HEART ATTACK BASICS, Dec 2022

HEART ATTACK

                  Heart Attack is the sudden blockage of one of the vessels that supply to the heart. Heart is an organ that works non stop to supply blood to the entire body by which the brain, kidney, liver, muscles and all organs maintain the function. No organ can withstand even in a decrease in the supply from the heart. If heart itself got into lack of supply, it withstands the block for a certain period after which it goes for permanent damage of that area of the heart which has got no supply. Hence those minutes are called as golden hours. Getting treated at that particular period saves lives and improves the future quality of life. When the area of heart affected is more, it leads to HEART FAILURE in both short and long term. Heart Failure is a complication of Heart attack in most situations. There are many other complications of the heart attack that is also prevented when heart attack is been addressed immediately. 

           how do we treat ? 

        EMERGENCY PHASE -  CARDIOLOGIST 

The patient is admitted to emergency department of the hospital and shall be taken for an emergency procedure that can open the vessel. The emergency drugs which includes blood thinners, cholesterol lowering medications and other supportive medications would be given. The patient is then shifted to CATH LAB where emergency CORONARY ANGIOGRAM ( referred as ANGIO by public ). If there is no facility of performing angiogram, the physician administers THROMBOLYTIC medications ( costly medicine to dissolve the clot until the patient reaches ANGIO capable centre ). After ANGIO, the cardiologist demonstrates the blockage to the patients family and proceed with ANGIOPLASTY AND STENTING ( referred as STENT ) so that the vessel is opened. Then the patient is shifted to CCU for other supportive care like BP control, sugar control and to be prepared for any unexpected complication that can happen after heart attack as mentioned earlier. Although the rate of complications is significantly lower after opening the vessel.

     CCU/ICU SUPPORTIVE CARE - ICU/CCU TEAM AS PER CARDIOLOGIST ADVICE

   The patient is supported by the INTENSIVIST and the team for all supportive care. after 24 hours of observation, The patient shall be shifted to ward after verifying multiple ECGs, ECHO and other blood tests in the CCU. The complication rate is significantly less although with very lesser risk of complications. 

    REHABILITATION AND RISK FACTOR ANALYSIS

   The cause of heart attack is analysed and the risk factors shall be rectified. Mobilisation, education about all risk factors, diet and exercise are all done by CARDIAC REHABILITATION team. This phase may extend for a couple of days and very essential for the patient to recover from the shock of the treatment which has happened very fast. this is the time where the patient along with his family understands the illness properly and start SECONDARY PREVENTION. 

   DISCHARGE AND FIRST OP VISIT

  the patient is discharged after both the doctor and the patient is well convinced in all aspects. He is advised about the steps to be taken in the house. He is educated about his JOB, given any Admission and discharge certificates, counselled about all other personal problems. The fist OP visit is important than all visits since they may come with the greatest recovery. He would have multiple medications and shall be slowly decreased in subsequent visits. 

DR ARUN KAUSHIK P, MD,DNB(MED),DNB(CARDIO),FIC,FESC,FSCAI,DIP(IBLM)

Senior Consultant interventional cardiologist, Cardio Diabetologist, Lifestyle medicine consultant, PSG hospitals and Shadow clinics