Family medicine specialist Nena Kopčaver Guček points out the circumstances that can lead to a sudden cardiac arrest and emphasizes that a very big factor is stress, which only we can deal with ourselves.
A little less than two thousand people die of a heart attack in Slovenia every year. Last year, it was the cause of 1,835 deaths, in 2021, 1,919 people died of heart attacks, in 2020, 1,769, in 2019, 1,862, and in 2018, 1,927 people, according to the NIJZ (more detailed information in the table below). It is more often the cause of death in men, who die on average of a little more than a thousand per year due to heart attacks.
The most typical sign of a heart attack is pain in the chest, in the middle between the nipples, behind the sternum, explains the family doctor Nena Kopčaver Guček. The pain is dull, not sharp, sometimes patients even describe it as burning. “It’s like someone pressing a stone into your chest, not like stabbing you with a knife. The pain can be extremely severe, so it is sometimes accompanied by sweating, pallor, and difficulty breathing. The pain can spread to the left shoulder, left arm, sometimes also to the neck, lower jaw and right arm. It usually lasts more than five minutes and does not depend on the position of the body, it does not get any better if we sit or lie down, it does not depend on breathing and is so severe that it reacts with morphine.“
The mentioned signs of a heart attack can be noticed by any layman, but as Kopčavar Guček warns, they can also be different. In diabetic patients, who already have a higher risk of heart attack, but at the same time have a damaged nervous system due to diabetes, the pain may also be absent and it is more difficult to recognize it. “In this case, signs of a heart attack include nausea, vomiting or short-term fainting due to poor blood circulation in the body.“
The heart is a hollow muscle through which enormous amounts of blood flow. At the same time, the heart needs its blood supply, which is provided by coronary vessels, better known as coronary vessels. “These are thin veins, narrow in diameter, from 0.5 to 2 millimeters, depending on our size. You can imagine that even a very small clot blocks such a narrow vein.“When we suspect that a loved one might be having a heart attack, the first thing we do is call 112.”Such a patient urgently needs help, he urgently needs oxygen and nitrolingual or nitroglycerin in a spray to dilate the coronary vessels.“The sublingual spray will not be found in first aid kits, but we can immediately offer the affected person aspirin, which prevents the formation of blood clots, which are most often the cause of a heart attack.
In the event that the heart stops completely, we must immediately start resuscitation. Everyone should know the basics of resuscitation, believes Kopčaver Guček. A heart attack means that a part of the heart is left without blood in an instant, but if the doctors manage to recanalize that part of the heart within an hour so that it does not die and does not scar, everything turns out well.
Heart failure can also be caused by a heart rhythm disorder. It starts with a very high heart rate, between 150 to 200 beats per minute, and then the heart jumps into atrial fibrillation. “In Slovenian, we translate this as the trembling of the vestibules. The heart is completely ineffective, it just trembles and no longer squeezes blood. This is a common cause of sudden cardiac death, but it is very difficult to prove. A clot can be found in the coronary vessels, but no evidence is found at autopsy of a heart rhythm disorder. Then we conclude that it was a heart rhythm disorder.“
Risk factors: lifestyle, medical conditions and genetics
Life circumstances and lifestyle contribute to a higher risk of heart attack. “Without a doubt, these are smoking, poorer physical fitness, which makes us less prepared for mental distress, which can be severe stimuli for heart rhythm disorders.” Being overweight also increases the risk of a heart attack, and excessive alcohol consumption can also damage the heart muscle. Heart attack occurs more often with certain medical conditions, such as diabetes, high blood pressure, elevated cholesterol and triglyceride levels… Attention should also be paid to a family history of cardiovascular diseases. “Sudden cardiac death often runs in some families. The death of a close relative under the age of 60 or even under the age of 50 puts a heavy strain on us genetically and greatly increases the chances of something similar happening to us.” Family doctors are very attentive to this information in the patient. As Kopčavar Guček explains, they also use tables with the help of which they can calculate the cardiovascular risk factors for a patient ten years in advance, based on the aforementioned factors.
At the systemic level, prevention and curative care are well taken care of
When asked whether we could do more to prevent heart attacks, Kopčavar Guček replies that both preventive and curative options are already well exhausted in our country. Regular medical examinations of employees are aimed at checking cardiovascular risks. “Blood sugar and cholesterol levels, EKG and blood pressure measurements are checked in every occupation.” Referral clinics also operate in health centers, which prevent many cardiovascular events by monitoring the patient and raising preventive awareness. Kopčavar Guček expresses his great satisfaction that a large number of defibrillators are installed in accessible outdoor locations in Slovenia, they can be found at fire stations, libraries, shopping centers… “These defibrillators tell every layman audibly what needs to be done, no special prior knowledge is required at all. They are adapted so that every citizen can use them.“
Kopčavar Guček emphasizes that emergency medical assistance in the event of a heart attack is also very well organized here. “Paramedics record the patient’s ECG already in the ambulance and send it to the doctor who recognizes the heart attack, then the patient is taken directly to the cardiac laboratory without any referral, where a substance is injected into the heart that dissolves the clot. The patient gets help before they even ask him his name. We can only deeply bow to the healthcare system in this area, even though it is often the target of criticism.”
If we face stress every day, we need to do something every day to relax
When it comes to heart attack risk factors, Kopčavar Guček repeatedly emphasizes the psychological aspect, or the way of dealing with stress. “Many professions are stressful, and I would allow myself to be counted among them. Psychologists warn that if we face stress every day, we must also do something against stress every day. You should treat yourself to a relaxing activity every day that is just for you.” And what works as an anti-stress? “A walk that lasts at least 20 minutes continuously keeps us physically fit enough. Once or twice a week, the exercise should be more intense, from 40 to 60 minutes. During physical activity, the body secretes endorphins, which have a soothing and calming effect. And Mroh, going to the hill once a week is not enough,” warns Kopčavar Guček. In addition to a stressful lifestyle, cardiologists even advise against irregular intense exercise, as it only puts additional strain on the heart.
People can tolerate very different amounts of stress, or even need it for stimulation. “We are very differently receptive and ready for it.” If we don’t manage stress on the go, it accumulates, “Mountains of stress are difficult to overcome”. “Psychologists emphasize that stress needs to be processed as if it is a material that you get willingly or unwillingly and you have to manage it”. The family doctor adds that we can only take care of this ourselves. “No one can run for you, lose weight for you. Sometimes in Slovenia, we talk a little less about the duties and responsibilities of patients and a lot about doctors, but there are things that we cannot do instead of patients.“
Physical activity is one way to deal with stress. Some like to read books, listen to music, garden, chat with friends… Kopčavar Guček says that he often embarrasses his patients when he asks them what their favorite song or music is. “Young people usually blurt out the answer. When I ask a 50-year-old lady who has children, a career, sick parents, I completely surprise her and she needs a few minutes to even decide on a genre. This is an interesting test that shows how we forget ourselves in this concern for others, in this modern way of life with a high pace, which can be fatal.“
The number of deaths due to the consequences of a heart attack in the last five years in Slovenia:
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