World over , fewer patients with heart attack are being seen in the emergency . Decrease in disease due to reduction of pollution , reduced stress by staying at home , decrease in eating out etc is wishful thinking . There may be some reduction but more likely patients are not reporting to hospitals for treatment and the number of sudden deaths is increasing .
Heart Attack occurs when the blood flow to the heart muscle is cut off by the formation of a clot , usually on an underlying cholesterol deposit (plaque ) . With every passing minute , the heart muscle gets progressively injured , and may get permanently damaged if the flow is not restored .
Symptoms are usually pain is in the center of the chest , more like pressure , radiates to arms , jaw , neck , back , may be associated with profuse sweating and a sense of doom . It may be milder , feeling like gas, or a cervical pain , may come and go and then become constant , progressively increasing , at times becoming unbearable . The patient just knows that there is something really wrong .
In the presence of chest discomfort , ECG is the first test done , there are changes called ST Elevation – that are diagnostic of blockage of a heart artery. These changes in a clinical context are adequate to diagnose a heart attack
Chest discomfort that comes and goes , with ECG changes suggestive of heart attack , usually is investigated further with 2 tests : troponin I and ECHO .
Troponin I is a blood test that indicates injury to heart muscle – it is a very sensitive test – is abnormal 4 – 6 hours after the onset of discomfort .
ECHO is a ultrasound of the heart – if a part of the heart is not contracting strong enough or the heart is weak – it is visible . These defects develop after injury to the heart . The presence of a normal ECHO does not rule out underlying heart problem.
If a patient has STEMI or acute heart attack – the standard of care is to shift the patient to the cath lab as fast as possible , the Cardiologist does a procedure to open the artery , usually by placing a stent , after giving blood thinner. Restoration of blood flow stops the heart attack and the heart starts healing . Recovery of the heart is slow if there have been delays in reaching hospital and delivery of care . Care is a team or Institution based process – where the emergency , Cardiologist , Post procedure CCU care are all done in an integrated seamless manner . Coordination between all team members is essential for each patient to get the best care . With optimal process of care the mortality after suffering heart attack has reduced from 20% in the 1980’s to 4-5% these days .
In the COVID -19 pandemic , fear has overtaken all – patients and healthcare workers . This fear is more from lack of understanding . As we care for patients with COVID infection , and we learn from others doing the same world over , we realize that this epidemic will take its time to settle . We all have to learn to take precautions : they are universal .
These precautions work if done together – Hand Hygiene , Screening , Distancing and use of Masks . Each sounds small but put together , by each one of us , the effect is huge : A chain is as strong as its weakest link !
At Max , if a patient comes in with Chest pain suggestive of a heart attack , and the ECG shows changes that require an immediate procedure , CODE STEMI is activated – the cath lab is prepared , the Interventional Cardiologist , technical staff and nurses are ready – while the emergency team prepares the patient and shifts to the Cath lab – usually within 15 minutes and the procedure is performed . In the COVID Times – universal precautions are taken , so you will find all of us working with PPE kits . After the procedure , the patient will be shifted to the CCU and observed for 48 – 72 hours till recovery and mobilization before discharge. If there is any index of suspicion , COVID testing will be done . To prevent spread of infection in the hospital , knowing that some patients are asymptomatic carriers , we are inclined to COVID testing more liberally although ICMR does not mandate the test .
In the last month , we have seen 40% decrease in number of patients with acute heart attack as compared to April last year . A majority of patients , particularly elderly women , have come in 24 – 48 hours after onset of heart attack – they fear putting their loved ones to risk of acquiring infection and suffer till it is unbearable . Unfortunately these delays translate to poor outcomes.
It is my humble request , if you are not well and need hospital care – please do not delay – it is painful to see patients with treatable disease die from delays in care . Please do not fear the emergency or worry about un necessary isolation – we will take precautions to keep healthcare workers and patients safe as we continue to do what we can – serve and take care of patients
