Importance of Primary PTCA for acute myocardial infarction, aka heart attack

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Common symptoms, diagnosis

The common symptoms of a heart attack are severe pain in the middle area of the chest, breathlessness, giddiness, sweating, weakness, loss of consciousness, or even sudden death.

A heart attack is diagnosed by a electrocardiogram (ECG), 2D echocardiography (Echo), and blood tests like troponin.

Angiography is done in the the cath lab to identify the blocked vessel. (Medline Plus)

The immediate treatment for a heart attack includes the use of aspirin and other anti-platelet drugs, statins, and definite therapy like clot buster injection or primary percutaneous transluminal coronary angioplasty (PTCA).

Primary PTCA is the process of taking the patient, who has had a heart attack, for an immediate angiography procedure in the catherisation lab (cath lab) and identifying the culprit vessel.

A small tube called a catheter is inserted via an artery in the arm or leg and is passed to the heart. Following this, a dye is injected to visualise the blocked vessel.

Primary PTCA is done in a cath lab-enabled hospital, with at least one round-the-clock cardiologist, a trained cath lab technician, and trained nurses.

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Treatment for heart attack

Depending on the findings in the angiography, balloon dilatation and stenting of the blocked artery or aspiration of blood clots may be done.

An inserted balloon catheter inflates to open blocked blood vessel. (Johns Hopkins Medicine)

Angiography with balloon dilatation, or angioplasty, is a minimally invasive procedure in which a balloon-tipped catheter is used to open blocked or narrowed blood vessels, improving blood flow, often followed by stent placement, if necessary.

In some cases, to temporarily augment heart function when the pumping is severely compromised, mechanical support devices like IABP (intra-aortic balloon pump), ECMO (extracorporeal membrane oxygenation), or Impella may be used to stabilise the condition and further facilitate angioplasty and stenting.

Once the culprit vessel is identified, the blockage can be cleared by using a guide catheter, wires, and balloons.

Depending on the necessity of it, a metal tube with medication (stent) will be placed to restore the blood flow to the artery.

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Importance of Primary PTCA

Following a non-fatal heart attack, it is important to do the PTCA procedure as early as possible, as it will prevent loss of heart and muscle function, and also save lives.

The ideal time limit to inflate the coronary artery balloon is within 90 minutes of the patient’s arrival to the hospital, to salvage maximum myocardium (heart muscle) as possible.

Primary PTCA preserves heart muscle, reduces complications, and has been proven to be life-saving. After Primary PTCA, the patient needs to be on dual anti-platelet drugs, cholesterol-reducing drugs, etc.

It is important to take the medicines regularly, as otherwise, there are chances of the stent getting blocked.

Along with medication, the patients should also follow a healthy lifestyle, combined with physical activity as per individual capacity, and periodic follow-ups with cardiologists to prevent the recurrence of a heart attack.

Also, concerned authorities should educate the community about heart attacks and treatment options like Primary PTCA.

(Dr Sashi K Srivastav is a Consultant Interventional Cardiologist at Yashoda Hospitals, Hyderabad.)