Cardiologists Dr NV Rayudu and Dr Prashant Prabhakar share the facts on one of the most feared medical conditions.
A heart attack is a serious medical emergency! Acute Myocardial Infarction (AMI), also known as heart attack, is a leading cause of death worldwide. It happens when there is a sudden complete blockage of an artery that supplies blood to an area of your heart.
How
The heart is a pump that moves blood around the entire body. As we get older, the smooth inner walls of the arteries that supply the blood to the heart can become damaged and narrow due to a build-up of fatty materials, called plaque.
This damages the heart muscle resulting in weakness and an inability to pump the blood to the vital organs. Depending on the blood vessel location, the heart attack may be considered mild or severe causing shock and heart failure. If the blockage is in the initial port of the heart’s blood vessel, it produces a massive heart attack and sometimes sudden death.
Why
A common cause of heart vessel blockage is the thickening of the inside portion of the blood vessel due to cholesterol deposits. The blood becomes thick and a clot completely blocks the blood flow to the heart muscles. When the heart vessel is blocked, the person feels pain or discomfort in the chest, breathlessness, giddiness and sweating. Often the pain or discomfort is mistaken for a gastric acidity problem or muscular pain.
Treatment
The immediate test is electrocardiogram (ECG), which is now widely available. If the ECG is abnormal, the patient must be transferred to the nearest cardiac centre where an Intensive Cardiac Care Unit (ICCU) is available.
Once a heart attack is confirmed, the patient is given aspirin and other medications to prevent platelet activation and further clot formation. Clot dissolving medication is given intravenously (IV). An angiogram must be done to discover the position of the clot which is then removed by catheter and 2-3 mm balloon is used to open the vessel. To prevent further blocks, a medicine-coated wire mesh, called a stent, is inserter into the vessel.
The earlier the blood vessel is opened, the better. Any delay can cause further damage and weakening of the heart muscle. Lack of awareness, sociocultural and financial reasons may result in pre-hospital delays which increase the incidence of AMI. It is crucial for both physicians and patients to be aware of risk factors, as well as cardiovascular signs and symptoms.
The heartbeat, blood pressure and oxygen are monitored thoroughly at the hospital, especially during the initial two to 48 hours. Any fast, irregular beat is treated with small doses of direct current shock called defibrillation. If the heart stops beating and respiration stops, a procedure called cardiopulmonary resuscitation is started wherein artificial mouth-to-mouth breathing and chest cardiac massage is applied to restart the breathing and heartbeat.
What’s Next?
In general, oxygen, pain relievers, blood thinners, heart rate control medicines and IV saline in proper doses are given. In mild cases and those receiving early treatment, patient is moved after 36 to 48 hours to a general ward or room. In stable patients sitting in bed or the bedside chair is allowed after 48 hours. After this, stable patients will be encouraged to walk with help and can be discharged after four to five days.
In unstable and complicated cases and patients who have suffered massive heart attacks, a longer period in ICCU and careful monitoring is required. Many patients undergo an angiogram depending on their condition. To prevent further attacks all patients receive blood thinners and cholesterol medications.
Patients are carefully observed by the cardiologist and any risk factors are identified, advised upon and counselling given. The risk factors for heart disease are smoking, diabetes mellitus, increased blood pressure (hypertension), high blood cholesterol called LDL and stress.
Rehabilitation
For cardiac rehabilitation, activities such as walking are encouraged slowly under guidance. Employment can be resumed in stable patients after three to four weeks. Test such as TMT, ECG, Holter (24-hour ECG), 2D Echo Doppler, several blood tests such as serum creatinine, haemoglobin, lipid profile, thyroid, blood sugar and BP monitoring are carried out on many patients before advising activity and employment.
With early treatment, modern medications and improved cardiac care many patients are able to resume their daily work at an early date. In general, family life can be resumed after three weeks depending on the state of the heart condition.
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