Early intervention saves heart muscle: doctors

Ramya Kannan

Smokers, those with diabetes or hypertension should not ignore pain in chest region

It has been established that thrombolysis agents relieve the clot in 60-65 per cent of cases

It is also necessary to ensure that the clot is removed entirely to maintain quality of life

CHENNAI: Tim (name changed), a 30-year old male, chronic smoker, suffered a kind of crushing pain in the chest. His pain started by about 8.30 a.m., he said later. But when he actually reached the hospital, it was 11.30 a.m. At Sri Ramachandra University Hospital, he was told that he had suffered an acute heart attack.

Everything was classic about this case, except perhaps the patient’s age. Tim was young, but his smoking habit; the pain; and the delayed admission to hospital were all typical. What was to happen next however, was not quite conventional, and it was to save Tim’s life. A primary angioplasty was performed to remove the clot and a stent placed to normalise blood flow. Only 76 minutes after he reached the hospital, his pain subsided and the ECG showed significant improvement.

Normally, any patient who is admitted with a heart attack is subjected to a process called thrombolysis, wherein, an intravenous drug is used to bust the attack-causing clot in the heart. “The conventional procedure the world over is to thrombolyse a patient who comes in with a heart attack,” explains S.Thanikachalam, Chairman, Cardiac Care, SRU. Alternatively, the patient gets a fibrinolutic drug to re-establish blood flow to the heart.

The theory now is that the heart muscle cannot withstand lack of blood supply over 90 minutes. Unless blood supply is renewed, the muscle will waste. “Our motto is ‘Time is Muscle.’ It is also necessary to ensure that the clot is removed entirely, or the patient’s quality of life will be compromised, apart from rendering him or her prone to sudden death,” Dr. Thanikachalam explained.

It has been established that thrombolysis agents relieve the clot in 60-65 per cent of cases. The remaining 40-35 per cent of cases die because of failed thrombolysis or go home with a weak heart due to a large portion of the heart muscle being permanently damaged, G. Sengottuvelu, interventional cardiologist, SRU Hospital, said.

The sooner intervention begins, the lesser the damage to heart muscle, he added. While angioplasty traditionally involves using a balloon to open up the clogged blood vessel, his team preferred to use a catheter and suction apparatus sent in through the radial artery in the hand, to remove the clot entirely in a procedure called Primary Angioplasty.

“More recently, this procedure is being done without the conventional balloon dilation because of the possibility of the blood clot migrating down the same vessel. The success rate of Primary Angioplasty is more than 95 per cent when performed by experienced personnel,” Dr. Sengottuvelu added.

While advances in medical technologies can reactivate blood flow in record time to save the heart muscle, unless the patient comes in early, there is very little medicine can do to help, Dr. Thanikachalam said.

“If anyone who is over 40 years of age, who is also a smoker, or has diabetes or hypertension, feels a diffused type of pain in the chest region, giddiness and has episodes of cold sweating, I’d advise them to take an aspirin along with an antacid and rush to a hospital. Let the doctor decide if it is chest pain or gastritis,” he added.

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