‘Tis The Coronary Season

 

# 9471

 

If history is any gauge the three deadliest coronary days of the year will occur over the next two weeks; Christmas day, the day after Christmas, and New Year’s Day.   Events that are commonly called `Christmas Coronaries’ or `Hanukkah Heart Attacks’.

 

Fifteen years ago, a study looked at the rate of heart attacks in the United States, and found that Acute Myocardial Infarctions (AMIs) run as much 53% higher during the winter months than than during the summer.

 

Seasonal distribution of acute myocardial infarction in the second National Registry of Myocardial Infarction.

Spencer FA, Goldberg RJ, Becker RC, Gore JM.

 

While cold weather combined with strenuous physical activity (like clearing snow from sidewalks) has often been blamed for this spike, even in balmy Southern California, studies have shown a 33% increase in heart attacks over the holidays (see below).

When Throughout the Year Is Coronary Death Most Likely to Occur?

A 12-Year Population-Based Analysis of More Than 220 000 Cases

Robert A. Kloner, MD, PhD; W. Kenneth Poole, PhD; Rebecca L. Perritt, MS

Non-climate related factors – like over indulgence in food and alcohol, diminished activity levels, forgetting to take prescription medicines, and combined holiday stressors like shopping, running up debt, traveling, meal preparation, and the angst that comes from dysfunctional family gatherings are likely contributors to this yearly spike. 

 

But increasingly influenza and other respiratory infections have been linked to this seasonal increase in heart attacks.

 

In 2012, in Study: Influenza And Heart Attacks, we looked at research that appeared in the Journal of Infectious Diseases that suggested Influenza - and other acute respiratory infections - can act as a trigger for heart attacks. The same issue carried an editorial called Increasing Evidence That Influenza Is a Trigger for Cardiovascular Disease.

 

Influenza Infection and Risk of Acute Myocardial Infarction in England and Wales: A CALIBER Self-Controlled Case Series Study

Charlotte Warren-Gash, Andrew C. Hayward1, Harry Hemingway2, Spiros Denaxas2, Sara L. Thomas3, Adam D. Timmis5, Heather Whitaker6 and Liam Smeeth4

In 2010, in CMAJ: Flu Vaccinations Reduce Heart Attack Risk we saw what would turn out to be a controversial study (see Vaccine/Heart Attack Study Questioned) that strongly suggested that those over the age of 40 who get a seasonal flu vaccine each year may reduce their risk of a heart attack by as much as 19%.

 

Last year (October 2013), in JAMA: Flu Vaccine and Cardiovascular Outcomes, we looked at a meta-analysis of  5 published and 1 unpublished randomized clinical trials involving  6735 patients – that found among those who had previously had a heart attack, the receipt of a flu vaccine was linked to a 55% reduction in having another major cardiac event in the next few months.

 

So the idea that heart attacks may be linked to influenza infection is hardly new.

 

In late October of this year, the Texas Heart Institute published this article, suggesting that tens of thousands of cardiac deaths could be prevented if every high-risk cardiac patient got the flu shot each year.

 

Research Shows Flu Can Trigger Heart Attacks

Influenza vaccinations could prevent thousands of deaths from heart disease

People who are at risk of heart disease should receive the influenza vaccine every autumn. Research shows that influenza epidemics are associated with a rise in deaths from heart disease and that flu can actually trigger the heart attacks that result in death.

However, only about 60 percent of people in the U.S. who ought to have a flu vaccination actually have one, said Mohammad Madjid, MD, MSc, a senior research scientist at the Atherosclerosis Research Lab of the Texas Heart Institute.

(Continue . . . )

 

If their hypothesis is correct – given the expected reduced effectiveness of this year’s flu vaccine (see CDC HAN Advisory On `Drifted’ H3N2 Seasonal Flu Virus) and the rising tide of H3N2 influenza across the country – the next couple of weeks could prove very busy for the nation’s EMS crews and Coronary care units.

But regardless of the effectiveness of this year’s flu shot, and influenza’s effects on cardiovascular events, even on an `average day’ roughly 1,000 people suffer a Sudden Cardiac Arrest (SCA) in the United States.

 

This from the Heart Rhythm Association:

• Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, claiming more than 350,000 lives each year.
• Approximately 92% of those who experience sudden cardiac arrest do not survive.
• SCA kills more than 1,000 people a day, or one person every 90 seconds

 

What the people who witness these events do in the first few minutes can mean the difference between life and death for the stricken individual. Luckily, hands-only CPR (cardio-pulmonary resuscitation) is easier to do than ever before, and there are thousands of AEDs (automated external defibrillators) stationed in public venues across the nation.

 

With a little bit of training, you have the potential to save someone’s life.

 

While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.  To learn how to use an AED, you can use this online training module  I wrote about in CPR Skills & AED Simulator.  A  CPR class only takes a few hours, can be fun, and is well worth the effort.  

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

Of course, despite your best efforts, many SCA victims will not survive. It isn’t at all like on TV, where 75% of  recipients of CPR survive.  Even when cardiac arrests occur inside a hospital, the survival to discharge rate is less than 40%. Outside the hospital, the odds of seeing a good outcome are lower.

 

While there are no guarantee of success, early and coordinated action taken by bystanders (calling 911, starting CPR, using AED if available) can substantially improve the SCA’s chances of survival. 

 

For more on heart attacks, and CPR, you may wish to visit some of these earlier blogs.

 

Deadlier Than For The Male

Survivability Of Non-Shockable Rhythms With New CPR Guidelines

Fear Of Trying

NPM11: Early CPR Saves Lives

NPM14: CPR Skills & AED Simulator

Source American Heart Association

Note: This is day 14 of National Preparedness Month.  Follow this year’s campaign on Twitter by searching for the #NatlPrep or #NPM14 hash tag. This month, as part of NPM14, I’ll be rerunning some updated  preparedness essays, along with some new ones.

 

#9075

 

Although we often talk about preparedness in terms of having an emergency plan and  the right supplies (First Aid Kit, Emergency Radio, Bottled Water, Full Pantry, etc.), it is also important to have the right skills to deal with an emergency. 

 

Basic stuff – like how to use a fire extinguisher, how to turn off the gas supply to your home or business, how to stop bleeding or apply first aid.

One of the most common emergency situations you are likely to encounter is witnessing a Sudden Cardiac Arrest (SCA).  More than a thousand occur every day across the nation, often in public places like parking lots, shopping malls, and houses of worship.   

 

This from the Heart Rhythm Association:

• Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, claiming more than 350,000 lives each year. 
• Approximately 92% of those who experience sudden cardiac arrest do not survive.
• SCA kills more than 1,000 people a day, or one person every 90 seconds

What the people who witness these events do in the first few minutes can mean the difference between life and death for the stricken individual. Luckily, hands-only CPR (cardio-pulmonary resuscitation) is easier to do than ever before, and there are thousands of AEDs (automated external defibrillators) stationed in public venues across the nation.

 

With a little bit of training, you have the potential to save someone’s life.

 

AEDs are designed to be used by laypersons who ideally should have received some AED training.  Like doing CPR, the required skills are relatively simple, but they do require some degree of familiarity.  I would strongly encourage everyone to take a CPR class, and if you already done so – take a refresher course every couple of years.

 

While this blog isn’t a substitute for taking a CPR class, it can help familiarize you with the basics.

 

Witnessing a cardiac arrest, particularly of a loved-one, can be a terrifying and traumatic experience. Far too often, bystanders are paralyzed into doing nothing while they wait for rescuers to arrive. As a paramedic, only rarely did I arrive on scene to find someone attempting to resuscitate a patient.

 

Almost inevitably, however, some kind soul had placed a pillow under the head of the victim to make them more `comfortable’, effectively closing off their airway.

 

Consequently, even with the advanced life support equipment we carried, our success rate in reviving these patients was dismally low.

 

Luckily, the new hands only resuscitation method -  which eliminates the need for mouth-to-mouth ventilation - makes doing CPR easier than ever before. But hand’s on training is still important, if you expect to be able to react properly during an emergency. While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A CPR class only takes a few hours, can be fun, and is well worth the effort.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

Last  year a buddy of mine passed along a link to an online training site that, in a few short minutes, can familiarize the layperson with what to do when confronted by a sudden cardiac arrest, and what to expect when opening and using an AED.

 

This interactive video is particularly well done, and is provided by the Medtronic Foundation, in conjunction with the Heart Rescue Project.  First the three steps you should know, then the video.

 

What to do if you see someone suddenly collapse.

If you see someone collapse suddenly, check if the victim is responsive. If not, remember these three easy steps.

Call 911

Have them send help. Stay on the line and listen for further instructions.

Start Chest Compressions

If the person is not breathing normally, start chest compressions. Push down hard and fast in the center of the chest. Keep your arms straight. Send someone to find an AED.

Use An AED

The AED (automated external defibrillator) is a portable medical device that delivers an electrical shock to restart a person’s heart. It provides voice prompts that tell you exactly what to do and will only administer a shock if needed, so there’s no reason to hesitate.

It only takes a few minutes to familiarize yourself with the operations of an AED by visiting the following website.  

LINK

 

I should point out that not all cardiac arrests can be corrected by defibrillation, even if conducted in a timely manner. There are non-shockable arrhythmias that an AED cannot convert to sinus rhythm.

Non-shockable cardiac arrest arrhythmias are asystole (flat line) and PEA (Pulseless Electrical Activity) – what we used to call back in the stone age of EMS, electromechanical dissociation.

Neither of which respond to defibrillation.

Patients can sometimes still be saved with CPR alone, at least until the right cardiac meds can be administered. For more on all of this, we have the press release from the American Heart Association.

 

Guidelines-based CPR saves more non-shockable cardiac arrest victims

April 02, 2012

Study Highlights:

• CPR can save someone with cardiac arrest even if they don’t respond to a defibrillator.
• People with non-shockable cardiac arrest are more likely to live if they receive CPR based on recent guidelines emphasizing chest compressions.
• The American Heart Association’s CPR guidelines emphasizing chest compressions are saving more lives, according to a new study.

 

Of course, despite your best efforts, many SCA victims will not survive. It isn’t at all like on TV, where 75% of  recipients of CPR survive.  Even when cardiac arrests occur inside a hospital, the survival to discharge rate is less than 40%. Outside the hospital, the odds of seeing a good outcome are lower.

 

While there are no guarantee of success, early and coordinated action taken by bystanders (calling 911, starting CPR, using AED if available) can substantially improve the SCA’s chances of survival. 

 

For more on heart attacks, and CPR, you may wish to visit some of these earlier blogs.

 

Deadlier Than For The Male

Survivability Of Non-Shockable Rhythms With New CPR Guidelines

Fear Of Trying

NPM11: Early CPR Saves Lives

A Minute Now Could Save A Life Later

 

# 7984

 

As a former CPR Instructor (American Heart Association & Red Cross), I’ve had the pleasure of teaching hundreds of people how perform this life saving technique, and as a paramedic, I’ve experienced the genuine pride of arriving on the scene to find one of my students doing effective CPR . . . on his grandfather (who survived).

 

While we carried the requisite EKG/Defibrillator, cardiac meds, and telemetry . . .  unless someone at the scene of a heart attack had initiated CPR before our arrival, the reality was, the odds of seeing a good patient outcome were next to zero.

 

One of the most common emergency situations you are likely to encounter is witnessing a Sudden Cardiac Arrest (SCA).  More than a thousand occur every day across the nation, often in public places like parking lots, shopping malls, and houses of worship

.   

This from the Heart Rhythm Association:

• Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, claiming more than 350,000 lives each year.^1,2  
• An estimated 382,800 people experience sudden cardiac arrest in the United States each year.
• Approximately 92% of those who experience sudden cardiac arrest do not survive.
• SCA kills more than 1,000 people a day, or one person every 90 seconds ^1,2 — a number great than the number of deaths each year from breast cancer, lung cancer, stroke or AIDS.

 

What the people who witness these events do in the first few minutes can mean the difference between life and death for the stricken individual. Luckily, hands-only CPR (cardio-pulmonary resuscitation) is easier to do than ever before, and there are now thousands of AEDs (automated external defibrillators) stationed in public venues across the nation.

 

And while taking a class is the preferable way to learn CPR, a new study presented at at the American Heart Association's Scientific Sessions 2013 (Nov 16th-20th) shows that even after watching a 1 minute CPR video, the ability for the layperson to react and respond to a cardiac emergency increases substantially.

 

The press release from the American Heart Association provides the details.

 

 

1 minute of CPR video training could save lives

 

RESS Abstract 19453/157 (Omni Dallas Hotel, Dallas Ballroom D-H)

Just one minute of CPR video training for bystanders in a shopping mall could save lives in emergencies, according to research presented at the American Heart Association's Scientific Sessions 2013.

Researchers used a one-minute CPR video to improve responsiveness and teach compression only CPR to people with no CPR experience.

Participants were divided into two groups: 48 adults looked at the video, while 47 sat idle for one minute. In a private area with a mannequin simulating a sudden collapse, both groups were asked to do "what they thought best." Researchers measured responsiveness as time to call 9-1-1 and start chest compression and CPR quality reflected by chest compression depth, rate and hands-off interval time.

Adults who saw the CPR video called 9-1-1 more frequently, initiated chest compression sooner, had an increased chest compression rate and a decreased hands-off interval, researchers said.

"Given the short length of training, these findings suggest that ultra-brief video training may have potential as a universal intervention for public venues to help bystander reaction and improve CPR skills," said Ashish Panchal, M.D., Ph.D. lead researcher of the study.

 

You can view one of these short videos by clicking this link, or the graphic below.

 

For more , follow this link.

 

In addition to doing CPR, knowing how to use one of the thousands of AED’s (automated external defibrillators) stationed in public areas like shopping malls, airports, bus terminals, schools, and other venues can be lifesaving.

 

AEDs are designed to be used by laypersons who ideally should have received some AED training.  Like doing CPR, the required skills are relatively simple, but they do require some degree of familiarity.

Earlier this year, in Interactive Video: Using An AED For Sudden Cardiac Arrest (SCA), I highlighted a brief, but informative, online presentation designed to teach you how to use one of these devices.

NPM13: CPR Skills & AED Simulator

Source American Heart Association

 

Note: This is day 29 of National Preparedness Month.  Follow this year’s campaign on Twitter by searching for the #NPM or #NPM13 hash tag.

This month, as part of NPM13, I’ll be rerunning some updated  preparedness essays, along with some new ones.

 

#7823

 

Although we often talk about preparedness in terms of having an emergency plan and  the right supplies (First Aid Kit, Emergency Radio, Bottled Water, Full Pantry, etc.), it is also important to have the right skills to deal with an emergency.  Basic stuff – like how to use a fire extinguisher, how to turn off the gas supply to your home or business, how to stop bleeding or apply first aid.

 

One of the most common emergency situations you are likely to encounter is witnessing a Sudden Cardiac Arrest (SCA).  More than a thousand occur every day across the nation, often in public places like parking lots, shopping malls, and houses of worship.   

 

This from the Heart Rhythm Association:

 

• Sudden Cardiac Arrest (SCA) is a leading cause of death in the United States, claiming more than 350,000 lives each year.^1,2  
• An estimated 382,800 people experience sudden cardiac arrest in the United States each year.
• Approximately 92% of those who experience sudden cardiac arrest do not survive.
• SCA kills more than 1,000 people a day, or one person every 90 seconds ^1,2 — a number great than the number of deaths each year from breast cancer, lung cancer, stroke or AIDS.

What the people who witness these events do in the first few minutes can mean the difference between life and death for the stricken individual. Luckily, hands-only CPR (cardio-pulmonary resuscitation) is easier to do than ever before, and there are thousands of AEDs (automated external defibrillators) stationed in public venues across the nation.

 

With a little bit of training, you can literally save someone’s life.

 

AEDs are designed to be used by laypersons who ideally should have received some AED training.  Like doing CPR, the required skills are relatively simple, but they do require some degree of familiarity.  I would strongly encourage everyone to take a CPR class, and if you already done so – take a refresher course every couple of years.

 

While this blog isn’t a substitute for taking a CPR class, it can help familiarize you with the basics.

 

Witnessing a cardiac arrest, particularly of a loved-one, can be a terrifying and traumatic experience. Far too often, bystanders are paralyzed into doing nothing while they wait for rescuers to arrive. As a paramedic, only rarely did I arrive on scene to find someone attempting to resuscitate a patient.

 

Almost inevitably, however, some kind soul had placed a pillow under the head of the victim to make them more `comfortable’, effectively closing off their airway.

 

Consequently, even with the advanced life support equipment we carried, our success rate in reviving these patients was dismally low.

 

Luckily, the new hands only resuscitation method -  which eliminates the need for mouth-to-mouth ventilation - makes doing CPR easier than ever before. But hand’s on training is still important, if you expect to be able to react properly during an emergency. While it won’t take the place of an actual class, you can watch how it is done on in this brief instructional video from the American Heart Association.

 

A CPR class only takes a few hours, can be fun, and is well worth the effort.

 

To find a local CPR course contact your local chapter of the American Red Cross, the American Heart Association, or (usually) your local fire department or EMS can steer you to a class.

 

Earlier this year a buddy of mine (thanks, Cliff) passed along a link to an online training site that, in a few short minutes, can familiarize the layperson with what to do when confronted by a sudden cardiac arrest, and what to expect when opening and using an AED.

 

This interactive video is particularly well done, and is provided by the Medtronic Foundation, in conjunction with the Heart Rescue Project.  First the three steps you should know, then the video.

What to do if you see someone suddenly collapse.

If you see someone collapse suddenly, check if the victim is responsive. If not, remember these three easy steps.

Call 911

Have them send help. Stay on the line and listen for further instructions.

Start Chest Compressions

If the person is not breathing normally, start chest compressions. Push down hard and fast in the center of the chest. Keep your arms straight. Send someone to find an AED.

Use An AED

The AED (automated external defibrillator) is a portable medical device that delivers an electrical shock to restart a person’s heart. It provides voice prompts that tell you exactly what to do and will only administer a shock if needed, so there’s no reason to hesitate.

 

It only takes a few minutes to familiarize yourself with the operations of an AED by visiting the following website.  

LINK

I should point out that not all cardiac arrests can be corrected by defibrillation, even if conducted in a timely manner. There are non-shockable arrhythmias that an AED cannot convert to sinus rhythm.

 

Non-shockable cardiac arrest arrhythmias are asystole (flat line) and PEA (Pulseless Electrical Activity) – what we used to call back in the stone age of EMS, electromechanical dissociation.

 

Neither of which respond to defibrillation.

 

Patients can sometimes still be saved with CPR alone, at least until the right cardiac meds can be administered. For more on all of this, we have the press release from the American Heart Association.

 

Guidelines-based CPR saves more non-shockable cardiac arrest victims

April 02, 2012

Study Highlights:

• CPR can save someone with cardiac arrest even if they don’t respond to a defibrillator.
• People with non-shockable cardiac arrest are more likely to live if they receive CPR based on recent guidelines emphasizing chest compressions.
• The American Heart Association’s CPR guidelines emphasizing chest compressions are saving more lives, according to a new study.

 

Of course, despite your best efforts, many SCA victims will not survive. But early and coordinated action taken by bystanders (calling 911, starting CPR, using AED if available) can substantially improve their chances.

 

For more on heart attacks, and CPR, you may wish to visit some of these earlier blogs.

 

Deadlier Than For The Male

Survivability Of Non-Shockable Rhythms With New CPR Guidelines

Fear Of Trying

NPM11: Early CPR Saves Lives

Interactive Video: Using An AED For Sudden Cardiac Arrest (SCA)

V-Fib Lead II – Credit Glenlarson Wikipedia Commons

 

 

# 6823

 

Thirty-ahem years ago, I was lucky enough to have one of the first truly portable EKG/Defibrillators in my EMS rig. It was a Life-Pak 5, a museum piece now, but state of the art in 1976. 

 

While having it did increase our ability to revive ardiac arrest patients, the sad truth was that it could take 10 minutes for us to arrive on scene.

 

Often too long to be of much use to the patient unless effective CPR was started before our arrival.

 

Today, there are thousands of AED’s (automated external defibrillators) stationed in public areas like shopping malls, airports, bus terminals, schools, and other venues. Their early use during a cardiac arrest could easily make the difference between a patient’s survival or death.

 

AEDs are designed to be used by laypersons who ideally should have received some AED training.  Like doing CPR, the required skills are relatively simple, but they do require some degree of familiarity.

 

A buddy of mine (thanks, Cliff) passed along a link to an online training site that, in a few short minutes, can familiarize the layperson with what to do when confronted by a sudden cardiac arrest, and what to expect when opening and using an AED.

 

This interactive video is particularly well done, and is provided by the Medtronic Foundation, in conjunction with the Heart Rescue Project.  First the three steps you should know, then the video.

 

What to do if you see someone suddenly collapse.

If you see someone collapse suddenly, check if the victim is responsive. If not, remember these three easy steps.

Call 911

Have them send help. Stay on the line and listen for further instructions.

Start Chest Compressions

If the person is not breathing normally, start chest compressions. Push down hard and fast in the center of the chest. Keep your arms straight. Send someone to find an AED.

Use An AED

The AED (automated external defibrillator) is a portable medical device that delivers an electrical shock to restart a person’s heart. It provides voice prompts that tell you exactly what to do and will only administer a shock if needed, so there’s no reason to hesitate.

 

It only takes a few minutes to familiarize yourself with the operations of an AED by visiting the following website.   And if you haven’t taken a CPR class recently, make it a priority to get recertified.

 

LINK

 

I should point out that not all cardiac arrests can be corrected by defibrillation, even if conducted in a timely manner. There are non-shockable arrhythmias that an AED cannot convert to sinus rhythm.

 

Non-shockable cardiac arrest arrhythmias are asystole (flat line) and PEA (Pulseless Electrical Activity) – what we used to call back in the stone age of EMS, electromechanical dissociation.

 

Neither of which respond to defibrillation.

 

Patients can sometimes still be saved with CPR alone, at least until the right cardiac meds can be administered. For more on all of this, we have the press release from the American Heart Association.

 

Guidelines-based CPR saves more non-shockable cardiac arrest victims

April 02, 2012

Study Highlights:

• CPR can save someone with cardiac arrest even if they don’t respond to a defibrillator.
• People with non-shockable cardiac arrest are more likely to live if they receive CPR based on recent guidelines emphasizing chest compressions.
• The American Heart Association’s CPR guidelines emphasizing chest compressions are saving more lives, according to a new study.

 

 

Of course, despite your best efforts, many SCA victims will not survive. But early and coordinated action taken by bystanders (calling 911, starting CPR, using AED if available) can substantially improve their chances.

 

For more on heart attacks, and CPR, you may wish to visit some of these earlier blogs.

 

Deadlier Than For The Male

Survivability Of Non-Shockable Rhythms With New CPR Guidelines

Fear Of Trying

NPM11: Early CPR Saves Lives