Paramedic medic medics

Learn the signs, but remember this: Even if you’re not sure it’s a heart attack, have it checked out. Minutes matter! Fast action can save lives — maybe your own.

 

A Johannesburg man holidaying with his family in the coastal town of Ballito on KwaZulu-Natal’s Dolphin Coast was fortunate that help was at hand to deliver lifesaving care when he suffered a heart attack on New Year’s Day 2018.

Johannes Pieterse, 45, who is now recovering back home, recounts: “On New Year’s Eve, I experienced some chest pain and thought perhaps I had ‘overdone it’ during the festive season. I decided to go for a check-up with Ballito general practitioner, Dr Ryall Hamlyn, and thank goodness I did, or I may not be here today to tell the tale.”

Dr Hamlyn, whose practice is opposite Netcare Alberlito Hospital, says that Mr Pieterse phoned his rooms early on 1 January, asking whether the doctors were consulting on the public holiday and mentioned that he had experienced chest pains the day before.

“When he arrived for the appointment, Mr Pieterse explained that he had angina-like pain for approximately 15 minutes the previous day. Even though he did not have hypertension or unhealthy cholesterol levels, he told me that his father had suffered a stroke at the age of 60, which we consider to be a significant familial risk,” Dr Hamlyn explains.

The doctor performed an electrocardiogram (ECG), which measures electrical activity and muscle function of the heart, which did not register any abnormalities.

“The patient was still having mild chest pain, and suspecting the likelihood of acute coronary syndrome, I insisted he have blood tested urgently for cardiac enzymes.  I instructed him to go immediately across the road to Netcare Alberlito Hospital’s Ampath Laboratory.”

At this point, Mr Pieterse was resting on a couch in the doctors’ waiting room when suddenly he started gasping for air and collapsed.

“I checked his pulse, but there was nothing, and he started turning grey. My wife, who is a registered nurse, and I started performing cardiopulmonary resuscitation [CPR] immediately,” Dr Hamlyn recalls.

“My wife phoned the Netcare 911 national emergency operations centre, however another man who was in waiting room had already run across the road to the Netcare 911 base at the hospital to summon assistance and a paramedic crew immediately responded.”

Netcare 911 intermediate life support paramedic, Donny Govender, and basic life support paramedic, Sundheer Singh, took over CPR while Dr Hamlyn briefed them on the patient’s condition.

Seconds later, advanced life support paramedic, Shaun Paul, arrived to attend to the critically ill patient.

“Mr Pieterse was in ventricular fibrillation, which is an often-fatal type of heart rhythm disturbance, and his skin was turning blue because his heart was not able pump and circulate oxygenated blood throughout his body. Fortunately, with early intervention and the aid of a defibrillator, we were able to treat this life-threatening condition,” Paul notes.

Paul administered a therapeutic electrical shock, known as defibrillation, and Singh continued CPR as the defibrillator showed that the patient’s heart was now exhibiting pulseless electrical activity (PEA), meaning that a heart rhythm was present but did not produce a pulse, while Govender administered an intravenous fluid challenge.

“Within minutes, Mr Pieterse’s heart developed a good pulse. We intubated the patient and kept him on a ventilator in a medically-induced coma, however his condition had stabilised and we were able to transport him to hospital for further care,” Paul says.

Mr Pieterse was later diagnosed with an inferior myocardial infarction, meaning that one of the main arteries of the heart had become blocked, resulting in a heart attack.

“I woke up in hospital and a stent was inserted to clear and support the artery that was blocked. I am so grateful to Dr Hamlyn and his wife, the man who ran across the road to call the paramedics, and Netcare 911 for their efforts that certainly saved my life. If not for them, I would probably not have lived to see more than the first day of 2018,” says Pieterse.

Dr Hamlyn says: “Having oxygen and emergency equipment at hand, the prompt intervention, including early goal-directed resuscitation and access to appropriate emergency cardiac care that this patient received certainly played an important role in the positive outcome of this case. Saving Mr Pieterse’s life was a great team effort in which everyone did their part. Had he left my office two minutes earlier, he would have died.”

Paul says the patient’s positive outcome was largely attributable to the streamlined ‘chain of survival’ care that Mr Pieterse benefitted from.

“Chain of survival is a principle of emergency cardiac care that includes early recognition of cardiac arrest, activation of appropriate emergency medical services, immediate CPR and early defibrillation, as well as advanced cardiac life support and in-hospital treatment for post-cardiac arrest care.

“We later visited Mr Pieterse in hospital and were delighted to learn that he would soon be discharged. It was a privilege to be part of the team effort that saved his life,” Paul concluded.

Don’t wait to get help if you experience any of these heart attack warning signs. Although some heart attacks are sudden and intense, most start slowly, with mild pain or discomfort. Pay attention to your body — and call emergency services if you feel:

  • Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
  • Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
  • Shortness of breath with or without chest discomfort.
  • Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

Sources: 
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Brent Lindeque is the founder and editor in charge at Good Things Guy.

Recognised as one of the Mail and Guardian’s Top 200 Young South African’s as well as a Primedia LeadSA Hero, Brent is a change maker, thought leader, radio host, foodie, vlogger, writer and all round good guy.

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