steps toward better heart health. This year’s theme empowers individuals to take charge of their own well-being by recognising the early signs of cardiac issues. In case of a cardiac emergency, it strikes without warning, compromising the heart’s function. Prompt recognition and intervention are crucial to save lives. Understanding the types of cardiac emergencies and how they present is the key to seeking timely medical attention.

Most of us are familiar with heart attacks and cardiac arrests. A heart attack, also known as acute myocardial infarction, occurs when blood flow to the heart muscle is blocked, leading to damage to the heart tissue. On the other hand, cardiac arrest results from a sudden stop in effective heart pumping, leading to the cessation of blood flow to both the body and to the heart itself. 

Other cardiac emergencies include arrhythmias which are irregular heart rhythms that interfere with the pumping of the heart ; heart failure which occurs when the heart is weakened and cannot pump blood efficiently; cardiogenic shock in which the heart is unable to pump enough blood to meet the body’s needs causing multiple system dysfunction, often following a severe heart attack; and, aortic dissection which is a tear in the inner layer of the largest blood vessel the aorta which blocks off the branch blood vessels that arise from the aorta supplying blood to the body.

We must learn to recognise the signs of a cardiac emergency. Otherwise, there is increasing risk of irreversible damage to the heart and vital organs leading to the prolongation of Intensive Care. What we call an ICU-Intensive Care Unit, plays an important role in saving lives. The World Heart Day 2024 theme also urges leaders to make cardiovascular health a priority, ensuring that life-saving facilities, like ICUs, are accessible and well equipped to handle cardiac and other emergencies.

While most ICUs are equipped with defibrillators, ventilators to assist with breathing, and medications to stabilise heart function, it has been observed that many ICUs lack specialised equipment like intra-aortic balloon pumps and extracorporeal membrane oxygenation (ECMO) machines. The Intra-aortic balloon pumps supports heart function in a failing heart and help it pump efficiently. ECMO machines largely take over the function of the heart and the lungs in life-threatening cardiorespiratory failure, and ensure that all parts of the body receive oxygen-rich blood during critically low flow states. Moreover, having these equipments in the ICU is not enough and there is requirement for specialist technicians to operate these machines, and the lack of such skill set and talent leads to ineffective application of the technology.

ICUs enable round-the-clock monitoring of heart rate, blood pressure, oxygen levels, and other vital signs. This allows doctors to detect any changes early and intervene promptly. In the case of a heart attack, ICU teams can administer clot-busting medication. The patient can be prepared for angioplasty and stent insertion to restore blood flow. Dangerous arrhythmias can be treated in the ICU with electrical cardioversion or defibrillation to restore normal heart rhythm. Post-resuscitation care, such as temperature management to cool the body following cardiac arrest to prevent brain damage, is best managed in an ICU.

Cardiac ICU care in a tertiary or quaternary hospital should have a multidisciplinary approach with cardiologists, intensivists, nurses, respiratory therapists, and other specialists who come together to provide comprehensive care. This integrated approach ensures that patients receive the best possible treatment for both their heart condition and any related complications, such as respiratory or kidney failure. Early rehabilitation, including physical therapy and nutrition management, can begin in the ICU to speed up recovery and get patients back on their feet as soon as possible.

Timely ICU care significantly improves survival rates for patients with cardiac emergencies. The golden hour is the first hour after a heart attack or cardiac arrest and is the most critical time to start treatment. This is because the heart muscle begins to die within 60-90 minutes of losing blood supply, and irreversible damage can occur to the heart within four to six hours. For conditions like cardiogenic shock, rapid intervention in the ICU can mean the difference between life and death.

This World Heart Day, let us raise awareness about the importance of early detection and prompt treatment, especially in cardiac emergencies. Let us use our hearts to inspire action—whether it is making healthier choices, advocating for policy changes, or supporting initiatives that improve access to care—because every heart matters!