A modern Outlook on the Heart Attack

Heart diseases have become the major killer disease all over the world with more people dying of heart attacks than of cancers, infectious diseases or respiratory diseases. Unfortunately, half the people who have had a heart attack have never had any symptoms before to warn them about the possibility of a heart problem. The first time they have a chest pain is when they are having a heart attack. Another important fact to note is that half the people who die of a heart attack die within the first hour. So, time is of essence and it is imperative that a heart attack is recognized at earliest and treated promptly.

Heart attack occurs when one of the arteries supplying blood to some part of heart, gets totally blocked. The final event causing heart attack is formation of blood clot on an underlying partial blockage in artery of the heart. So, the logical treatment for some one having heart attack, is to restore flow through the blocked artery either by dissolving the clot. partially or totally by “Clot buster” medications and is termed as “Thrombolysis”. Another alternative is to open up the blocked artery by balloon angioplasty with or without stenting, within 90 minutes of arrival to the hospital. This mode of treatment is called “Primary angioplasty”. Either of these will abort the heart attack by restoring blood flow through the blocked artery to muscles of the heart supplied by that artery. The sooner it is done better it is, as more heart muscle is saved from damage. As more and more time passes by from the time of onset of chest pain, more and more heart muscle is damaged permanently and the process is completed in 8-12 hours.

 

What should one do if one suspects that he is having a heart attack?

Any chest pain lasting longer than 15 min needs to have immediate medical attention, particularly if it is associated with sweating, profound weakness or shortness of breath. Waiting for family doctor to turn up and see you at home a few hours later or planning to see your doctor next morning in his chamber may not be such a good idea under the circumstances. One should immediately see the doctor. It may be good idea to rush them to a well-equipped hospital where all facilities to treat a heart attack are available in case it turns out to be one.

Is there some medicine which should be given at home before going to the hospital?

Yes, anyone suspected of having a heart attack should be given 325 mg of Aspirin immediately and it should be crushed in the mouth before swallowing. Only people who are allergic to asprin or have contraindication to it, should avoid this. They can have Clopidogrel 75 mg 4 tabs at one go instead. They should also try taking Sorbitrate 5 mg tablet under tongue, after sitting or lying down, and this may help relieve pain in some cases.

What happens after one gets to a hospital?

Immediate ECG and clinical examination by a trained doctor will confirm or refute diagnosis of heart attack in a hospital with well-equipped cath lab. Whenever a heart attack patients arrives, (after diagnosis of heart attack is established after taking a quick history, clinical examination and on ECG) the doctor would after ask the patient’s relative about choosing between 2 modes of treatment. “Thrombolysis” (i.e. attempt to dissolve clot in coronary artery with medicines) or “Primary angioplasty” (opening up artery with immediate angioplasty). Currently, the best available treatment of Heart attack patient reaching hospital in the first 12 hours of onset of chest pain is “Primary angioplasty” with success rate of 90 % in opening up the blocked artery. The success rate of Thrombolysis with first 2 hours is good to the extent of 50-70 % with STK/injection and a little higher with more expensive medicines like Tenecteplase. However, after the first 2-3 hours the success rate with Thrombolytic medicines progressively declines but that with “Primary angioplasty” remains same at 12 hours as in the first hour. However, the difference in cost of treatment is significant between the two modes. While thrombolysis medicine could cost anything form 4,000-30,000 the primary angioplasty with cost of a stent could be Rs 1.0- 1.5 lacs.

Is Primary Angioplasty available in our city?

With 20 years of experience of angiography and angioplasties behind them the team at B M Birla Heart Research now has good experience of primary angioplasty behind them as well. There is a round the clock “Primary angioplasty” service and team available at the centre for people having heart attack at any time of day or night. More and more primary angioplasties are being done every month since the launch of services 2 years ago, as people are getting aware of the better results with this new mode of treatment of a heart attack.

Often, a person experiencing chest pain or heart burn, ignores it as a gastric issue. It might be a heart attack as well. You are advised to go to your nearest medical center in the case of chest pain or heart burn.

 


Dr. Anil Mishra
Dr. Anil Mishra

Medical Director & Senior Consultant Interventional Cardiologist
Department of Cardiology