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February 2011
Immediate Cardiac Care
Dr Y Vijay Chandra Reddy
 
The whole, they say, is greater than the sum of the parts. Our delayed action on the New Year good health resolutions might add up faster than we think. The decision to have that one last cigarette before you quit, to postpone taking a walk till tomorrow, or to indulge in just one more piece of halwa… these procrastinated decisions are constantly adding up. Acute myocardial infraction or heart attack is the commonest cause for the loss of life among both young and old people today.

As a matter of fact, India is the only country in the world, in which people in their twenties and thirties suffer massive heart attacks which require immediate angioplasties. Consider this – 40 per cent of the victims are below the age of 45 years.

We, Indians, are genetically more prone to heart attacks – and our dietary habits, sedentary lifestyle and newfound stress post-liberalisation, add to the problem.

The Hours
To tackle this problem we need to take two steps. The first one is, to prevent people from neglecting their health to such an extent that they have a heart attack in the first place. The second step is, to take immediate action when a heart attack does take place.
  • When an artery gets blocked, heart muscles begin to die.
  • If a patient comes to a doctor within two hours of a heart attack, he will immediately be administered thrombolytic agents to dissolve blood clots causing the heart attack.
  • After this, a primary angioplasty is carried out,even while the heart attack is taking place.
  • Both these measures dramatically improve the patient’s chance to survive the attack.
  • Beyond two hours, thrombolytic agents cease to work effectively.
  • Unfortunately, most patients reach the hospital after two hours. This significantly lowers their options.
Lost Time, Lost Life
The effective treatment of heart attacks is hampered by time delays. Most patients arrive too late to be treated with thrombolytic agents, significantly lowering their chances of survival. Young patients, meanwhile, don’t believe that they are having a heart attack. A 20-year-old student, for instance, will probably think that he has gastritis or something minor and neglect the initial warning signs of a heart attack.

Who Will Die of a Heart Attack?
The Killip classification system is used to stratify those having a heart attack. Those with a low Killip class are less likely to die within the first 30 days after their myocardial infraction (heart attack) than individuals with a high Killip class:

1. Killip class I: Individuals with no clinical signs of heart failure.

2. Killip class II: Those with crackles in the lungs and elevated jugular venous pressure.

3. Killip class III: Patients with frank acute pulmonary oedema (failure of the heart to remove fluid from the lung circulation fluid accumulation in the lungs, leading to impaired gas exchange, liable to may cause respiratory failure).

4. Killip class IV describes individuals in cardiogenic shock or hypotension (measured as systolic blood pressure lower than 90 mmHg), and evidence of peripheral vasoconstriction (oliguria, cyanosis or sweating).

While Class I patients have a 99 per cent survival rate, Class IV patients are the least likely to make it. But today, owing to advancements in technology, even Killip Class IV patients can have low mortality rates.

Immediate Help
  • Once a patient reaches a hospital, in-hospital delay also lowers their chances of survival.
  • Ensure the hospital you drive to in case of a cardiac emergency is Primary Angioplasty (PA) capable. These hospitals should have technicians who work round-the-clock to deliver medical reports. For instance, Apollo Hospitals is one of the few in the country to have a 24x7 CAT lab.
  • If a hospital does not have the necessary expertise, they should arrange for the immediate transfer of their patients to hospitals with PA capabilities, after administering preliminary treatment to the patient.
  Dr Y Vijay Chandra Reddy is Consultant Cardiologist at Apollo Hospitals, Chennai


    
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