Heart Attack

Its Consequences and Remedial Measures

HEALTH

PROF UPENDRA KAUL

Heart attack is the most catastrophic presentation of a heart disease.  If not treated effectively it has a mortality of up to 25%. A heart attack happens when blood supply to this vital organ gets blocked. It can be a silent disease and can be a cause of sudden death. Although typically it is seen more often in people with increasing age in both men and women, it is being seen often in younger people in our country. Men in early 30’s and 40’s are seen getting this potentially lethal disease with increasing frequency.
 The commonest cause is a sudden and complete blockage of a patent coronary artery by a freshly formed blood clot. The area of the heart supplied by this artery immediately gets affected and if blood supply remains cut off gets completely damaged (necrosed). The outcome of such a patient depends upon the size of the attack. If more than 50% muscle is affected the mortality can be up to 80% if not treated promptly.
Today very effective treatments for heart attack are available that can save lives and prevent sudden death. Its treatment is most effective when started within one hour of the beginning of heart attack symptoms. If patient get help during that first hour then chances of recovery increase. Many people hesitate to help heart patients because lack of knowledge and right information. It is very important to know the symptoms that may indicate heart attack and the emergency first aid treatments.

Symptoms:
• Chest pain with shortness of breath: Uncomfortable pressure, fullness, squeezing or pain in the center of the chest lasting more than a few minutes.
• Shoulder/arm pain: Pain spreading to the shoulders, neck or arms. The pain may be mild to intense. It may feel like pressure, tightness, burning or heavy weight.
• Other symptoms: May include anxiety, nervousness, cold, sweaty skin, Increased or irregular heart rate. Profuse sweating is a common accompaniment.
The patient may suddenly become breathless with severe air hunger and gasp for breath in a massive heart attack leading to heart failure. In some situations patient may lose consciousness and have what appears like a convulsion. This is related to either a very fast and chaotic heart beat or stoppage of the heart beat called a cardiac arrest.

  Symptoms Mimicking a Heart Attack and often ignored:
• Severe upper abdominal discomfort with feeling of fainting or throwing up.
• Pain in the jaw and teeth without any local dental problem, this is a
 referred pain and often accompanied by sweating and difficulty in     breathing.
How is a Heart Attack Diagnosed?
The actual diagnosis of a heart attack is always made by a doctor or a medical person. The diagnostic test is an Electrocardiogram which must be done as soon as possible and is a must before specific treatment can be started. There are situations though not very common in a full fledged attack in which ECG may not be diagnostic. Certain specific blood tests like troponin and MB CPK estimation are diagnostic in these situations.
A situation in which ECG may not be diagnostic is in patients with history of previous heart attacks and patients on permanent pacemakers. Blood tests and nuclear scintigrams are useful in such situations.
There are instances where the diagnosis of a heart attack is made by chance when an ECG is taken for clearance before undergoing surgery for an un related illness or for insurance purposes. These silent heart attacks are seen commonly in diabetics where the symptom of pain at the time of a heart attack is masked.

What should be done in this situation (First Aid)
Time is the most important factor to save the heart muscle from getting permanently damaged with bad short term and long term prognosis. The first
Hour after heart is also called the “Golden Hour” because effective treatment instituted within one hour to open the blocked artery can lead to complete reversal of the damage suffered. Delay in starting the treatment leads to irreversible damage to the heart. Treatment started more than 12 hours after suffering a heart attack is of very little use in most instances.
The best place to manage a patient with a heart attack is a hospital with facility of ECG monitoring and providing critical care. Coronary Care Units (CCU) are specialized areas where equipment and medical personnel to manage these sick patients is kept at one place. Early detection and prompt treatment is the goal of keeping these patients in this area which reduces the mortality of a heart attack from approximately 20% to 3-5%. This is achieved by restoring the blood flow in the blocked coronary artery eith er by using drugs “clot busters” (Streptokinase, tenectaplase etc) or if facilities exist by doing an emergency angioplasty and stenting.

Role of Health Service Providers:
A large number of patients with heart attacks do not live in major metros and cities and may not have access to basic facilities. It is therefore imperative that all the primary health centers and district hospitals to have the facility of ECG recording and interpretation. Besides this training of the physicians posted there to administer life saving drugs like aspirin and clot busters ( tenecteplase or at least streptokinase). Facilities for transferring these patients to bigger centers with facility of monitoring the ECG and higher treatment protocols also need to be reinforced.
Such basic facilities need to be created so that a patient with acute chest pain can reach a center with such basic facilities within 1 hour.

Health Education and Awareness Programs:
For any program to succeed the people are to be made aware about the symptoms of an impending heart attack. Unless this is done all programs developed to save the lives are not going to succeed. The importance of the community recognizing the need to seek health care cannot be overemphasized. The myths associated with chest discomfort and ascribing it to indigestion and gas need to be removed.
Unless a ECG is done diagnosis cannot be established. The guidelines state that within 10 minutes of the onset of chest pain a ECG should be done for prompt treatment to be initiated. It may look a tall order in several parts of our country but unless efforts are made precious lives will continue to be lost.
Lessons learnt from industrialized countries are before us. The mortality of a heart attack in these countries has been brought down to below 5%.

General Measures Before Patient is Shifted to a Hospital or a Medical Center
1. Have the person sit down and keep him calm. If clothing is tight then loosen it.
2. Immediately transport to the nearest hospital or ambulance service if available. Do not leave the person alone.
3. Nothing should be given except for sublingual tablets or any other medication prescribed by the doctor. A tablet of aspirin helps person to limit the damage.
300 mgs of aspirin chewed at the time of heart attack can reduce the mortality by 15 to 20%.
4. Make sure the patient continues breathing and has a pulse until the ambulance arrives or the patient reaches the emergency department of a hospital.
5. If there is no breathing or pulse, give Cardiopulmonary Resuscitation (CPR). Immediately place the palm of your hand on the patient’s chest just over the lower part of the sternum (breast bone) and press your hand in a pumping motion once or twice by using the other hand. This may make the heart beat again. If possible, raise the legs up 10 to 15 inches to allow more blood to flow towards the heart.
The most effective way to improve the survival after a heart attack is a prompt recognition and reaching a facility where at least a basic treatment can be initiated. If time permits reaching a well equipped cardiac center is the best bet. Remember delay can be fatal, Time is muscle. Getting a treatment of heart attack after 12 to 24 hours of the onset of chest pain is often futile.

Author is Executive Director and Dean Escorts Heart Institute and Research Center and Fortis Hospital, Vasant Kunj , Delhi

Lastupdate on : Mon, 29 Oct 2012 21:30:00 Makkah time
Lastupdate on : Mon, 29 Oct 2012 18:30:00 GMT
Lastupdate on : Tue, 30 Oct 2012 00:00:00 IST




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