If you are with someone whose heart has stopped beating, call 911 or your local emergency number. Administer cardiopulmonary resuscitation (CPR) immediately. CPR will supply oxygen to parts of the body until the ambulance arrives. It is important to have a family member or caretaker trained in CPR, especially if there is diagnosed heart disease in the family. Local community centers, the Red Cross and hospitals can provide information on CPR training.
In the emergency department
Treatment goals at the emergency department are to decrease the demands on your heart and prevent and treat complications. An IV (intravenous catheter) will be placed in a vein. This is the best way to administer fluids and medications. Even if blood levels of oxygen are normal, oxygen will be administered to decrease the workload of the heart. A urinary catheter might be inserted to help monitor the input and output of fluid from the body.
Your doctor will use the following information to determine the severity of your condition and treatment of choice: previous medical history, physical examination, an electrocardiogram (ECG or EKG), and the level of certain chemicals in your blood.
Physicians will want to know what type of chest pain you may have experienced previously. They will also want to know whether you have had a heart attack in the past, surgeries, and if you take any medications. (It is useful if a family member has knowledge of medication dosages.) This information will help physicians determine whether the pain you are feeling is due to a heart attack.
The physical examination will concentrate on checking your blood pressure and heart rate and listening to your heart and lungs for abnormal sounds. The ECG (or EKG) is a test that records the electrical rhythm of your heart. Wires (or leads) are attached to the chest, arms, and legs using pads with gel or tape. This procedure is not painful. Specific changes in the ECG may alert the physician if a heart attack is occurring. EKG monitoring is generally started immediately since life-threatening dysrhythmias (defective rhythm) are the leading cause of death during the first several hours following an acute heart attack. Sometimes an echocardiogram will be required. This is a test done by ultrasound. A transducer (a device that looks a bit like a microphone) will be placed against your chest in order to visualize the beating heart. This is totally painless, and you can actually watch the screen. Using the echocardiogram we can see whether the valves are working properly, and whether the heart muscle is functioning as it should. This device does not visualize the coronary arteries however. Occasionally CT (computerized tomography, a form of x-ray), or MRI or MRA (magnetic resonance imaging, magnetic resonance angiography) or transesophageal echocardiography may be required.
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