Health Focus: Heart

Each year, according to the National Institutes of Health, an estimated 1.5 million Americans suffer a heart attack or myocardial infarction. For nearly a third of them, the attack is fatal. But many of those deaths could have been prevented - if only the victim had received help in time. That's why it's so essential for all of us to know the warning signs of a heart attack.

Uncomfortable chest pain, pressure or a squeezing sensation in the chest that lasts for more than a few minutes
Pain that radiates to the shoulders, neck, jaw or arms
Chest pain accompanied by dizziness, sweating, nausea or shortness of breath. Not all of these symptoms will be present in all cases. The American Academy of Family Physicians says symptoms may come and go; some people having a heart attack may experience no observable symptoms

In addition, the U.S. Food and Drug Administration (FDA) say that women are more likely to have so-called silent or unrecognized heart attacks. In women as well as men, the symptoms may subside and then come back. But it's still essential to get immediate medical help if you suspect a heart attack. But studies show that many heart attack victims wait several hours - even up to ten hours or more - before seeking help.

Clot-busting or thrombolytic agents can be injected to dissolve clots and reopen arteries. Clot-dissolving drugs should be injected within a few hours of the onset of the heart attack, when they are most effective. However, that there are dangers from clot-dissolving drugs including stroke and internal bleeding in the brain, so they should be used with caution especially in elderly patients.

According to the recommendations of the American College of Cardiology and the American Heart Association Guidelines, emergency angioplasty-stent is the first choice of treatment for heart attack and should be preferred if :

It can be accomplished in a timely manner by skilled and experienced staff.
There is prompt access to coronary bypass graft surgery, if necessary.

Advantages of Angioplasty - Stent

About half the patients treated with thrombolytic therapy continue to have a significant blockage (since the treatment breaks up blood clots but does nothing for the underlying blockage) and reduced blood flow in the affected artery. In comparison, blood flow is brisk and a mild or no blockage is left behind in over 90% of cases treated with primary angioplasty with or without stenting.
The mortality or death rate with primary angioplasty is 60% lower than that achieved with thrombolytic therapy.
Risk of bleeding in the brain is 1/100 for thrombolytic therapy compared to 1/2000 for angioplasty-stent.

If Primary Angioplasty and Stenting is so good why is it not used in every patient with a heart attack? Nationally only 18% of hospitals are equipped to perform emergency angioplasty and stenting in patients with heart attacks, this form of treatment is not available in the remaining 82% of hospitals that admit patient's with chest pain. Remember that time is of essence in getting rid of obstructing blood clots and salvaging heart muscle. In most cases, the patient is far better off in receiving a "clot buster" medication in the emergency room if access to a hospital with a cardiac Cath lab that can perform angioplasty-stent is not readily available. The patient should then be transferred to the tertiary care hospital as soon as possible

Earlier the blocked artery to the heart muscle is opened, less is the damage. American College of Cardiology recommends such artery should be opened within 90 minutes of the patient's arrival to the ER. Nationally hospitals are able to provide that to less than 35% of patients.

As a director of the McLeod Cath lab, I am happy to report that in 2005, 70% and in 2006, 81% of such patients successfully underwent the procedure within 90 minutes at McLeod Hospital. This was possible as a result of team efforts of the staff in the ER, Cath lab team and the physicians. Every patient with chest pain in ER is considered, as if they have a heart attack and is triaged ASAP. If they do have a heart attack, the cardiologist and the Cath team, are called in STAT and every effort is made to open the artery ASAP. This and other achievements in cardiac care have led McLeod to be one of the best hospitals for heart patients in South Carolina. More information in that regard can be obtained at Healthgrades.com

Both hospitals in Florence, McLeod and Carolinas hospitals systems have the facility to provide the immediate care for patients with heart attack with angioplasty-stent. It is the vision of all cardiologists to continue to improve the time to open the blocked arteries and minimize the heart damage.

Heart disease risk factors

The risk factors for heart disease include:

Smoking
Lack of exercise
High blood pressure
Obesity
High cholesterol
Diabetes
Family history of heart disease
Gender, since males are at greater risk than females
Age, since the risk increases as we get older

It is important to remember that people without these risk factors can also have heart disease.

A RECENT CASE

A 63 year old patient with history of hypertension and high cholesterol presented to McLeod ER with a large heart attack leading to significantly low blood pressure and heart rate. Emergently, the patient was taken to Cath Lab., and a completely blocked artery to the heart was opened up with a stent, within 65 minutes. Patient went home on the fourth day with no damage to the heart muscle.

Dr. Anil Om can be reached at Pee Dee Cardiology Associates. Offices are in Florence, Loris and Seacoast Medical Center. His main office number is 667-1891.

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