How to deal with a heart attack while driving

Drivers texting, eating, changing radio stations and talking on the phone behind the wheel, driving drunk or recklessly - these scenarios all add to the dangers we face on our roads. But, what level of risk does driver-health status bring to the picture? There's never a good time to have a heart attack. But one of the worst times is likely behind the wheel. With cardiovascular diseases (CVDs) the number one cause of death globally, how likely are you to be affected by your own or someone else's heart attack while on the road?

"We quite often get a call with a description of a vehicle stopped on the side of the road. Our paramedics carry ECGs (electrocardiograms, devices that check for problems with the electrical activity of your heart) to enable them to do clinical assessment on a patient's heart without delay," says paramedic and Head of Clinical Leadership at Netcare 911, David Stanton. "People - men in particular - often ignore the symptoms believing they will simply go away. The important thing is that if you have the chest pain or pain down your arm, or other symptoms of heart attack, don't ignore them," adds Stanton.

"There are interesting relationships between stress on the road and heart attack," explains cardiologist Dr Tony Dalby. "Anything that gets adrenalin pumping will increase heart rate and blood pressure and, in that time, increase the risk of heart attack. In the case of stress cardiomyopathy, patients experience a stressful situation and have a heart attack as a result of the stress - despite their coronary arteries being healthy or normal."

You're also at risk of heart attack if you're overweight, a smoker, a diabetic, have high blood pressure (hypertension), high cholesterol, eat unhealthily, use alcohol to excess and lead an inactive life - exacerbated by a family history of heart disease or related conditions. "Hypertension is a condition in which your blood vessels have persistently high pressure," explains Dr Deepak Patel, Clinical Specialist at Discovery Vitality. "A healthy blood pressure is 120/80 mmHg. If you have your blood pressure taken on three different days, and all your readings are 140/90 mmHg or higher, it is very likely that you have hypertension. The upshot of this is that your heart has to work harder to pump blood through your body." According to the World Health Organization (WHO), uncontrolled high blood pressure is dangerous because it can lead to strokes (brain attacks), heart attacks, heart enlargement, and eventually heart failure. Hypertension can also damage your blood vessels and lead to aneurysms (weak spots and bulging in your vessels). Additional negative health consequences include possible kidney failure, blindness, and cognitive impairment.

Symptoms of a heart attack

• an ache in the chest confused as indigestion or gas-like pain
• an uncomfortable feeling in the centre of the chest and going into the arm, neck or shoulder
• pressure or pain in the centre of the chest which may spread to the arm
• upper back, shoulder, or throat pain
• jaw pain or pain that spreads up to the jaw
• breathlessness or fatigue
• a pain in the tummy or the neck or teeth, discomfort in the stomach
• breaking out in a cold sweat
• nausea and shortness of breath
• unusual fatigue lasting for several days or sudden severe fatigue, light-headedness
• sleep disturbances
• anxiety

Key steps to follow when facing a heart attack - as a driver or passenger

• If you're driving and experience the symptoms of a heart attack, ease off the accelerator and try to find an opening in the flow of traffic to allow you to steer to a safe place and bring the vehicle to a standstill as soon as possible.
• If you have a passenger with you, ask them to assist you to steer the car to safety.
• Whether the person experiencing the heart attack is the driver or passenger, the medical episode is exacerbated several fold by panicking. Keep calm.
• Some medical sources recommend that the affected person cough over and over in a rhythmic fashion to increase the flow of oxygen-rich blood and get breathing back under control, yet both Dalby and Stanton feel this method is ineffective. "Rhythmic coughing is not going to make a life and death difference," adds Stanton. "It buys seconds rather than minutes."
•  "Get the patient to an angiogram-competent hospital within an hour of onset of symptoms. Their prognosis will then be better," adds Dalby. Stanton agrees: "Don't go to your GP - go the closest hospital emergency unit. If you are close to a hospital ask your passenger to drive you to the emergency unit." Timing is everything when it comes to heart attack symptoms, as the quicker they're recognized, the faster the condition can be treated.
• If you're a little far from a hospital or unable to drive there, immediately contact the emergency services and tell them where you are parked and the type of car you are driving," says Stanton.
• "Before the emergency services arrive, if available, and as soon as possible - give aspirin by mouth. It doesn't have to be a big dose. A 150-300mg Disprin tablet is sufficient," explains Dalby. "This is really the only thing you can do to self-treat the symptoms of heart attack," adds Stanton. "In the mouth, chew and swallow."
• If the patient goes into cardiac arrest then those with resuscitation training should begin Cardiopulmonary Resuscitation (CPR), the emergency procedure that combines manual chest compressions with mouth-to-mouth artificial ventilation to preserve brain function until further steps can be taken to restore blood circulation and breathing. Stanton advises that if you're not trained in CPR, then provide hands-only CPR: "This means uninterrupted chest compressions of 100 to 120 a minute until paramedics arrive - in the middle of the chest pushing down as hard as you can, fairly fast." You don't need to try rescue breathing if untrained in CPR.  If you're well-trained and confident in your ability, start CPR with 30 chest compressions before checking the airway and giving rescue breaths.
• If you're close to a shopping centre call for a defibrillator. Automatic defibrillators read the rhythm of a person's heart and advise you on whether to shock the person's heart or not.

Are you liable for injury or damage caused when you pass out behind the wheel?

"Strictly speaking you are not liable for damage to person or property if you can prove that you had a heart attack when you're approached by an injured party claiming for damages," says Rene Esterhuizen, Head of Legal at Discovery Insure. "But, obtaining that medical proof is easier said than done as doctors are reluctant to state an event occurred without absolute certainty of what happened at the time of an accident. If you cannot prove a heart attack at the time of an accident, on the balance of probabilities, you will be unlikely to rely on this defence." Your doctor's prior advice will also be considered. If a doctor has advised you not to drive as a result of your risk of heart attack, this will also count against you and your doctor will be called to testify in any legal proceedings. "Similarly, if you're in bad health and take medication that you know causes drowsiness and pass out behind the wheel, you cannot claim not to have had no control over your actions," adds Esterhuizen.

Avoid triggers for stress on South African roads

• Road rage exacerbates an already dangerous situation.
• Breathing deeply is excellent way to de-stress in a heated moment.
• If you're feeling particularly overwhelmed by emotions such as anger, pull over and take a break from driving - preferably stopping at a safe location such as a shopping centre or petrol station. Take time to calm down: Close your eyes, listen to soothing music and focus on taking long, slow breaths. Getting out of the car for a short walk or a drink of water could help too.
• Leaving your point of departure slightly earlier will help you to avoid the frustration that comes from being stuck in traffic.

"It's important to know your health status," concludes Dr Patel. "Even if you feel fine, visit your GP or a clinic for a general check-up once a year, or book a Vitality Health Check to track your key health indicators on a regular basis. Taking steps towards prevention and early treatment of hypertension and other risk factors, will help ensure a healthier heart."

Discovery Insure24 agents offer support even in a client's darkest hour

When Janine Petterson's partner Steve suffered a fatal heart attack while driving to gym (only a few kilometers from their home), an ImpactAlert registered on the Discovery Insure system. Insure24 agents not only sent emergency services to Steve right away but also alerted Janine to the situation, giving her time to get to the scene and spend precious final moments with Steve.