Wednesday, June 28, 2006

Best Treatment for Acute Heart Attack

Acute heart attacks kill, explaining why the tremendous fear and importance in the management of coronary heart disease. Cholesterol accumulation in the wall of arteries, restricts blood flow, without damaging heart muscle, causes chest pains (angina) and can be uncomfortable. On their own, does not kill. However, heart attacks, caused by sudden total occusion of heart arteries, causes chest pains and damages heart muscle. This total occlusion, if not immediately relieved can cause severe heart muscle damage, can cause the heart to fail and sometimes to stop suddenly, resulting in death of patient.

Almost 40% of heart attack victims die suddenly, before medical attention can be given. For those who suffer a heart attack and seek medical treatment, in the 1970s, 20-30% die in hospital. Currently, in the new millinium, with the advent of IV clot busters, and angioplasty, this risk of dying, has reduce to 10% or less. Most deaths are those occuring in patient who are admitted in shock following an acute heart attack.

Most American Hospitals with good angioplasty teams (trained interventionist, with trained nurses on in-hospital 24hrs/7days call, and full supporting facilities), prefer angioplasty as the first choice and the medical evidence in these centers are excellent, though the cost is high. There is a recent paper, from Canada, by Dr Paul Armstrong, who studied 304 patients, who were divided into three groups (the first group receiving just IV clot buster, the second group receiving IV clot buster and then angioplasty the next day, and the third group receiving immediate angioplasty). He wanted to find out which group did the best. Of course, this study involved patients who were admitted with a heart attack of 6 hours or less duration. (timing is absolutely important. "TIME IS MUSCLE"). One of the difference between this study and the earlier ones, include the use of IV TNK (tenecteplase), the use of clopidogrel and of course 21st century angioplasty technique. It is also important to note that Canadians are more circumspect about heart attack angioplasty. As the study shows, group 2 and 3 had equal outcomes, but both were better then group 1. What it means is that IV clot-busters can help to save muscle to stabilise and recover and angioplasty the next day, is good enough. There is then no need to keep a full 24/7 team in hospital.

We still need to see this evidence duplicated by some other team. The last word is not yet said, although we all know the guidelines by the AHA and ACC. BUT, I must use this opportunity to again reinforce the message that the best treatment for heart attacks is to prevent coronary heart disease with diet, exercise and avoidance of diabetes, hypertention, obesity and cigarrette smoking. All males above 40 years and females above 50 years, should go for a routine medical examination. Also, if you have any two of these risk factors, and you have chest pains, please seek a medical opinion as soon as possible. Do not just deny it. Prevention is much better than cure.

1 comment:

Brate said...

In the cases of heart attack and cardiac arrest, or any other heart shocks, time sets to be the most crucial factor for the survival of the patient. Sometimes, a little knowledge regarding the immediate actions to be taken may help your near and dear ones to survive in such incidents. The response a person takes to treat a victim decides the probability of his/her survival. Its been my personal experience fighting to survive against a heart attack. A quick reorganization of your bodily responses may increase your chances of survival. Because of having many heart problems, I was enrolled in a concierge Healthcare program from elite health. I was attacked by a severe heart attack in a party, luckily surrounded by many people. Some of the sudden changes in my body was recognized by me and anticipated immediately. I got a very severe chest pain which was almost unbearable for more than a minute. I got the suspicion that I might be having heart attack, and immediately called my physician on the phone, and explained my condition and its severity. Because of the immediate guidance, I was directed immediately to have an aspirin which I used to carry with me as prescribed by my physician. It was quite a frightening experience for me to face such a heart attack, but somehow I managed to be calm until 911 arrived. I was immediately taken to the nearest hospital, where already my physician were present and have got everything setup according to my medical history. And it was in some matter of seconds that everything was in control. A doctor, who already have the complete knowledge of the medical history and fitness of the person, extra ordinarily ameliorate your recovery process. Hence such a concierge level program from Elite health, helped me a save my life, like many others.