Are You Prepared for a Cardiac Emergency?

Most heart attacks happen at home. Be ready if one strikes at yours.

If home is where the heart is, it's also where the heart attacks and cardiac arrests are — up to three-quarters of them happen at home. Yet family members of those at high risk tend to be unprepared for these devastating emergencies. The sad fact is that people are more likely to get potentially lifesaving cardiopulmonary resuscitation (CPR) in an airport, mall, or other public place than at home.

You can help change this by resolving to learn what to do if someone has a heart attack. This entails learning CPR, learning how to use an automated external defibrillator, and making an emergency plan.

Remember, there are two types of heart attack. A myocardial infarction is the slower-moving type, caused by a clot blocking a coronary artery. It's usually accompanied by pain in the chest, jaw, or arm, or by nausea, shortness of breath, a cold sweat, or other symptoms. The second type, cardiac arrest, tends to come on faster, though it can be foreshadowed by chest pain and other symptoms. During a cardiac arrest, heartbeats capable of circulating blood cease. Collapse and unconsciousness follow, with death a few minutes behind unless resuscitation is started.

Call for help

The first step in responding to any kind of cardiac emergency is calling 911 or your local emergency number. In addition to summoning help and lifesaving equipment, it puts you in touch with professionals who can coach you through CPR or other helpful actions while the emergency team is en route.

If you are witnessing a cardiac arrest and there is someone else with you, send him or her to look for a defibrillator. They are commonly found in airports, stores, schools, and other public places. If you are alone, stick with the victim and start CPR.

Press, press, press

Knowing how to do CPR is like installing a smoke detector or buying car insurance: You may never need it, but you'll be ever so grateful you have this skill if the need arises.

Doing CPR on someone who has collapsed is simpler than you might think. Put one hand on the center of the person's chest. Put your other hand on top of it. Press down firmly, using your weight if necessary, to push the chest inward. Relax only long enough to let the chest spring back, and do it again. Keep repeating the press-relax cycle about twice a second (the ideal is 100 per minute). Don't worry about doing it wrong — poorly performed CPR is better than none at all.

Until recently, CPR for a cardiac arrest was much more complicated. Guidelines and classes recommended checking the airway, looking for a pulse, starting chest compressions, giving two breaths every 15 seconds, and checking for a pulse every so often. All of this took away from the vital task of compressing the chest to keep blood flowing through the brain, heart, and other organs.

A person who collapses with a cardiac arrest usually has enough oxygen in his or her bloodstream to nourish the brain for several minutes. So it's best to focus on rapid but steady chest compressions for a minute or two before stopping to give two quick breaths every 30 seconds or so. You do this by pinching the person's nose shut, then placing your mouth over his or hers and blowing. Immediately get back to being an artificial heart. If there is someone with you, switch every minute or so to keep from tiring out.

The information above might get you through an emergency. Taking a course would prepare you much better. You can find one in your area by calling the American Heart Association at 800-242-8721 (toll free) or the American Red Cross at 202-303-4498. Or you can practice at home using the Heart Association's CPR Anytime Kit, which costs $30, available at 877-242-4277 (toll free).

Shock box

During a cardiac arrest, CPR only buys time. It can't restore a healthy heart rhythm. That's up to the automated external defibrillator. It can shock the heart out of a deadly quivering rhythm — or none at all — and into a normal one.

Automated defibrillators are surprisingly easy to use. You attach the pads of the device to a cardiac arrest victim's bare chest. The machine analyzes his or her heart rhythm. If it's the kind that can be fixed by a shock, the machine tells you to stand clear and hit the "Shock" button.

Once available only to trained emergency crews, these lunchbox-size devices can now be had by anyone. The FDA has approved one model — the Philips HeartStart — for home use, and you don't even need a prescription to buy it. Whether it's worth the $1,200 or so price tag is an open question. Some public health experts believe that home defibrillators will save lives. Others worry that they will end up sitting hidden in closets, their batteries quietly running down, and won't work when needed. Still others think that the money would be better spent on a gym membership, which could help prevent a heart attack or cardiac arrest.

Results from the ongoing Home Automated External Defibrillator Trial should shed some light on whether having these machines at home saves lives. Until then, it is a personal medical and financial decision. If you have one, take a course to learn how to use it properly.

Although automated defibrillators may be easy to use, they are sophisticated machines subject to the same kinds of updates and recalls that affect pacemakers and implantable cardioverter/defibrillators. In 2005, a Harvard-based study found that nearly 1 in 5 automated defibrillators sold between 1996 and 2006 were recalled, usually because of an electrical or software problem. If you have one at home, it's important to register it with the manufacturer and keep your contact information up to date so you can be advised of any problems.

Emergency plan

Cities, hospitals, schools, and other public entities have — and practice — emergency plans. You should, too. A plan won't stop a heart attack or make a cardiac arrest any less frightening and confusing. But it can save precious time. Here are four key steps for pre-attack planning:

• Know the warning signs of a heart attack (see health.harvard.edu/110). Go over them with family and friends. Stress the importance of calling 911.

• Decide who would take care of children, an ailing spouse, or other dependents.

• Make sure your house or apartment building has a number that is clearly visible from the street.

• Make emergency envelopes that include information about which family members or friends to call in case of an emergency, your doctor's phone number, a list of medications you are taking and those you are allergic to, and, if you have it, a copy of your latest electrocardiogram. Keep one envelope at home, one at work, and another in the car.

There's no predicting who will have a cardiac emergency, or when or where it might happen. What we do know is that they are common — striking more than one million Americans each year — and that the majority of them happen at home.

In the aftermath of a heart attack or cardiac arrest, family members and friends often find themselves wishing they had done more. Instead of looking back with regret, make an emergency plan and learn to do CPR and use an automated defibrillator. That way you can feel you did everything possible and, more important, maybe save a life.