Heart Month 2024: understanding cardiac arrests and heart attacks, and what to do when they occur

Posted: 13/02/2024

Each year in the UK and the US, the month of February is marked as Heart Month; a time when various organisations contribute to raising awareness about heart health and educating individuals on ways to prevent cardiovascular fatalities.

This article concerns cardiac arrests and heart attacks; the main life-threatening conditions that arise when cardiovascular health is compromised. It looks at how cardiac arrests and heart attacks occur and the actions we can take to save lives when they do.

First, clarification of a common misunderstanding. Heart attacks and cardiac arrest are not the same. People often use these terms interchangeably, but this is incorrect. A heart attack (also known as a myocardial infarction) is when blood flow to the heart is blocked (often caused by a clot in one of the coronary arteries). Cardiac arrest is when the heart’s electrical system malfunctions and the heart suddenly stops beating or begins beating too fast to pump any blood around the body.

A heart attack is a ‘circulation’ problem and cardiac arrest is an ‘electrical’ problem. Confusingly, a heart attack may lead to cardiac arrest. However, there is no need to get too bogged down in the science; both are emergencies and require urgent action to increase the likelihood of survival.

The statistics surrounding heart attacks and cardiac arrests in the United Kingdom are alarming. According to a recent factsheet published by the British Heart Foundation (BHF), around 100,000 hospital admissions each year are due to heart attacks; that equates to 290 admissions each day or one every five minutes. When we look at cardiac arrests, the statistics are even more shocking. Approximately 30,000 cardiac arrests occur outside of hospitals in the UK each year. Devastatingly, less than 10% of those affected survive. These figures highlight the urgent need for widespread awareness and action to improve survival rates.

Signs of cardiac arrest

If someone is in cardiac arrest, they usually collapse suddenly and will be:

• unconscious;
• unresponsive; and
• not breathing or not breathing normally – this may mean they are making gasping noises.

Signs of a heart attack

If someone is having a heart attack, they will usually be conscious and breathing. The symptoms of a heart attack vary from person to person. However, usually they include:

• sudden pain or discomfort in your chest that does not go away;
• pain that spreads to your left or right arm, or to your neck, jaw, back or stomach; and
• feeling sick, sweaty, light-headed or short of breath.

When to act and what to do

Unconscious and not breathing
If someone is unconscious and not breathing, it is imperative that you act swiftly and confidently, every second counts. The following steps can significantly increase the chances of saving a life:

1. Call for emergency assistance: dial 999 immediately.
2. Clear the airway: sweep out the casualty’s mouth with a clean (if possible, gloved) finger to remove any obstructions near the tongue.
3. Start CPR: cardiopulmonary resuscitation (CPR) is a life-saving technique that helps maintain blood flow and oxygenation to vital organs until professional help arrives. By providing chest compressions and rescue breaths, you can sustain the person's chances of survival. Keep giving CPR until emergency services arrive or the person regains consciousness. If there is somebody else with you, ask them to take turns giving CPR.
4. Use a defibrillator: in addition to CPR, the use of a defibrillator plays a vital role in saving lives. A defibrillator is a device that delivers an electric shock to the heart to restore its normal rhythm. When used within the first few minutes of cardiac arrest, defibrillation can significantly increase the chances of survival. If there is somebody else with you, ask them to locate and prepare the defibrillator while you continue with CPR.

If someone collapses and is unconscious and not breathing, their chances of survival in the community are only about 6%. However, if they receive quality CPR, and a defibrillator is deployed within minutes and they are in a shockable rhythm, the chances of survival jump to 74%.

Unconscious/conscious and breathing
Alternatively, if the casualty is breathing, do not perform CPR or use a defibrillator. Call 999 immediately and follow instructions from the 999 operator until emergency services take over.

If they are unconscious, you should put them in the recovery position and monitor them closely to make sure they continue to breathe. If they stop breathing, commence CPR and use a defibrillator.

If they are conscious, sit with them and try to keep them calm. If you have it and are able to confirm they are not allergic, give them 300mg of aspirin.

Defibrillators

An automatic external defibrillator (AED) is a type of defibrillator machine that is designed for public use and differs to those found in hospitals. An AED can automatically detect if someone is in a shockable rhythm and speak to you, to tell you what to do.

Defibrillators do not jump start the heart, like when you jump start a car. Instead, they stop and reset the heart, like rebooting a computer. This allows the individual heart cells to recharge simultaneously and the pacemaker in the heart to restart it in a normal (sinus) rhythm. For a defibrillator to work, the heart must be in an abnormal but shockable rhythm, which the defibrillator will detect. The AED will not deliver a shock if the heart does not have a shockable rhythm, so you do not need to worry about hurting someone with unnecessary defibrillation.

Currently, defibrillators are mostly located in hospitals. While there has been a recent movement to increase their prevalence in public spaces, their accessibility still needs to be expanded. The placement of defibrillators in schools, shopping centres, sports facilities, and other high-traffic areas can save countless lives. However, AEDs are not cheap, and can cost up to £2,500. Sourcing funding for these devices is not always easy.

If you wish to obtain a defibrillator for the benefit of a community group, the BHF accepts applications for a free, BHF-funded defibrillator. Applications will close on 28 February 2024. If you are ineligible for, or unsuccessful in obtaining a defibrillator from the BHF, it is recommended you investigate the possibility of government grants, community fundraising, and corporate sponsorships.

Learning effective CPR and how to use a defibrillator

This World Heart Month, you can support efforts to improve survival rates for heart attack and cardiac arrest by securing a defibrillator for your local community and educating yourself on the safe and effective technique for CPR and the use of a defibrillator.

Recognising the urgent need to equip individuals with the knowledge and confidence to safely perform CPR and use a defibrillator, the BHF has launched an online training course called RevivR. This course teaches participants the correct techniques for CPR and the effective use of defibrillators. By enrolling in this 15-minute course, you can become certified in CPR and contribute to a safer and more prepared society. All you need is a mobile phone or tablet and a cushion to practise on.

While the statistics on heart attacks and cardiac arrest are worrying, there is room to be hopeful. In the 1960s more than 7 out of 10 heart attacks in the UK were fatal. Today, more than 7 out of 10 people survive.

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