A heart attack without a happy ending

Every disease has a beginning somewhere. From a certain moment, a bomb starts to tick in our body. We could often disarm it if we only wanted to hear that the countdown has begun.

Fifty-year-old Lucyna died in the hospital in T. at 14.40 on a winter Saturday. Despite the fact that the ambulance came to her 19 minutes from the moment the ambulance was notified by the vigilant neighbor, and the rescue operation was undertaken with all due diligence and in accordance with the applicable procedures, Lucyna did not survive the heart attack. The cause of death in the death certificate was cardiac arrest as a result of acute myocardial infarction.

After the funeral, her son couldn’t understand how it all happened. He met the family doctor and asked for an explanation. Why wasn’t mom saved? What has been neglected? The conversation proceeded in a nervous atmosphere, but remained without conclusions. There are no guilty and no innocent, which makes it even harder to come to terms with the loss. Lucyna’s son would like one answer, but the doctor presented the cause of her death as a trial. More dominoes falling over.

10 years before the incident

Work and family life

Lucyna, 40, is a librarian. Despite the unsatisfactory salary, he enjoys his job. She loves books. When the library receives new items, it unpacks them, gives signatures and places them on the shelves. Other employees know that she would be offended if someone took this privilege from her, so new acquisitions are waiting for her even if she is sick for a few days. He has good contact with regular readers of the adult section. He knows their reading preferences and knows what to recommend to them. He spends a lot of time at the desk. Sometimes, after a few hours in a sitting position, her feet hurt, but as she says “it’s not a big deal”.

Lucyna is the mother of Łukasz studying in another city. She lives in a partnership with a man who is older than her a few years. After a very bad divorce, she no longer wants to be associated with someone in the office.

Physical activity

Lucyna is in reasonably good health, she is not in the habit of complaining about minor ailments. Once, when she was pregnant, her doctor told her she had “good genes.” My paternal grandmother lived to be 98, her sister a little less. Lucyna likes to think she comes from a long-lived family. She is less eager to think about her mother’s family, because my mother and grandmother both had diabetes.

He plans to lose weight a little, but jokes among his friends that he is planning more than losing weight. Overweight is not a lot, only eight kilograms. Just enough to buy clothes one number bigger. Well, maybe two.

In order to fight overweight, he buys a stationary bicycle, which he places in his son’s old room. He even gets on it a few times and spins the pedals for a few minutes, but it quickly gives up. Driving is tedious. If so, you could place the bike in front of the TV and exercise while watching TV series! The bike, however, is old, heavy, difficult to carry to and from the showroom every day. Together with the ground floor they come to the conclusion that they will buy a small TV for a small room. Later, however, Lucyna puts an ironing board there, which … stays there permanently. There is no room for a TV set, there are clothes to be ironed or ironed everywhere. The bicycle begins to serve as a dryer for extra sheets, e.g. when it is necessary to wash bed linen after guests have visited.

Diet

A few months earlier, as a Christmas present, Lucyna receives from her son a cookbook with recipes for healthy, “green” dishes. He looks at it several times, then sets it back on the shelf. Most of the ingredients she has barely heard of before, although she is a well-read person. Where in a small town can you get skimmed cocoa, extra virgin olive oil, broccoli, spelled products, sprouts? Lucyna also knows that her partner would not be able to follow this type of diet. Like every man, he needs a pork chop, dumplings, noodles, a lot of sauce and a good dough for dessert.

Young women no longer believe that the way to a man’s heart is through the stomach. According to Lucyna, wrongly. My son’s friends, the ones from the dormitory, can barely pour water on Chinese soup, so it is no wonder that the boy, visiting his family home, eats for three. She would not have her heart stuffed with greens, and yet it is impossible to make a separate dinner for herself. It is not practical, time-consuming and uneconomical with a modest home budget.

Medical examination

Lucyna does not avoid doctors, but it cannot be said that she visits them with pleasure. He goes to the clinic when he has to. Because it is dripping from the nose, because it annoys the tired shoulder a lot, because the head hurts for several days. He tries to spend as little time as possible in the clinic. He believes that many patients only take away doctors’ time with their minor matters, and the corridors in front of the offices could be called “complaints”.

During one of his visits, instead of an old, well-known doctor, he goes to see a young doctor. Instead of the 5 minutes needed to write an antibiotic prescription, he spends half an hour in the office. The woman measures her blood pressure (too high) and takes a thorough health interview. Lucyna leaves the office with her soul on her arm and she is referred for detailed blood and urine tests. The doctor scared her that poor eating habits and lack of exercise could end up seriously ill. She had her glucose, blood pressure and cholesterol checked regularly.

When Lucyna returns to the clinic with the test results (too high cholesterol, but fortunately the sugar level is only a few points higher than the norm), she no longer meets the young doctor. The old doctor reassures her that it is impossible to think about the darkest scenario right away. It does not push so clearly to change the lifestyle, it does not scare you with consequences. Maybe something to do with his attitude is the fact that he weighs 30 kg too much himself, he rarely gets up from the chair, and the deodorant used without moderation does not mask the aftertreatment of the smell of cigarette smoke.

The librarian leaves the office a bit reassured. It seems to her that she was unnecessarily frightened by the young doctor. He explains to himself that newly minted adepts of medicine take everything too seriously.

2 years before the incident

Lucyna is 48 years old. He still works in the library. She lives alone, some time earlier she broke up with her partner because he began to abuse alcohol, which she hates. She has bad habits herself, she smokes 5-7 cigarettes a day. The justification is that they are thin light cigarettes, and besides, “smokers do not argue under the influence of their stimulants”.

Recently, she has been very worried that she has entered menopause prematurely. She had not expected such troubles before the beginning of the sixth decade. A body that has served quite well for so many years now refuses to cooperate. Lucyna has the impression that she does not recognize her body – pains in the spine, headaches, irritability, strange breathlessness … Fatigue accompanies her every day. He puts it down to hormonal changes. Increased sweating also matches the symptoms of menopause, Lucyna does not associate it with the condition of her circulatory system, although she already knows that it is not the best with her heart and coronary vessels.

Her “old doctor” was replaced by another doctor at the clinic. This one advises Lucyna to exercise a lot and change her lifestyle. She warns that the hormones that protected her before will no longer help. Each kilogram will be twice as hard to lose, and each additional kilogram will be deposited around the waist and hips twice as fast. At the end, he orders her many tests, including cardiology. After this conversation, Lucy stays at home for the whole weekend and cries. He decides to go for himself. He wants to ride a stationary bike every day and drastically change his diet. He intends to go for long walks and find other passions besides reading. May we not spend the day in a chair first and then in bed! He wants to scrupulously do tests and see a doctor. She sticks to this plan for a while, then her enthusiasm subsides.

The cardiologist is concerned about the results of her basic research, so she recommends more. It tells in detail about the risk of atherosclerosis and the worst possible consequence – a heart attack. Lucyna is afraid of the research and is a little happy in her spirit that it cannot be done immediately, because there are no available dates. Weeks pass …

5 days before the incident

In the library

– Are you well? – asks Lucyna, an elegant elderly man who has recently visited the library on average once a week to borrow something from fiction and browse through a beekeeping magazine.

– Not good, but nothing dangerous – replies the librarian embarrassed ashamed of the blush crawling on her cheeks. “I think I ate something stale yesterday and my stomach is teasing.”

– Nutcracker! – says the old man, raising the index finger of his right hand. – It always helps me with such ailments. I must admit that it is as strong as a thunderbolt, so I do not recommend it at work, but at home it is. I will bring you – he assures.

– No need, really – Lucyna, increasingly embarrassed, tries to stop him.

“I’ll get it and period, I’ll be before closing,” the man insists.

Lucyna smiles involuntarily. There is no traffic in the library today. Outside, a few degrees below zero, and the clouded sky does not invite you to walk. The woman goes to the employee’s bathroom and looks at herself in the mirror. She is actually pale. She has sweat stains under her armpits and her hands are sticky too. She wonders what is happening to her body. She slept very badly at night and woke up many times with a feeling of anxiety. She thought that someone was walking near the house, but although she listened for a long time, she did not catch any suspicious sounds. There was also pain in the stomach area. Its source was difficult to determine – once it seemed to Lucyna that it was teasing her spine, then that the kidney, then she suspected it was the liver, and finally put it on the stomach. She felt like a hypochondriac.

In the morning and during the day it was no better. Most of all she felt very weak, to go up the stairs to the library door she had to make two stops! She thought it was time to see the doctor and called the clinic. To meet her doctor, she would have had to close the library two hours early, and that was something she would not allow herself to do. She ordered an appointment with another specialist after 16 p.m.

Just before closing time, an elderly gentleman approached Lucyna. As promised, he had a bottle of homemade nutcracker with him. In the same bag, the librarian found a package from a nearby pastry shop. Her beloved Napoleons, which she often tasted at her desk! He must have noticed that he liked sweet pastries. She wanted to thank you for such a nice gesture, but the man had already disappeared. Perhaps, like her, he did not like to accept thanks. On the way to the clinic, she wondered how she could repay.

In clinic

The family medicine doctor tried to concentrate on the young man’s stories about mysterious, recurring headaches. He glanced surreptitiously at his watch. He did not want to allow himself to show impatience, although he was in a special hurry that day. He and his wife were to celebrate their 10th wedding anniversary. He had forgotten about at least three such ceremonies in recent years, so now he could not fail. He planned a wonderful evening for the two.

“… as if someone was drilling in my skull,” continued his boyfriend.

– Do you have an exam? The doctor asked. – It’s session time, isn’t it? If you do have pain attacks, we’ll do a full diagnosis. But if you haven’t studied and you are afraid to go to the exam, please save my and my patients time. Do you want sick leave or treatment?

“Dismissal,” muttered the boy.

– When is the second exam date? The doctor asked, writing out the certificate.

– In three weeks.

– You are supposed to come to me after the exam with the index and show a positive grade, we understand? Otherwise, I will report that the forms that I am writing to you are missing. Goodbye!

The boy’s mouth dropped open, not knowing whether to believe him or not.

– Next one! The doctor shouted.

Lucyna entered the office. She was very good at non-verbal communication, and she noticed the handsome doctor’s concealed irritation. She decided to get it over with quickly. She told about lack of sleep and stomach pains, and also about menopause. She didn’t mention atherosclerosis, cholesterol, blood pressure. The doctor didn’t ask. On another day, he would probably have done it. He would start by taking the pressure, carefully going through the chart in front of him, not just the last page. Although the patient was pale, she clearly emphasized that she had stomach problems and menopausal symptoms.

He wrote a referral to a gastroenterologist, asked about an appointment with a gynecologist and advised him to talk to him about hormone replacement therapy. Lucyna nodded eagerly and quickly rose from her chair. She felt that something had gone wrong, she felt as if she had deceived the nice doctor in something.

– Doctor? She asked, turning to him in the doorway.

– Yes? He replied, but looking at him Lucyna saw in her smile something invisible to the average person, but easy to detect for her. Pretend interest. She put on such an expression on her face when she was tormented by questions from a disliked reader who was in the habit of returning books well past the deadline.

“Just one question,” she said smiling. – Does the nutcracker help the stomach?

“Mostly, especially when you believe it,” he replied with a smile. – It definitely cheers you up.

Lucyna closed the door behind her, hid the referral in her purse and slowly headed home.

1,5 hours before the incident

Is Saturday. Lucyna is waiting for her son, who will come for dinner together with his wife and grandson. The woman is very much looking forward to this meeting, although she has felt “indistinct” since morning. Her head is spinning, something stings in her side. There was a moment when she got scared for her life, felt like something very bad was about to happen. In a reflex of panic, she wanted to go to her neighbor, Alina. Just not to sit alone. However, Alina does not know anything about her health problems, because Lucyna does not like to confide in them, she is ashamed of her weakness. There is no awareness that this is a mistake that will cost you very dearly.

He sits down heavily in the chair. She can’t be sick, not today! After all, he is making dinner for the family: beloved son’s hooves and pork loin in a thick sauce. She thinks she must be with the flu. He takes a paracetamol tablet and two rutinoscorbines just in case. He thinks that he will not kiss his granddaughter so as not to infect him. She plans to cut the onion in the evening and pour it over with honey, in the morning the best flu mixture will be ready.

However, there is no flu virus in Lucyna’s body. If the doctor had studied the patient’s chart carefully, he could explain to her that the danger lurked in the coronary vessels corroded with atherosclerosis. The atherosclerotic plaque was formed from lipids, mainly cholesterol, and significantly reduced the cross-section (lumen) of the artery. As a result, specialized cells, whose task is to create and conduct the electrical impulses necessary for the proper functioning of the heart, do not receive nutrients.

0,5 hours before the incident

Lucyna, despite taking the painkiller, does not feel well. It is also no worse, not enough to lie down or ask someone for help. Contrary to what she thinks, this is the worst-case scenario that doctors fear – there are no so-called ‘heralds’ symptoms that alert 60% of patients that the heart is in mortal danger.

The woman thinks a little exercise will do her good. It weighs too much, moves too little. He wants to clear the driveway in front of the house so that his son can safely drive in. He picks up a shovel in front of the house and starts working.

10 seconds before the incident

The snow is fluffy, so Lucyna is a little surprised that she works so sluggishly. It feels as if the clothes on it have become too tight. Beads of sweat bead on her forehead, and she pays for each movement of the shovel with a wheezing, heavy breath. Suddenly he feels a sharp, penetrating pain in his chest. As if someone had opened her chest and started ironing her heart with a hot iron. The right arm feels paralyzed. Lucyna has an impression as if it was dark, although the sun was shining since the morning. He tries to call for help, but is unable to speak.

Infarct

Lucyna’s coronary vessel affected by atherosclerosis finally closes. Cracked atherosclerotic plaque causes a clot. Blood that should flow freely to the heart has no way of passing through a clogged artery. Now every minute counts. Lack of oxygen and glucose causes myocardial cells to die.

Lucyna’s neighbor, Alina, returns that day from the grocery store and sees her friend lying in the snow. At first she thinks that Lucyna wanted to scare her for a joke, but she goes to check what happened anyway. The neighbor is very pale. Her eyes are half open, she seems not fully conscious. He doesn’t react to shaking his shoulder and questions, just moans softly. Part of his face is caked with snow.

Alina is calling the emergency room on her cell phone. The dispatcher tells you to describe the symptoms, asks if the neighbor had any health problems. Alina is not sure. It seems to her that Lucyna “only” fainted. Maybe she slipped on the ice? The worried woman speculates. She cannot check the patient’s pulse on her own, both of them are wrapped in thick, winter clothes, and besides, Alina is so upset that her heart is pounding like a hammer. Following the instructions of the ambulance dispatcher, after the conversation is over, he unbuttons his neighbor’s jacket and puts her bag under her head. She holds Lucyna’s cold hand and repeats that everything will be fine. He prays for an ambulance to arrive quickly and tries to recall everything he knows about emergency medical services. Unfortunately, not much, only as much as you can learn from watching the series “For good and for bad.”

19 minutes after the incident

An ambulance arrives at the scene. This is a core team consisting of two paramedics. A specialist ambulance with a crew of three, which includes a doctor, the dispatcher decided to send to another part of the city, where the family of a heart patient alerted him for a heart attack.

Rescuers know their tasks well. They check the patient’s vital signs. One of them asks Alina about Lucyna’s health before the incident, but the neighbor cannot help them.

The rescuers suspect a heart attack, but cannot decide on their own to transport the patient to the nearest cardiology department. A doctor in Poland makes such a decision. According to European standards, the patient should be handed over to doctors within 120 minutes, who will perform the restoration of the coronary artery. In practice, this is not always possible. Few Polish ambulances have a system installed that allows information about the patient to be transferred directly from the ambulance to the hospital, which shortens the decision-making process. The task of rescuers is therefore to transport the patient as soon as possible to the nearest hospital emergency department (HED), where the doctors will make a diagnosis and refer the patient to the cardiology department. On the way to the hospital, they usually administer oxygen and painkillers to the patient and put a cannula into the vein. Pain relief is a necessary factor as pain contributes to the drop in blood pressure and increases the disturbance of blood flow through the organs.

Lucyna is conscious in the ambulance, but is unable to rationally answer the paramedic’s questions. In half-words he complains of severe pain. The only full sentence he utters is: “I didn’t lock up the house.”

59–126 minutes after the incident

Lucyna goes to the hospital emergency department in the city of M. Acute myocardial infarction is not difficult for doctors to diagnose – all you need is an EKG and a blood test. The ECG shows characteristic changes that allow to determine the affected vessel and the stage of the infarction. Dying heart muscle cells secrete characteristic substances into the blood, which can be detected by examining a blood sample.

Now the main task of doctors is to “dissolve” the clot that has formed and prevent it from growing. Normally, doctors give patients aspirin or polopyrin, which has an anticoagulant effect, and heparin. People are also given Clopidogrel.

Lucyna is referred to a specialist hospital in T. which has a hemodynamic laboratory. In the ambulance, apart from the rescuer, a doctor is to accompany her, who will constantly monitor her condition.

176 minutes after the incident

Lucyna arrives at a specialist hospital in T. with a specialized cardiology department. Here, doctors can catheterize the coronary vessels. It is a procedure involving the insertion of a thin probe into the vessel affected by the infarction. A balloon is mounted on the probe, which often carries the so-called stent, i.e. a precise braid made of a special metal coated with a highly specialized drug.

During this procedure, the probe inserted into the closed coronary vessel pierces the thrombus formed, and the balloon is then blown out (sometimes even with a force of 20 atmospheres). Braided and placed on a balloon, the stent expands and adheres closely to the walls of the dilated coronary vessel. The drug coating the stent is designed to protect the vessel from restenosis.

After the intervention is completed, the balloon is flattened again and the doctors remove the probe from the artery. After the procedure, the patient is carefully monitored and has been undergoing intensive pharmacotherapy. Usually, he has to stay in the hospital for up to several weeks, and after he goes home, he will be rehabilitated and changed his lifestyle.

Unfortunately, this did not happen in the case of Lucyna. In the ambulance, her condition gradually deteriorated. Administration of fibrinolytic, a drug administered by the intravenous route to dissolve a blood clot in a coronary artery, did not help. Lucyna in the ambulance regained and lost full consciousness. She could see blurry faces above her through a blur, but if someone had told her to swear, she wouldn’t have been able to decide if they were real people or just ghosts. Sometimes she felt a hand pressing against her chest. The same man’s face was coming back. He seemed to be worried about something. His voice was urgent and firm. I think he was talking to her, asking something. She wanted to tell him not to worry so much, it would all end well. Then she swam away. She no longer felt desperate, successive discharges of the defibrillator.

The ambulance crew resuscitated her for several minutes. The doctor knew that the patient’s loss of consciousness was a very bad sign. The resuscitation continued even when the woman was transported from the ambulance to the hospital. The cardiac surgeon who waited for the patient to arrive at the hospital, seeing her and the doctor focused on resuscitation, knew it was too late. Lucyna’s death was confirmed at 14.40.

Shortly before Lucyna’s death, her body experienced a heart rhythm disturbance involving uncoordinated work of the heart muscle called ventricular fibrillation. It’s a process that only CPR can stop. If they are not successful, circulation stops and eventually cerebral ischemia occurs. Even if oxygen was pumped into the patient’s lungs, the blood would not transport it to vital organs. In the absence of oxygen, brain cells die very quickly. The patient is unaware that he is dying.

What if …

The tragedy could have been avoided at every stage. 10 years before the heart attack, Lucyna was able to stop the already developing disease processes at a relatively low cost. It was enough to exercise a few minutes a day, change the diet or support with supplements, which have a beneficial effect on the functioning of the heart and the entire circulatory system, and thus maintain the proper condition of the blood vessel walls. This would reduce her body weight, lower her cholesterol levels, slow down or stop the development of atherosclerotic lesions significantly. If she had taken the young doctor’s warning to heart, her future life would have been completely different.

Another strategy might have been adopted by her family doctor, but the latter wanted to calm her down temporarily and, as a result, put her to sleep. The attitude of the woman’s relatives was also important. Your partner or son should encourage her to lose weight – continue exercising and change her diet.

Even two years before the incident, Lucyna had a fully probable chance of avoiding the tragedy. She was able to change her diet again and quit her sedentary lifestyle and quit smoking. She should remain under the strict supervision of a specialist doctor and not postpone diagnostic tests. She would face numerous medical visits, probably pharmacological treatment, but it could stop the progressive disease process. Meanwhile, after several weeks of mobilization, she stopped controlling her body. She returned to bad eating habits and blamed all the disturbing symptoms with the menopausal hormonal changes.

Five days before the event, she should inform her doctor about her health condition. It does not matter what the doctor’s mood is, he does his job in the clinic. In order to make a correct diagnosis, he needs all the relevant information about the patient. One of the basic tasks of a patient during a visit to a new doctor is to provide medical history, especially if it was under the care of a specialist.

On the day of the incident, Lucy could ask for help from her family or a neighbor, or call the ambulance. The patient does not have to make a diagnosis himself, that’s what doctors are for. If it had fallen into the hands of the medical staff sooner, the tragedy could have been prevented.

All people at risk of a heart attack should inform their relatives and friends who, in a critical situation, may become a valuable source of information for medical personnel. If Lucyna’s neighbor informed the dispatcher about the risk of a heart attack, a specialist ambulance could reach the patient, i.e. it would be possible to reach the specialist cardiology department faster.

Lucyna was one of the people who paid the highest price for things that we do not consider reprehensible on a daily basis: lack of care for the body and the feeling that others should not be bothered with their problems.

Worth knowing

A heart like an engine

Dr. Jacek Cichoń, cardiac surgeon: – Immediately after birth, a newborn’s heart weighs 20 grams and beats with a frequency of about 120–160 beats per minute. An adult heart weighs less than half a kilogram and normally performs 60 to 90 (average 72) beats per minute when resting. In an average life, the heart beats 2,5 billion times. During one human heart cycle, the heart pushes the entire volume of blood in the bloodstream. It is a brilliant machine. Compare it to an engine in a car to understand the mechanism of heart failure. The car will run as long as it has enough fuel. Even with a full tank of gas, however, it will begin to choke if the fuel lines are leaking or dirty. Suppose our car’s engine has four cylinders. If at least one is not getting enough fuel, the engine is upset. The heart has three main coronary vessels, these are the fuel supply channels, our three cylinders. If one is corroded or constricted, the heart starts to “choke” and fail, especially during exercise when the need for “fuel” is increased.

Lucyna could have avoided a heart attack. It was enough to exercise a few minutes a day, change the diet or support with supplements that improve the functioning of the heart.

important

Scheme of procedure in the event of a suspected infarction

We check the patient’s condition and call an ambulance. While waiting for the help of the patient, it is necessary to facilitate breathing, loosen his clothes, provide fresh air. It should be placed in a position that relieves the heart, i.e. with a slightly elevated torso (e.g. half leaning it against a wall). It must not be left alone or laid flat. Its vital functions should be constantly monitored and resuscitation undertaken if necessary.

Terrifying statistics

100 heart attacks a year

In Poland, we note:

– 1,5 million patients with coronary heart disease;

– 100 thousand heart attacks annually;

– 30 thousand deaths from coronary heart disease (15% of all deaths);

– 30% of hospitalizations for cardiac reasons.

Despite tremendous advances in cardiology, many thousands of patients die each year from coronary heart disease. A heart attack is the most serious, but only one of the many symptoms of this disease. About 30% of patients with acute myocardial infarction die before the arrival of the doctor, another 20% go to hospital despite the efforts of doctors. This means that in the event of an acute infarction, the patient statistically has only a 50% chance of survival.

Text: Sylwia Skorstad

Source: Let’s live longer

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