What to do in case of a suspected severe cardiovascular (CV) event?

From the Guidelines

In case of a suspected severe cardiovascular event, call emergency services (911 in the US or equivalent local emergency number) immediately. While waiting for help, have the person sit or lie down in a comfortable position. If the person is conscious and not allergic to aspirin, give them one adult aspirin (325 mg) or four baby aspirins (81 mg each) to chew, as recommended by the 2013 ACCF/AHA guideline update 1. If the person becomes unresponsive and stops breathing normally, begin CPR if you're trained. For chest pain suspected to be a heart attack, help the person take their prescribed nitroglycerin if available, but do not give someone else's medication. For suspected stroke, note the time symptoms began as this affects treatment options. Keep the person as calm as possible and loosen tight clothing. Do not give food or drink as this could cause choking if their condition worsens.

Key Considerations

• Quick action is crucial because cardiovascular events like heart attacks and strokes cause tissue damage that worsens with time, as highlighted in the 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation 1.
• Early intervention with treatments like clot-busting medications or cardiac catheterization can significantly improve outcomes and prevent permanent damage to the heart or brain.
• The most recent and highest quality study, the 2017 ESC guidelines 1, emphasizes the importance of immediate action and access to emergency medical services for patients with suspected severe cardiovascular events.

Additional Recommendations

• Patients with suspected ACS and high-risk features such as continuing chest pain, severe dyspnea, syncope/presyncope, or palpitations should be referred immediately to the emergency department (ED) and transported by emergency medical services when available, as stated in the 2014 AHA/ACC guideline 1.
• Prehospital EMS providers should administer 162 to 325 mg of ASA (chewed) to chest pain patients suspected of having ACS unless contraindicated or already taken by the patient, as recommended by the 2007 ACC/AHA guidelines 1.

From the FDA Drug Label

In patients with STEMI, the safety and efficacy of clopidogrel were evaluated in the randomized, placebo-controlled, double-blind study, COMMIT. The primary endpoints were death from any cause and the first occurrence of re-infarction, stroke or death As shown in Table 5 and Figure 4 and Figure 5 below, clopidogrel significantly reduced the relative risk of death from any cause by 7% (p=0.029), and the relative risk of the combination of re-infarction, stroke or death by 9% (p=0.029)

In case of a suspected severe cardiovascular (CV) event, clopidogrel may be used to reduce the risk of death from any cause and the combination of re-infarction, stroke, or death 2.

• The patient should be treated with aspirin (75 to 325 mg once daily) and clopidogrel (75 mg once daily) for 28 days or until hospital discharge, whichever comes first.
• It is essential to note that bleeding is a potential risk factor for patients taking clopidogrel, and the incidence of major bleeding may be higher in patients receiving clopidogrel and aspirin compared to those receiving aspirin alone 2.
• Patients should be monitored for signs of bleeding, and the treatment should be discontinued if bleeding occurs.
• If clopidogrel must be temporarily discontinued, it should be restarted as soon as possible to minimize the risk of cardiovascular events 2.

From the Research

Suspected Severe Cardiovascular (CV) Event

In case of a suspected severe CV event, it is crucial to act quickly and seek medical help immediately. The following steps can be taken:

• Call emergency services (such as 999) for an ambulance, as timely medical intervention can significantly improve outcomes 3
• If the person is experiencing symptoms such as chest pain, shortness of breath, or dizziness, try to keep them calm and comfortable until medical help arrives
• If the person is unresponsive, not breathing, or has no pulse, begin CPR (cardiopulmonary resuscitation) if you are trained to do so

Prevention and Risk Reduction

To reduce the risk of CV events, the following measures can be taken:

• Take antiplatelet drugs such as aspirin and clopidogrel as prescribed by a doctor, as they can help prevent blood clots and reduce the risk of CV events 4, 5
• Maintain a healthy lifestyle, including a balanced diet, regular exercise, and not smoking
• Monitor and manage risk factors such as high blood pressure, high cholesterol, and diabetes

Importance of Prompt Medical Attention

Prompt medical attention is critical in case of a suspected CV event, as delays in seeking help can lead to poorer outcomes 3, 6. A study found that patients who delayed seeking medical help for more than 4 hours after the onset of symptoms had a higher mortality rate compared to those who sought help within 4 hours 6. Another study found that some in-hospital cardio-respiratory arrests could be prevented if patients and healthcare professionals recognized the warning signs and took prompt action 7.