The blood pressure of the body is maintained by a certain quantity of blood flowing through blood vessels in a given period of time. When the heart is unable to pump an adequate amount of blood, the blood pressure in the entire body will fall and a state of shock will develop. The patient experiences this as a sensation of weakness, faintness, and possibly profuse perspiration. The physician recognizes this state by a low blood pressure and a weak pulse. If this state persists for a sufficient time, the brain and other vital organs will suffer from lack of blood and irreparable damage or death may occur.
The heart normally contracts 60 to 100 times a minute, propelling blood with each contraction. The stimulus for each contraction is a discharge from nervous tissue within the heart at the same rate. The origin of these stimuli is usually the sino-atrial node, which is known as the pacemaker of the heart. However, any portion of the heart has the potential capacity for initiating a nervous impulse that can result in contraction of the heart muscle. When a portion of heart muscle dies, the remaining muscle may become very irritable and multiple areas of discharge may compete with the pacemaker, resulting in a rapid or erratic heartbeat. This rhythm may be a tachycardia (rapid action) or fibrillation. If the speed of contraction is not too fast or if the rhythm of contraction is not too erratic, the heart will still pump blood effectively. If, on the other hand, the rate is too fast or the rhythm too irregular, the actual amount of blood pumped will greatly diminish and a shock-like picture will develop. The patient may experience these events as a palpitation or fluttering in his chest. The development of shock is accompanied by feelings of weakness, faintness or profuse sweating.
Physicians today are familiar with these events, and hospitals are equipped to combat many of these complicating factors. Therefore, the safest place for a person who has suffered a heart attack is in a hospital under close supervision of trained personnel. It is nostalgic to remember Grandfather’s, heart attack as he remained in his comfortable bed at home, visited daily by his family doctor, until it was felt safe for him to get out of bed. At that time, however, many of these serious complications were not known, and effective treatment for them was not available. Today’s doctor may very well recognize over the telephone that his patient has gone into shock the third day after his heart attack, but if the patient is at home it may be too late for the doctor to do anything effective about it by the time he reaches the bedside.
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