One of the biggest achievements in medical history of recent times has been the improvement in the treatment and management of a heart attack. Three decades ago, a patient who reached the hospital with a heart attack had as much as 25 per cent risk of dying. Now, thanks to several strategies that have evolved over the years, the risk in a tertiary care centre has come down to 3-5 per cent.
This remarkable journey in the management of a heart attack has been possible primarily due to important milestones in the diagnosis and treatment of a heart attack.
Setting up of Coronary Care Units (CCU) for intensive monitoring of patients has reduced the mortality risk. Monitoring is crucial during the first few days after a heart attack because the risk is the highest. Use of aspirin, thrombolytic medications and newer blood thinner injections (glycoprotein receptor blockers) are some of the other important strategies that have helped reduce the threat to life after a heart attack.
Angioplasty is a technique that effectively clears blocks in the arteries of the heart and thereby, minimises heart muscle damage and the risks of dying. Angioplasty has been one of the key strategies in bringing down the mortality rate after a heart attack.
After a heart attack, angioplasty is done in three situations: primary angioplasty soon after a patient suffers a heart attack; rescue angioplasty when initial medical treatment is ineffective and angioplasty is required to clear the block; and staged angioplasty when a patient’s condition does not stabilise even after days of hospital stay.
Primary angioplasty has been highly effective in saving heart attack patients. But patients suffering from cardiogenic shock after a massive heart attack with extensive heart muscle damage cannot be saved. In such patients, the pumping action of the heart is so weak that the patient’s blood pressure drops to a very low level. This could lead to even massive fluid accumulation in the lungs, thereby causing severe breathing difficulty.
Even in these high risk patients, primary angioplasty has made a difference in outcomes. Two or three decades ago, patients with cardiogenic shock ran a 80-85 per cent risk of dying. Today, with the use of multiple strategies, including primary angioplasty, this risk is down to 40-45 per cent.
Sometimes a delay in conducting an angioplasty could also be the reason for mortality. In fact, time is the essence after a heart attack. The ideal time within which an angioplasty should be conducted is within six hours after the onset of the heart attack. Often, there is delay in recognising a heart attack and in transporting the patient to the hospital. Patients who develop chest pain in whom heart attack is even remotely suspected should be shifted to a hospital that has the facilities to diagnose a heart attack and offer state-of-the-art treatment modalities.
Such a hospital should be capable of performing angioplasty within a short while after arrival (door-to-balloon time). It has been shown that centres with door-to-balloon time of less than 90 minutes have a decreased patient risk and improved health outcomes. Such centres are also required to have doctors and paramedics trained and well-experienced in conducting primary angioplasties and in dealing with severely ill patients with heart attacks.
If you are a high risk patient or have such a patient at home, you need to do some homework beforehand. Find out which nearby centre specialises in angioplasty and has the latest technology and experienced clinicians on board. Look for a centre that conducts a large number of such procedures. It is a complex procedure that requires coordination among interventional cardiologists, anaesthesists and nurses and paramedics experienced in cardiac care. If an eventuality arises, the patient should be rushed to such a centre without any delay.
Understanding this need for quality medical care with least delay often sets the stage for a successful outcome after primary angioplasty.
By Dr Ranganath Nayak, Consultant Cardiologist at Wockhardt Hospitals, Bangalore.
