Monday, February 06, 2006

What to do in case of a heart attack

This is part twelve of the series the heart of the matter. Part eleven can be found here and the disclaimer should be read here.

What to do if you think that you have a heart attack?

If you have a suspicion that you may be having a heart attack (chest pains as described, or not so typical chest pains in someone with two or more coronary risk factors), rest and call for help from a friend or relative. With their help, call for an ambulance to take you to the nearest medical clinic or medical center, where an ECG can be done. Blood tests may also be necessary. Time is of the essence. Delays should be avoided. The sooner treatment be started, the better.

At the offset, a few points must be understood and followed.
1. Allow the patient as much rest as possible. Don't let him exert or stress.
2. Get help as soon as possible. Try not to do it alone.
3. Get medical help as soon as possible. More time loss, more heart damage.

Remember "TIME IS MUSCLE".

If you experience chest pains, which you think could be due to a heart attack, especially if you have 2 or more cardiac risk factors, call a relative, friend or colleague to send you to the nearest medical clinic or center where an ECG can be done, and where you can be attended to quickly. DO NOT DELAY. TIME IS HEART MUSCLE.

Once a diagnosis of heart attack is established, the attending physician or cardiologist can re-establish blood flow quickly with the use of an IV thrombolytic (commomly called "clot buster"). These could be drugs like streptokinase or other clot-busters which are now available. The cause of the acute heart attack is very likely to be a blood clot in the major artery. Eating the clot away (that's how clot-buster drug works) is an effective way to restore blood flow.

However, it is important to note that some patients cannot receive these clot buster drugs. For example patients who have recently undergone major surgery, patient with bleeding tendencies, patient with a history of internal bleeding like bleeding peptic ulcer, patient who are allergic to the drug, patient who have had a recent stroke, and patients with uncontrolled hypertension. There are some drugs that work alongside the IV clot busters, like aspirin and plavix. They assist and enhance the good results obtained with the clot busters.

IV clot busters are good treatment for acute heart attacks. It is easily available. It can be administered by physicians and general cardiologists, and it is relatively cheap. However, there are many patients in-eligible for the clot buster therapy. The other very good means of re-establishing blood flow is direct, or primary angioplasty (clearing the artery with the balloon).

Angiogram and angioplasty can now be safely performed in patients who have just suffered a heart attack by interventional cardiologist and their team. In fact many clinical studies have shown that direct or primary angioplasty, when performed by a good interventional cardiology team, yield very good results. The procedure directly addresses the cholesterol plaque narrowing the artery as well as clearing the blood clot in the stenosis. It restores blood flow immediately. It is invariably associated with implantation of a coronary stent. The successful results or failures are immediately known. However the disadvantage is that, results are only good in centers who do them regularly. It also has to be done by specially trained "interventional cardiologist" and their teams to get good results. When done by teams not conversant with the technique, deaths can occur. Training and skill of the angioplasty operator and the team are important to get good results. Also, to get good results, the angioplasty has to be done as soon as possible after the heart attack, before the heart muscle cell damage becomes permanent. REMEMBER TIME IS HEART MUSCLE. Restoring blood flow with angioplasty after 4 hours or longer of chest pains only allows minimal recovery of the heart muscle and is of minimal help to the patient.

Not only does angioplasty provide complete clearance for the blockage, the accompanying angiogram allow detail examination of the whole heart circulation, providing a complete check for other potential culprit blockages waiting to cause another heart attack. Of course, besides the need for skilled personnel, direct angioplasty's other disadvantage is cost.

Other medications important in the management of a heart attack include, cholesterol lowering agents like "statins", agents to smoothen the artery wall like ACE-inhibitors (eg captopril) and angiotensin receptor blocking agents (eg Valsartan), vasodilators of the artery (eg nitrates), and betablockers (eg metoprolol). These drugs are in addition to the medication for hypertension and diabetes (common associated conditions). As you can see, the patient may indeed be loaded with a whole fistful of drugs, even after successful direct angioplasty.

In the next part we look at a case study.

Update: Greets to the folks heading over here from Glumbert. After watching the video we can only say, "Don't try this at home"

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