How To Stop A Heart Attack In 30 Seconds: Fact

Every year, millions of people worldwide have a heart attack. This is a life-threatening situation that needs quick action. Knowing the right steps during a heart attack is essential for survival. Studies show that learning life-saving techniques can greatly improve chances of recovery.

Learn how to stop a heart attack in 30 seconds by knowing the facts. Avoid deadly mistakes and discover the life-saving steps you need now.

Imagine being able to stop a heart attack fast and save a life. We will look into the importance of quick action during a heart attack. We will also talk about ways to help you survive such emergencies.

Key Takeaways

• Recognizing heart attack symptoms is the first step to survival.
• Knowing life-saving techniques can greatly improve heart attack outcomes.
• Immediate action is vital during a heart attack.
• There are specific steps you can take to potentially stop a heart attack fast.
• Understanding what to do during a heart attack can save lives.

Understanding Heart Attacks: What Happens to Your Body

Knowing what happens during a heart attack is key for quick and effective treatment. A heart attack, or myocardial infarction, happens when blood flow to the heart is blocked. This blockage damages or kills part of the heart muscle.

The Physiological Process of a Heart Attack

When a heart attack occurs, the heart muscle doesn’t get enough oxygen and nutrients. This is because blood flow is blocked. This blockage is usually caused by a blood clot on atherosclerosis (plaque) inside a coronary artery. The coronary arteries carry blood to the heart muscle.

The process can be broken down into several key steps:

• The coronary artery gets blocked, usually by a blood clot.
• The heart muscle it supplies becomes ischemic (oxygen-deprived).
• If the blockage isn’t fixed, the heart muscle starts to die.
• The damage’s extent depends on how long the blockage lasts and the heart area affected.

Common Warning Signs and Symptoms

It’s important to know the warning signs and symptoms of a heart attack. This is because they can vary from person to person. Yet, there are common signs to look out for.

Symptom	Description
Chest Pain or Discomfort	Feeling of pressure, tightness, or pain in the center or left side of the chest.
Shortness of Breath	Difficulty breathing or feeling winded even when sitting or doing light activities.
Pain or Discomfort in Other Areas	Pain or discomfort that spreads to the arms, back, neck, jaw, or stomach.

As a medical expert says, “The symptoms of a heart attack can be subtle. But it’s vital to act fast if you or someone you’re with is showing them.”

“Time is muscle” when it comes to heart attacks, highlighting the need for quick treatment to reduce damage.

Knowing these warning signs and understanding the heart attack process can greatly improve outcomes. It helps by allowing for quicker responses.

Heart Attack Risk Factors and Warning Signs

Having a heart attack can be influenced by many factors. Knowing these factors and the early signs can help prevent heart attacks. It can also improve outcomes if a heart attack does happen.

Modifiable vs. Non-Modifiable Risk Factors

There are two types of heart attack risk factors: modifiable and non-modifiable. Modifiable risk factors are things you can change. These include high blood pressure, high cholesterol, smoking, diabetes, obesity, and not being active enough. Non-modifiable risk factors are things you can’t change. These include your age, gender, and family history of heart disease.

Risk Factor Type	Examples	Intervention
Modifiable	High Blood Pressure, Smoking	Lifestyle changes, Medication
Non-Modifiable	Age, Family History	Monitoring, Preventive measures

Early Warning Signs That Shouldn’t Be Ignored

It’s important to know the early signs of a heart attack. Common symptoms include chest pain or discomfort, shortness of breath, nausea, feeling lightheaded, and pain in the arms, back, neck, jaw, or stomach. If you experience these symptoms, get medical help right away.

Gender Differences in Heart Attack Symptoms

Men and women can have different symptoms of a heart attack. While both may feel chest pain, women often have other symptoms like shortness of breath, nausea, and pain in the back or jaw. It’s important for both men and women to know these differences to get the right medical care quickly.

By knowing the risk factors and warning signs, you can take steps to lower your heart attack risk. This includes making healthy lifestyle choices and working with your healthcare provider to manage risk factors you can change.

Recognizing a Heart Attack vs. Other Conditions

Knowing the difference between a heart attack and other conditions can save lives. When you have symptoms that might be a heart attack, it’s key to tell them apart from other emergencies. This helps you get the right treatment quickly.

Heart Attack vs. Cardiac Arrest

A heart attack and cardiac arrest are not the same. A heart attack happens when blood flow to the heart stops, damaging the heart muscle. Cardiac arrest, on the other hand, is when the heart suddenly stops beating well. It can be caused by a heart attack or other reasons.

Key differences:

• A heart attack is about blocked blood flow, while cardiac arrest is about the heart stopping.
• Symptoms of a heart attack include chest pain and shortness of breath. Cardiac arrest is marked by sudden collapse and loss of consciousness.

Heart Attack vs. Panic Attack

Panic attacks can feel like a heart attack, with symptoms like a fast heartbeat and chest discomfort. But, a panic attack is a sudden intense fear or discomfort that peaks in minutes. It doesn’t damage the heart like a heart attack does.

Distinguishing factors:

• Panic attacks are often filled with intense fear or anxiety, unlike a heart attack.
• Using breathing techniques can help with panic attacks, but heart attack symptoms keep going.

Heart Attack vs. Angina

Angina is chest pain or discomfort from reduced blood flow to the heart. It’s a sign of coronary artery disease and can warn of a heart attack. Unlike a heart attack, angina is usually triggered by exertion or stress and gets better with rest or medicine.

Condition	Cause	Symptoms	Duration
Heart Attack	Blockage of blood flow to the heart	Chest pain, shortness of breath, nausea	Can last from minutes to hours
Cardiac Arrest	Sudden loss of heart function	Sudden collapse, loss of consciousness	Sudden onset
Panic Attack	Intense fear or discomfort	Rapid heartbeat, sweating, trembling	Peaks within minutes
Angina	Reduced blood flow to the heart	Chest pain or discomfort	Typically short, relieved by rest

Critical Mistake #1: Ignoring the Warning Signs

When a heart attack happens, it’s key to spot the warning signs early. Yet, many ignore or underestimate these symptoms. This can cause a delay in getting medical help, which can be very harmful.

Why People Dismiss Heart Attack Symptoms

There are many reasons why people ignore heart attack symptoms. Sometimes, the signs aren’t as obvious as chest pain. Women, in particular, may have different symptoms, like shortness of breath or pain in the arm or jaw.

People often think these symptoms are from something less serious, like indigestion. This thinking can lead to a big delay in getting medical help. A study found that “patients often fail to recognize the severity of their symptoms, leading to delayed hospital arrival.”

“The most common reason for delay is that patients do not recognize the symptoms of a heart attack.”

The Danger of Delayed Response

Delaying treatment for a heart attack can be very dangerous. The sooner treatment starts, the better the chances of survival and less heart damage. Every minute is critical because the heart muscle starts to get damaged without blood flow.

A delayed response can also make recovery harder. Quick medical help can greatly improve outcomes by getting blood flow back to the heart and reducing damage.

Time-to-Treatment Impact on Survival Rates

The time from when symptoms start to when treatment begins is very important. Studies show that quick action, within the first hour, can greatly increase survival chances. The American Heart Association stresses that “time is muscle,” showing how urgent treatment is.

Time to Treatment	Survival Rate
Within 1 hour	Higher survival rate
Within 2-4 hours	Moderate survival rate
After 4 hours	Lower survival rate

It’s vital to understand the importance of quick medical help during a heart attack. By spotting warning signs early and acting fast, people can greatly improve their survival chances and reduce long-term damage.

Critical Mistake #2: Driving Yourself to the Hospital

Driving yourself to the hospital during a heart attack is very dangerous. It can risk your life and the lives of others on the road.

The Risks of Self-Transportation

Driving to the hospital during a heart attack is very risky. Heart attack symptoms like chest pain and dizziness can make driving unsafe. The stress of driving can also make your heart attack worse.

Key risks associated with self-transportation include:

• Increased risk of accidents due to impaired driving abilities
• Worsening of heart attack symptoms due to stress and physical exertion
• Delayed medical attention as you focus on driving instead of receiving immediate care

Why Ambulance Transport Is Essential

Ambulance transport is key during a heart attack. It ensures you get quick medical care on the way to the hospital. Ambulance crews know how to handle heart emergencies and can save lives.

The benefits of ambulance transport include:

• Immediate medical care and monitoring during transport
• Quick response to any changes in your condition, including the administration of life-saving medications
• Priority access to hospital facilities and cardiac care teams

What to Do If No Ambulance Is Available

If no ambulance is available, have a backup plan. If you’re with someone having a heart attack, drive them to the hospital if it’s safe. Or call for other emergency transport. But never drive yourself if you’re having symptoms.

If you’re alone and think you’re having a heart attack, call emergency services right away. If you’re in a remote area with no cell service, pull over to a safe spot. Wait for help or try to flag down another driver.

Critical Mistake #3: Taking Inappropriate Medications

During a heart attack, knowing which medications to avoid is key. Some drugs, usually safe, can harm you during a cardiac event.

Medications That Can Worsen a Heart Attack

Some drugs can make a heart attack worse or complicate treatment. Over-the-counter pain relievers and anti-inflammatory drugs can up the risk of heart attack. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, can raise blood pressure and reduce heart medication effectiveness.

Also, herbal supplements and dietary aids can interact badly with heart medications. It’s vital to tell your doctor about all drugs and supplements you’re taking.

When Certain Heart Medications Are Dangerous

Some heart medications can be harmful during a heart attack if not used right. Anti-arrhythmic drugs, for example, can have bad effects under certain conditions. Always follow your doctor’s advice and don’t change your medication without their say-so.

Medications that affect blood clotting, like anticoagulants, need careful handling during a heart attack. They can prevent clots but might make surgery harder if not watched closely.

The Truth About Cough CPR and Other Unproven Methods

Cough CPR is a method sometimes talked about for heart attacks. It involves coughing hard to try and fix the heart rhythm. But, there’s little medical proof it works, and it’s not a trusted treatment for heart attacks.

Using unproven methods can make getting the right medical help harder. We should stick to proven ways, like calling emergency services fast and listening to doctors.

Critical Mistake #4: Lying Flat on Your Back

The way you sit during a heart attack can make things better or worse. Knowing how your body position affects your heart is key to lessening damage during a heart attack.

How Position Affects Heart Function During an Attack

During a heart attack, the heart doesn’t get enough oxygen. This can harm or kill heart tissue. The body’s position can change how hard the heart works and how well it pumps blood. Lying flat on the back can make things worse by putting more pressure on the heart and lungs.

Studies show that your position during a heart attack can affect how bad it is. For example, sitting up can ease the heart’s work by lowering blood pressure in the heart.

The Optimal Position During a Heart Attack

The best position during a heart attack is sitting or leaning back with your upper body up. This can help your heart work less hard and make breathing easier. Sit comfortably with your back straight and your legs out or slightly bent.

Position	Effect on Heart Function	Breathing Difficulty
Lying Flat	Increased strain	Worsened
Sitting/Semi-reclining	Reduced strain	Improved
Standing	Increased workload	Variable

Adjusting Position for Breathing Difficulties

If you’re having trouble breathing during a heart attack, changing your position can help. Raising your head and upper body can make it easier to breathe. Also, taking off tight clothes around your neck can help.

In short, knowing the best position during a heart attack can make a big difference. Sitting or leaning back can help your heart and improve your chances of getting better until help arrives.

Critical Mistake #5: Continuing Physical Activity

It’s important to know that keeping active during a heart attack is dangerous. The heart is already under a lot of stress because of a blockage. More activity can make the damage worse.

Why Rest Is Critical During a Heart Attack

Resting is key during a heart attack. It helps lower the heart’s workload and reduces damage. Resting right away can greatly improve your chances by easing the heart’s burden.

The Impact of Exertion on Heart Damage

Exertion during a heart attack can make things worse. It raises the heart rate and blood pressure, increasing oxygen demand. But, the heart is already not getting enough oxygen because of the blockage. Keeping active can make the heart damage even more severe.

• Increased heart rate and blood pressure
• Higher demand for oxygen
• Worsening ischemia due to blocked coronary arteries

Safely Limiting Movement During a Cardiac Event

To safely limit movement during a heart attack, stop all activity right away. Sit or lie down comfortably and try to stay calm. If someone is having a heart attack, help them get into a comfortable spot and reassure them help is coming. Avoid any strenuous activities, like walking or standing, as they can make things worse.

Understanding the dangers of activity during a heart attack and resting immediately can greatly improve survival chances. It also reduces the risk of more heart damage.

Critical Mistake #6: Consuming Food or Drinks

When you have a heart attack, it’s important to avoid eating or drinking. This might seem harmless, but it can harm your body’s ability to handle the attack.

Why Eating Can Complicate a Heart Attack

Eating or drinking during a heart attack can make things worse. It can take blood away from your heart, making it harder for it to pump blood. This can make your heart work even harder, causing more damage.

a cardiologist, says, “Eating or drinking during a heart attack is like adding more work to a heart that’s already struggling. It’s not helpful and can lead to worse outcomes.”

“The body’s response to a heart attack is not just about the heart; it’s a whole-body response. Eating can disrupt this delicate balance.”

Fluids to Avoid During a Cardiac Emergency

Some fluids are bad during a heart attack. Caffeinated drinks can make your heart rate and blood pressure go up. Alcohol can slow down your heart, making things worse.

Fluid Type	Potential Risk
Caffeinated Drinks	Increased heart rate and blood pressure
Alcohol	Depressant effect on the heart
High-Sugar Beverages	Potential for increased inflammation

The Myth of “Heart Attack Remedies”

Many myths exist about “remedies” for heart attacks, like certain foods or drinks. But there’s no scientific proof they work. Relying on these myths can delay getting medical help, which is key in treating heart attacks.

Stick to proven medical treatments and guidelines during a heart attack. Eating or drinking is not a replacement for getting medical help right away. If you or someone else is having a heart attack, call emergency services and follow their advice.

How to Stop a Heart Attack in 30 Seconds: Immediate Response Techniques

When a heart attack happens, every second is critical. Knowing how to act quickly can save a life. “Time is muscle” is a key phrase in cardiology. It means the sooner help arrives, the less damage there is.

Aspirin Protocol: When and How to Take It

Aspirin is a key first step in a heart attack. If the person is not allergic and it’s safe, chewing an aspirin can stop more clots. Remember, aspirin is not a replacement for medical help but can be a vital first action while waiting for help.

Key considerations for aspirin use:

• Check for aspirin allergy
• Ensure the person is conscious and able to chew and swallow
• Use a regular aspirin (not enteric-coated or buffered)
• Call emergency services before or immediately after administering aspirin

Nitroglycerin Use for Heart Attack Patients

Nitroglycerin can ease heart attack symptoms by improving blood flow. It’s given under the tongue. Always follow the doctor’s instructions or the label on the medication.

Important points about nitroglycerin:

• Only use nitroglycerin if it’s prescribed by a doctor
• Be aware of possible side effects like dizziness or headache
• Nitroglycerin should not be taken if the person has used erectile dysfunction medication recently

Breathing Techniques to Reduce Cardiac Stress

Deep, controlled breathing can ease heart stress during a cardiac event. Encouraging slow, deep breaths can help calm the person and reduce heart workload.

“Deep breathing can help lower blood pressure and heart rate, providing a calming effect during a heart attack.”

Steps for effective breathing:

1. Find a comfortable, semi-reclining position
2. Inhale slowly through the nose for a count of 4
3. Hold the breath for a count of 4
4. Exhale slowly through the mouth for a count of 4
5. Repeat as necessary until help arrives

The Correct First Aid Response to a Heart Attack

Every second matters when someone has a heart attack. Knowing the right first aid can save lives. A heart attack happens when blood flow to the heart stops, damaging the muscle. Quick and correct action can greatly improve survival chances and reduce complications.

To help effectively, it’s key to know the steps for first aid during a heart attack. We’ll cover a detailed emergency response plan. This includes CPR and using an Automated External Defibrillator (AED).

Step-by-Step Emergency Response Protocol

The first step is to call emergency services right away. If alone with the person, call for help first. In public, ask someone to call while you help.

• Check the person’s airway, breathing, and circulation (ABCs). If they’re unresponsive, not breathing, or without a pulse, start CPR.
• If they’re awake and having symptoms, have them sit or lie down comfortably.
• Loosen tight clothing around their neck, chest, and arms to help them breathe better.

Administering Aspirin: If awake and not allergic to aspirin, give one adult aspirin (325 mg) or two low-dose aspirins (81 mg each) to chew. Aspirin helps prevent further clotting and reduces heart damage.

When and How to Perform CPR

CPR is vital if the person’s heart stops or they’re not breathing. To do CPR, follow these steps:

1. Start with 30 chest compressions. Place your heel on the center of their chest, and your other hand on top. Push down about 2 inches at a rate of 100-120 compressions per minute.
2. Give two breaths. Pinch their nose shut and give one breath through their mouth. The breath should last about one second and make their chest rise.
3. Continue cycles of 30 chest compressions followed by two breaths until help arrives, an AED is available, or they regain consciousness.

Using an AED (Automated External Defibrillator)

An AED is a portable device that analyzes the heart’s rhythm and, if needed, delivers an electric shock to restore a normal heartbeat. If trained to use an AED, follow these steps:

• Turn on the AED and follow the voice prompts or visual instructions.
• Attach the electrode pads to the person’s bare chest as indicated on the pads or in the device’s instructions.
• If the AED advises a shock, ensure no one is touching the person and press the shock button.
• Continue CPR after the shock until emergency personnel arrive.

By knowing and using the correct first aid for a heart attack, including CPR and AED use, you can greatly improve survival and recovery chances for someone having a cardiac emergency.

Calling Emergency Services: What Information to Provide

When you or someone else is having a heart attack, calling emergency services is vital. You need to give accurate information to get help fast. This can greatly affect the outcome.

Critical Details to Share with 911 Operators

When you call 911, it’s important to give clear information. You should:

• Tell them where you are or where the heart attack is happening
• Give them your phone number
• Describe the symptoms you’re seeing
• Mention any medical history, like heart conditions or allergies

Stay calm and speak clearly. This helps the operator understand what’s happening. It’s also good to have this info ready to share.

How to Help First Responders Upon Arrival

When first responders get there, they need specific info to help. To assist them:

Information to Provide	Why It’s Important
Medical history, including any heart conditions or medications	Helps responders understand what’s going on and how to treat it
Any changes in symptoms or condition	Helps responders know how serious the situation is
List of medications and dosages	Ensures responders know about any drug interactions or allergies

Having this info ready helps responders give better care faster.

What to Bring to the Hospital

When going to the hospital, bring:

1. A list of your medications and dosages
2. Any important medical records or test results
3. Contact info for emergency contacts and healthcare providers
4. Insurance info, if you have it

Supporting Someone Having a Heart Attack

The moments before medical help arrives are key. Supporting someone having a heart attack can make a big difference. It’s important to stay calm and offer the right support until help comes.

Psychological First Aid During a Cardiac Emergency

Psychological first aid is about giving emotional support in tough times. During a heart attack, it’s as important as physical aid. We can help by being there, speaking softly, and telling them help is coming.

It’s vital to avoid panic and keep a calm space. This can lessen their stress and worry.

Some key aspects of psychological first aid include:

• Remaining calm and composed
• Providing reassurance without being overly optimistic
• Listening to the person’s concerns
• Avoiding arguments or confrontations

How to Keep the Person Calm and Comfortable

Keeping someone calm and comfy is key during a heart attack. Make sure they’re in a good spot, like sitting or lying down with their head up. Loosen tight clothes around their neck, chest, and arms.

Stay with them and talk reassuringly to keep them calm.

Some additional tips include:

1. Encouraging the person to breathe slowly and deeply
2. Avoid giving them food or drink unless it’s a special medicine
3. Stay with the person until medical help arrives

Monitoring Vital Signs While Awaiting Help

While waiting for help, check the person’s vital signs if you can. Look at their pulse, breathing, and if they’re awake. If they’re not breathing or their heart stops, know how to do CPR if you can.

By following these steps, we can give vital support to someone having a heart attack. The main thing is to stay calm, reassure them, and get medical help as fast as we can.

Common Myths About Heart Attack Response

There’s a lot of wrong information about heart attacks. It’s key to know what’s true to save lives. Many believe in home remedies or have wrong ideas about treating heart attacks, which can be dangerous.

Debunking Dangerous Home Remedies

Some think home remedies can fix a heart attack. But, these remedies lack scientific proof and can hurt by delaying medical help. For example, some believe coughing can fix a heart rhythm. This “cough CPR” idea is wrong, says doctors.

Coughing doesn’t replace getting medical help right away. Relying on it can be risky.

Misconceptions About Heart Attack Treatment

Another myth is driving to the hospital if you’re having a heart attack. This is very dangerous. Driving can cause loss of control or even a crash because of the strain and risk of losing consciousness. Instead, calling emergency services is the safest and most effective way. They can give immediate care and take you to a hospital.

The Truth About “Silent” Heart Attacks

“Silent” heart attacks happen without symptoms for some. These can be as harmful as ones with symptoms and need the same medical care. The idea that heart attacks always have severe chest pain is wrong. Knowing the different symptoms of heart attacks is key for quick and right action.

Understanding these myths helps us respond better to heart attacks and save lives. It’s important to stay informed and teach others about heart attack response and treatment.

Heart Attack Survival: What to Expect at the Hospital

Knowing what happens at the hospital during a heart attack can help reduce stress. When a patient arrives, a team of healthcare professionals quickly acts to provide care.

Emergency Room Procedures

The emergency room staff quickly checks the patient’s condition. Heart attack patients get priority to ensure they get timely treatment. The first steps include:

• Checking vital signs like heart rate, blood pressure, and oxygen levels.
• Doing an electrocardiogram (ECG) to check heart activity.
• Testing blood for cardiac biomarkers to confirm a heart attack.

Common Medical Interventions

Medical treatments for heart attacks aim to restore blood flow and reduce damage. Common treatments are:

1. Aspirin and Antiplatelet Therapy: To stop further clotting.
2. Nitroglycerin: To ease chest pain and lower heart workload.
3. Beta-blockers: To slow heart rate and lower blood pressure.
4. Angioplasty and Stenting: To open blocked arteries.
5. Thrombolytic Therapy: To dissolve clots causing the heart attack.

Recovery Timeline After Treatment

The recovery time varies based on the heart attack’s severity and treatment success. Patients usually go through:

• Initial Recovery (1-3 days): Close monitoring in the hospital for complications.
• Rehabilitation Phase (weeks to months): Slow return to normal activities under medical watch.
• Long-term Recovery (months to a year or more): Making lifestyle changes, taking medication, and follow-up care to avoid future heart attacks.

By knowing these steps, patients and their families can better understand the hospital experience during a heart attack. This leads to better survival and recovery chances.

Prevention: Reducing the Risk of Future Heart Attacks

To prevent future heart attacks, we need to make lifestyle changes and follow our medication. Knowing what affects heart health helps us take action to lower our risk.

Lifestyle Changes After a Heart Attack

After a heart attack, big lifestyle changes are key. Eating healthy, being active, quitting smoking, and managing stress are important. Eating a diet full of fruits, veggies, whole grains, and lean proteins is great for the heart.

Starting to exercise slowly and gradually is important. It helps in recovering from a heart attack and prevents future ones. Always follow your doctor’s advice on how much and how often to exercise.

“The journey to recovery and prevention begins with small, achievable steps. By incorporating healthy habits into daily life, individuals can significantly reduce their risk of future heart attacks.”

Medication Adherence and Follow-up Care

It’s vital to take your heart medications as prescribed. These can include drugs to lower cholesterol, control blood pressure, or prevent blood clots. Understanding why you take each medication and following the dosage is key.

Regular check-ups with your doctor are also essential. These visits help monitor your heart health and adjust your treatment plan as needed.

Medication Type	Purpose	Frequency
Cholesterol-lowering	Reduce LDL cholesterol	Daily
Blood Pressure Medication	Manage hypertension	Daily
Antiplatelet Therapy	Prevent blood clots	Daily

Creating a Personal Emergency Plan

Having a personal emergency plan is vital after a heart attack. It should list warning signs, emergency contacts, and the nearest hospital.

Review and practice your emergency plan with family or caregivers. This ensures a quick and effective response to future heart issues.

Conclusion: Being Prepared Can Save Lives

Being ready for a heart attack can greatly improve survival chances. We’ve talked about common mistakes to avoid and how to act quickly to save lives. Knowing the warning signs and how to respond can lower the risk of death.

We stressed the need to call for help, take aspirin, and use nitroglycerin when needed. It’s also key to stay calm, not move too much, and not eat or drink during a heart attack. Taking the right steps can greatly improve the outcome.

In short, being ready for a heart attack is key to saving lives. We’ve covered the most important points and why quick, right action is vital. We hope to give our readers the knowledge and confidence to act fast in a heart attack situation.

FAQ

References

New England Journal of Medicine. Evidence-Based Medical Insight. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMra1910762