Lack of knowledge of heart attacks and inadequate transportation facility and treatment options at small centres combine to take a toll of lives. But, the rate of fatalities can be reduced if people are educated on chest pain/symptoms of heart attack, if ambulances with life-saving systems are at hand, and patients reach well-equipped centres in time, says Cardiologist Thomas Alexander, who spearheads STEMI (ST Elevation in Myocardial Infarction), a movement to save heart attack patients.
Acute coronary syndrome (ACS) comprises a spectrum of acute cardiac emergencies resulting in reduction or complete cessation of blood flow through one of the coronary arteries, says Dr. Alexander. The consequence of this could vary depending on the vessel involved, area of myocardium supplied and the degree of blood flow reduction.
Types of ACS
There are three clinical conditions that make up ACS. Unstable angina is on one end of the spectrum and a patient undergoes sudden worsening of symptoms. However, there is no myocardial damage.
Non ST Elevation Myocardial Infarction (NSTEMI) is another condition which results in some myocardial damage. This is usually diagnosed by symptoms, ECG changes and an increase in cardiac enzymes — which indicate myocardial damage. The third condition and most dangerous condition is ST Elevation in Myocardial Infarction (STEMI). This is a condition commonly referred to as heart attack and requires emergency treatment, Dr. Alexander explains.
Significant myocardial salvage, after total occlusion (block) of blood flow through an artery, can be done only if the blood vessel is opened within the first three hours. The greatest benefit can be obtained if the artery can be opened within the first hour, and the smallest, though, until 12 hours.
Reasons for delayed treatment
The major reason for delay in treatment occurs because the patient does not recognise the symptoms as those of a heart attack.
Studies have shown that in India, the average time to get to a hospital after onset of chest pain is six hours. So any treatment given after this can only give marginal benefits. The reasons for this are many. Often the patient thinks it is a gastric problem and takes medications or tries some home remedies, thereby delaying going to a hospital. Or, if the pain occurs at night, it may be that the patient waits till morning to decide on seeking medical help.
Delay in hospitals
Delay occurs when a patient goes to a small hospital and a doctor has to come in to read the electrocardiogram (ECG) and make a diagnosis. However, the major source of delay in hospitals is the delay in the patient making a decision on the treatment.
Often, the decision on treatment and the ability to pay for, whether out of pocket or insurance, is decided not by the patient. Delays could occur while waiting for other relatives to arrive. Sadly, delayed decision making or consent can impact outcomes of treatment and even result in death. Studies have shown that delay by an hour can double mortality in patients with heart attacks.
Anybody with chest pain, especially with coronary risk factors such as diabetes, hypertension, high cholesterol, family history of heart disease or smoking, should not delay getting to a hospital and getting an ECG done. “Try to go to a hospital, preferably that has a STEMI (heart attack management) programme, or at least where you know an ECG can be done and interpreted immediately. Calling the 108 ambulance system is also another very effective way to get to an appropriate hospital,” Dr. Alexander advises.
Waiting for transport
While waiting for transport to a hospital using a soluble or chewable aspirin will help. However, it is very important to start early, definitive treatment and this can be done only in a hospital. “So do not delay getting to a hospital,” he says.