Friday, November 22, 2019

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

MOST READ

Annamaya Kosha

As per Ayurvedic and Yogic philosophy, ‘koshas’ are layer of energetic sheaths that are similar to energy bodies. These sheaths encase the physical human...

The 4th Edition of Isa Award for Service to Humanity Conferred to “EDHI Foundation”

His Majesty King Hamad bin Isa Al Khalifa patronised a ceremony at Isa Cultural Centre to confer the 2018-2019 Isa Award for Service to...

VIVA Bahrain partners with HRR Properties for Swiss-Belsuites Admiral Juffair

Offering integrated ICT and digital solutions to equip businesses with next-generation technologies, the agreement is part of VIVA’s commitment to support the Kingdom of...

Gulf Air and SpiceJet Sign MoU to Explore Greater Cooperation

  The two airlines to look at interline and codeshare operations between and beyond hubs Coordinated cargo services in India and Bahrain, engineering, security...

BREEF Fully Prepared for New Season

The Board of Directors of Bahrain Equestrian and Endurance Federation (BREEF) escalated their utmost thanks and gratitude to HH Shaikh Nasser bin Hamad Al...

19 Schools Join Zain Bahrain’s e-Waste Initiative in Partnership with Ministry of Education and the Supreme Council for Environment

Zain Bahrain, a leading telecommunications provider in the Kingdom, in partnership with the Ministry of Education and the Supreme Council for Environment (SCE), has...

Simple and Effective Tips to Prevent Dandruff in winter

Winter is just around the corner and with it comes one of the most common hair issues of all time - dandruff. Here, we...

Al Haddad Motors Service Week

Al Haddad Motors service week is back from November the 16th until the 21st with fresh offers. Get your Mercedes-Benz ready for the roads...

Growth and Transformation of Mature Economies with special reference to GCC countries

All the developed countries today passed through different stages of development. Initially, the contribution of the agricultural sector dominates. For example, at the early...

The ENTERTAINER 2020 has landed and it’s bigger and better than ever before!

Global digital lifestyle brand, the ENTERTAINER has launched its 2020 products with unbeatable offers in Bahrain on a private gathering at Baharat Restaurant at...

AUBH Welcomes Globally Acclaimed U.S.-based Incentive Engineering Expert for Series of Panels

Mr. Jaison Morgan, former White House and UAE Government Advisor holds three panels for AUBH ’s Inaugural Class, Faculty, Staff and Community The American University...

Azamat crowned inaugural KHK World Champion with two vicious performances in single magical night

Azamat Murzakanov maintained his professional record intact and made sure to get the most prestigious prize in sports under his provisional possession with two...

Bahrain growth narrative focus at Chartered Accountants’ conference

Speaker panel designed to make international expertise accessible to Bahrain’s exciting growth story Nearly 350 delegates from diverse industry sectors to attend annual...

Bahrain ranked first in MENA by Islamic Finance Development Indicator (IFDI) for seventh consecutive year

Bahrain has topped the entire MENA region for Islamic Finance development, according to the seventh and latest annual Islamic Finance Development Indicator (IFDI). The...

Southern Governor launched health programme

Southern Governor His Highness Shaikh Khalifa bin Ali bin Khalifa Al-Khalifa has today inaugurated a programme aimed at combating diabetes. The event  was attended by...