Tuesday, July 14, 2020

Acute Myocardial Infaraction-Heart Attack

Highlights: 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. Present article is aimed to provide information about how and why heart attack (AMI) occurs, their treatment and prevention strategies.

Acute Myocardial Infarction also called heart attack, is due to a sudden occlusion of blood vessels called coronary arteries that supply blood to the heart muscles. Heart is a pump and pumps blood to the entire body and organs according to the need of the body and activities. 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 build up of fatty materials, called plaque. They damage the heart muscle as a result of which pump becomes weak and unable to pump the blood to the vital organs. Depending on the blood vessel location, the heart attack may be called mild attack to severe attack causing shock and heart failure. If the block is in the initial port of heart blood vessel, it produces massive heart attack and sometime sudden death.

The common cause of heart vessel block is thickening of the inside portion of blood vessel due to cholesterol deposition and sudden developments of blocks on the inside vessel of the heart. The blood becomes thick and clot completely block the blood flow to the heart muscles. When the heart vessel get blocked, the person feel pain or discomfort in the chest, breathlessness, giddiness and sweating. Many a times the pain or discomfort is mistaken to have gastric acidity problem or muscular pain. The immediate test is Electrocardiogram (ECG), now available in many places. If ECG is abnormal, patient must be shifted to nearest cardiac center where Intensive Cardiac Care Unit (ICCU) is available.

After confirmation of heart attack, patient is given 300 mg of tablet Aspirin dissolved in water and Tablet Clopidogrel 300 to 600 mg by mouth. These medications prevent platelet activation and further clot formation. To dissolve the clot, clot dissolving medicines called Tenceteplase 30 to 40 mg is given intravenously (IV). Patient must be shifted to hospital having angiographic laboratories and angiogram must be done to know the position of clot. Clot is removed by catheter and blocked blood vessel is opened by small 2 to 3 mm balloon. To prevent further block formation, a wire mesh called stent, is kept at the blocked site inside the vessel. These stents are coated with everolumus medicine to prevent re-blocking. These stents are called Drug Eluting Stents (DES).

The early the blood vessel opened, the better will be the benefit. Any delay in opening the blood vessel, the more the heart muscle is damaged and heart pump becomes weak. So early the vessel is opened, the more the heart muscles is saved. Ideally, the vessel opened within one hour is called Golden hour. Up to 4 to 6 hours also the benefit will be good. Suboptimal awareness, sociocultural and financial reason result in pre-hospital delays result in increasing the incidence of AMI. It is crucial for both physicians and patients to be aware of desire risk factors, as well as cardiovascular sign and symptoms, in order to mitigate symptoms to presentation times, towards optimizing patient care.

The heartbeat and blood pressure and oxygen is monitored thoroughly at the hospital stay especially during the initial 2 hours to 48 hours and appropriate treatment is followed in ICCU. Any fast, irregular beat is treated with small doses of direct current shock called defibrillation. If heart stops beating and respiration stops, a procedure called cardiopulmonary resuscitation is started wherein artificial mouth to mouth breathing and chest cardiac massage started to restart breathing and hear beat. In general, oxygen, pain relievers, blood thinners, heart rate control medicines and IV saline in proper doses is given. \in mild cases and those receive early treatment, patient is shifted after 36 to 48 hours to step down care or to ward or to room. In stable patients sitting in bed, bedside chair is allowed after 48 hours. After that the stable patients is slowly made to walk (ambulation) with help and can be discharged after 4 to 5 days or in a weak. An unstable and complicated cases and patient with massive heart attack, are kept more time in ICCU and ward and carefully monitored. Many patients undergo angiogram depending on the condition of patient. To prevent further attack all patients are continued on blood thinners like Aspirin, Plavix and cholesterol controlling medicines called statins.

All heart attack patients are carefully followed by Cardiologist to prevent further attack and improve the cardiac function. Any risk factors for heart attack are identified and advised and counselling given. The risk factors for heart disease are smoking, diabetes mellitus, increased blood pressure (hypertension), high blood cholesterol called LDL and stress. Activities like walking is encouraged slowly under guidance called cardiac rehabilitation. Employment can be resumed in stable patients after 3 to 4 weeks. Test like TMT, ECG, Holter (24 hours ECG), 2D Echo Doppler, several blood test like serum creatinine, hemoglobin, lipid profile, thyroid, blood sugar and BP monitoring is done in many patients before advising activity and employment. With early treatments, modern medications and improved cardiac care many patients are able to resume their daily work at an early date. In general, family life case be started after 3 weeks depending on the state of the heart condition. By early detection, treatment and proper medical help and guidance, most patients are resuming their normal health and activities.

Dr. N.V. Rayudu
Dr. Prashant Prabhakar
Cardiologist
Bahrain Specialist Hospital Juffair

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