Acute myocardial infarction — heart attack or heart stroke in common words — is a common life-threatening emergency.
It is caused by total or near total blockage of the coronary artery — the artery supplying blood to the heart. There are three coronary arteries and the sudden blockage of one or more of these arteries results in a heart attack.
Since blood supply to a part of the heart is cut off, it can result in the risk of death. These blockages are usually the result of a sudden closure of the blood vessels due to the formation of blood clots and fatty plaques on pre-existing blocks.
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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.
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.
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.)
