View Full Version : Heart Attack Expert Needed for Help with Killing Character

08-22-2009, 04:27 AM

I need to kill off a pivotal character who has a family history of heart disease and is on cholesterol meds and and a BP med.

The setting is:
Male, 40ish
At home, at night, preferably in bed.
He can't linger for the EMTs to arrive.
His wife is on scene, but he needs to go quickly, as she can't save him.

I wrote a very short but dramatic scene based on my mother-in-law's description of my father-in-law's death—this involved foaming from the mouth—pink foam actually, from a mix with blood. She said his heart "exploded," which seems more common with people as an in-hospital post-attack occurrence than one that occurs on-site, and mainly seems to afflict people who've had previous stress or injury to the heart muscle. My father-in-law was older (57) at the time of his attack and had just exercised outdoors. He also had a history of multiple bypass surgeries, which my book character does not. So I am afraid now that my scene isn't really possible for a younger person at home, even with his family history.

I need it to be fast and somewhat dramatic (no going in his sleep, as the wife has to see it). If he suffers dramatic pain and goes quickly, might he foam at the mouth? I've read a lot about the possible symptoms and effects of heart attacks and sudden cardiac arrest, but I am having a hard time putting them together into one believable description.

If it's fast, is it AMI, or sudden cardiac arrest? I know the first can lead to the second, so I've been using the second. For reasons I won't bore you all with, I want to use the right medical term, vs. the generic "heart attack."

Any facts and advice as to what behaviors and symptoms would fit with this scenario are greatly appreciated.


08-22-2009, 05:15 AM
Unfortunately, if he is alive when his wife sees him have the attack, his wife calls 911, and the paramedics arrive in any sort of reasonable time, the paramedics aren't going to declare him dead. They will start CPR, intubate him, maybe shock him, start an IV, give drugs, and take him to the ER. All this is almost certainly pointless, but they will do it anyway unless it's obviously too late (the body is cold).

08-22-2009, 05:24 AM
Unfortunately, if he is alive when his wife sees him have the attack, his wife calls 911, and the paramedics arrive in any sort of reasonable time, the paramedics aren't going to declare him dead. They will start CPR, intubate him, maybe shock him, start an IV, give drugs, and take him to the ER. All this is almost certainly pointless, but they will do it anyway unless it's obviously too late (the body is cold).

Well, he doesn't have to be declared dead at the apartment. He only has to be die. I can make that work. The point is that he's out, and EMTs can't save him. They do come to the house. I should have mentioned that. She calls 9-1-1; the husband just doesn't survive.

08-22-2009, 05:43 AM
This is the combination of a couple of medical calls, but should be a good scenario for you.

Husband and wife in bed, husband watching TV, but had fallen asleep, slightly snoring. Wife is reading. Husband suddenly sits straight up, grabs chest, groans, and falls out of bed. He's dead by the time he hits the floor.

Wife calls 9-1-1 immediately, and is instructed to do CPR. Ambulance arrives within a couple of minutes and goes through the entire drug box. Initial rhythm on the monitor indicates electric shock is possible. They worked the patient for about half an hour at the hospital, without any results.

No previous indication of heart disease that the patient had reported. Total blockage of the heart. Foaming at the mouth is unusual.

Or if you want another classic:

Husband goes to bathroom with magazine. Wife hears loud groan from bathroom, but doesn't worry. After half an hour and no response to pounding on door, wife calls 9-1-1. Ambulance arrives to find guy on toilet, unresponsive, checks vitals, checks with ER doctor, and declares the husband.

Best of luck,

Jim Clark-Dawe

08-22-2009, 06:02 AM
I agree foaming at the mouth is unusual for a heart attack; it might be more common with something like congenital heart failure.

My mother in law died from heart failure. In her case when it happened she was being walked and said she needed to stop to catch her breath and then said I can't catch my breath. I wasn't there so I don't know all the details, but it might be something worth looking into.

My husband survived his heart attack, but he did go completely out in the ER. When he had the attack he woke me up during the wee hours of the night. He was bathed in sweat, dripping actually, and cold and clammy to the touch. By the time he woke me he'd consumed about a dozen anti-acids, but they hadn't done anything to relieve the pain. He was ambulatory and able to walk to the ambulance, but then "died" in the ER. When he went out, his eyes rolled back in his head and his head slumped over. It was obvious he wasn't there. One of his arteries was completely blocked.

Check into "widow maker" on Google to see if you can get more information. Puma

08-22-2009, 06:13 AM
A med call I did once involved a male, 60ish who had been exercising a bit in late afternoon. He had a family history of heart problems, but hadn't had any himself. He started having pain about 11:00. We were called in about midnight. When EMS arrived they told him he wasn't in too much danger (due to where the blockage seemed to be), but was having a heart attack. The thing that struck me was how upset/anxious he was (not that you wouldn't have a right to be upset...) even before we put him on the stretcher and told him what was going on. If your patient is aware of his surroundings, I would think he's going to be freaking out until he goes unconcious, which would be rough on the wife.

Around here, if she were to call 9-1-1, when he hits the floor (or perhaps even before that if she has time to realize something is wrong before he goes into cardiac arrest), she would be asked if she could do CPR. When Fire or EMS arrives, they'll take over, or start CPR and hook up a De-Fib. If there's a shockable rhythym, we'll try that. I have never seen them use drugs here. EMS will take a Firefighter on the Ambulance with them to help do CPR all the way to the hospital. The person won't be declared dead until they get to ER.

08-22-2009, 06:13 AM

jclarkedawe, that first scenario could work. He does have the family history and meds, though.

Puma, thanks. The details are helpful, and I appreciate your willingness to share them. I will check out that search.

JrFFKacy, thanks for the detail. Very helpful.

08-22-2009, 06:42 AM
Foaming at the mouth is not at all typical of an MI. In fact, I've never heard of it.

When a main coronary artery is blocked, the symptoms of chest or arm pain, shortness of breath, and profuse sweating, as was described, are common. However, when the blood supply is cut off from the heart, the heart muscle dies, and depending on the extent of the damage, that can cause an arrhythmia which results in loss of consciousness in a matter of seconds, sometimes without warning. In a case that severe the heart often stops and death is the usual outcome, and although resuscitation efforts may take place, the victim is for all intents and purposes already dead.

So yes, it can happen very quickly -- basically you just keel over.

08-22-2009, 06:46 AM
rugcat, thanks for all.

Re: the foaming ... I think the situation my father-in-law suffered was atypical. Due to the sensitive nature of the event, I can't really ask my mother-in-law for details or help—which is too bad because she is an RN with loads of experience in this area. She would be an excellent resource, but it's just too close to home for her for me to be posing cold questions related to my writing.

08-22-2009, 07:11 AM
Bit out in left field, but I have heard of a heart "exploding" as the result of a drug overdose - pretty sure it was heroin - and from what I understand that can happen. So that's another possible google search. Might give you some insights. Puma

08-22-2009, 07:22 AM
I have heard of one person who's heart exploded. But he'd had loads of trouble. He was a mortician and had just helped load in a very heavy body, he started having chest pains there, but decided to get the body back to the morgue before it warmed up and then call for help according to the other person in the car with him.

He drove for about five minutes, grabbed his chest, veered off the road and was dead. 911 was called, they tried and tried to revive him but when they took a chest x-ray to see the damage, there was simply not a whole heart left, it had exploded. I don't know all the details as it was my friend's father and really didn't want to press her for all the gory details while she was mourning for her father, who was only 46 btw.

ETA: I was searching around because i was curious as to why a heart would explode. This site has a lot of indepth answers about the whole heart attack thing.


08-23-2009, 04:17 PM
The red/pink foaming at the mouth sounds like a popped pulmonary embolism. That would push a lot of blood into the lungs, mixing it with the air and eventually making its way out to the mouth.

08-27-2009, 12:33 PM
A relative died of a heart attack. It was completely silent. His wife woke him as usual for morning tea; he said he'd like to sleep in a bit. Later, there was a phone call for him, and she went to wake him up and couldn't. He was gone. She was in the same apartment the whole time, knew nothing, saw nothing, suspected nothing.

Someone who had sat at several deathbeds once told me that the 'death-rattle' really did happen, a sort of gasp/ snore/ strange sound.

08-27-2009, 02:26 PM
Actually pink frothy foam coming from the mouth could be pulmanary edema- which can accompany a heart condition or occur on its own- A heart doesn't literally 'explode' but the muscle can be so damaged it looks like it has on autopsy-

a Possible scenario for your character (other than the great ones already suggested) could be something called Prolonged QT syndrome-a condition that affects, often fatally, young people- if you google it, you'l get more detailed info than I could give you on only one cup of coffee :)

08-27-2009, 06:33 PM
I wasn't present at the time, but my father went with a massive heart attack. He and my mother were leaving a Bingo game, walking to the car. Next to the car, he grabbed his chest, winced in pain, and fell to the ground. Paramedics were called and performed CPR, but they estimated he was dead before he hit the ground.
Unfortunately, my mother refused to allow an autopsy, so the doctors could only base the COD on the symptoms and his history.