Heart Attack

heart attack1 heart attack2

Myocardial Infarction, or Acute Myocardial Infarction (AMI) is the medical term for an event commonly known as a Heart Attack.

An MI occurs when blood stops flowing properly to a part of the heart, and the heart muscle is injured because it is not receiving enough oxygen.

Usually this is because one of the coronary arteries that supplies blood to the heart develops a blockage due to an unstable buildup of white blood cells, cholesterol and fat. The event is called "acute" if it is sudden and serious. Myocardial infarction differs from cardiac arrest, although cardiac arrest can be a consequence of MI. A person having an acute MI usually has sudden chest pain that is felt behind the sternum and sometimes travels to the left arm or the left side of the neck. Additionally, the person may have shortness of breath, sweating, nausea, vomiting, abnormal heartbeats, and anxiety.

Women experience fewer of these symptoms than men, but usually have shortness of breath, weakness, a feeling of indigestion, and fatigue. In many cases, in some estimates as high as 64%, the person does not have chest pain or other symptoms. These are called "silent" myocardial infarctions.

Important risks are previous cardiovascular disease, old age, tobacco smoking, abnormal blood levels of certain lipids, diabetes, high blood pressure, lack of physical activity, obesity, chronic kidney disease, excessive alcohol consumption.

The main way to determine if a person has had a myocardial infarction are electrocardiograms (ECGs) that trace the electrical signals in the heart and testing the blood for substances associated with damage to the heart muscle. ECG testing is used to differentiate between two types of myocardial infarction based on the appearance of the tracing.

An ST section of the tracing higher than the baseline is called an ST elevation MI (STEMI) which usually requires more aggressive treatment. If this is not the case, the diagnosis is confirmed with a blood test (usually troponin). Immediate treatment is Primary Angioplasty.

Primary Angioplasty -- Radial Angioplasty

How is Primary Angioplasty done?

after primary angioplasty before primary angioplasty
  • Get ECG done at earliest and consult Cardiologist.
  • If MI is confirmed in ECG, contact Dr Sunip Banerjee and his team.
  • If you have smart phone, the easiest way is to take the snap of ECG and send it via Whatsapp to our Consultant Interventional Cardiologist at +91 9836206342.
  • Do accordingly as advised by Consultant Cardiologist. If you are unable to contact an Interventional Cardiologist, then shift the patient immediately to the Health Centre capable of doing Primary Angioplasty.
  • Remember, first 2 hours from onset of disease is called "Golden Period" which implies restoration of blood supply through Primary Angioplasty - and causes minimal loss to the cardiac muscle.
  • If you reside remotely, shift the patient to the health centre who could do fibrinolysis through ST-K, and after initial stabilization of patient, they should be shifted to Primary Angioplasty enabled Hospital.


radial angioplasty

Convenience of Radial Angioplasty

Clearing a clogged or blocked heart artery once required open-heart surgery, followed by a weeks-long recovery period. Angioplasty, first done in 1977, offers a simpler alternative that doesn't require surgery or much recovery.

Results from a large international trial provide strong evidence for an even easier type of angioplasty that is done through the radial artery in the wrist instead of the femoral artery in the groin.

The radial artery supplies the hand with blood. It's the artery you press when you take your pulse.

This artery offers ready access to the heart and is sometimes easier to get at. Doing angioplasty through it also tends to cause less bleeding around the puncture after the procedure is over than the femoral approach.

Stent

A stent is a small mesh tube that's used to treat narrow or weak arteries. Arteries are blood vessels that carry blood away from your heart to other parts of your body.

A stent is placed in an artery as part of a procedure called percutaneous (per-ku-TA-ne-us) coronary intervention (PCI), sometimes referred to as coronary angioplasty (AN-jee-oh-plas-tee).

stent

PCI restores blood flow through narrow or blocked arteries. A stent helps support the inner wall of the artery in the months or years after PCI. Doctors also may place stents in weak arteries to improve blood flow and help prevent the arteries from bursting.

Stents usually are made of metal mesh, but sometimes they're made of fabric. Fabric stents, also called stent grafts, are used in larger arteries. Some stents are coated with medicine that is slowly and continuously released into the artery. These stents are called drug-eluting stents. The medicine helps prevent the artery from becoming blocked again.

Heart Failure

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Heart Failure (HF), often termed Chronic Heart Failure (CHF), occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the needs of the body. Symptoms commonly include shortness of breath, excessive tiredness, and leg swellingCommon causes of heart failure include coronary artery disease including a previous myocardial infarction (heart attack), high blood pressure, atrial fibrillation, valvular heart disease, and cardiomyopathy. The condition is diagnosed based on the history of the symptoms and a physical examination with confirmation by echocardiography, blood tests, electrocardiography, and chest radiography.

Here are some basic guidelines that will help you get started...

  • Control the salt in your diet. Decreasing the total amount of sodium you consume to no more than 1,500 mg (1.5 grams) per day is one of the most important ways to manage heart failure.
  • Learn to read food labels. Use the label information on food packages to help you to make the best low-sodium selections.
  • Eat a variety of foods to get all the nutrients you need.
  • Include high-fiber foods in your diet. Fiber is the indigestible part of plant food that helps move food along the digestive tract, controls blood sugar levels, and may reduce the level of cholesterol in the blood. Vegetables, beans (legumes), whole-grain foods, bran, and fresh fruit are high in fiber. The goal for everyone is to consume 25 to 35 grams of fiber per day.
  • Carefully follow your fluid management guidelines. Reduce your fluid intake if you have become more short of breath or notice swelling.
  • Maintain a healthy body weight. This includes losing weight if you are overweight. Limit your total daily calories and exercise regularly to achieve or maintain your ideal body weight.
  • Reduce alcohol consumption. Because alcohol can affect your heart rate and worsen your heart failure, your doctor may tell you to avoid or limit alcoholic beverages. Alcohol may also interact with the medications you are taking. Ask your doctor for specific guidelines regarding alcohol.

Cardiac Resynchronization Therapy

crt

An Implanted Cardiac Resynchronization Device is a medical device used in Cardiac Resynchronization Therapy (CRT). It resynchronizes the contractions of the heart's ventricles by sending tiny electrical impulses to the heart muscle, which can help the heart pump blood throughout the body more efficiently.

CRT defibrillators (CRT-D) also incorporate the additional function of an implantable cardioverter-defibrillator, to quickly terminate an abnormally fast, life-threatening heart rhythm. CRT and CRT-D have become increasingly important therapeutic options for patients with moderate and severe heart failure. CRT Three leads can be seen in this example of a cardiac resynchronization device: a right atrial lead (solid black arrow), a right ventricular lead (dashed black arrow), and a coronary sinus lead (red arrow). The coronary sinus lead wraps around the outside of the left ventricle, enabling pacing of the left ventricle.

Note that the right ventricular lead in this case has 2 thickened aspects that represent conduction coils and that the generator is larger than typical pacemaker generators, demonstrating that this device is both a pacemaker and a cardioverter - defibrillator, capable of delivering electrical shocks for dangerously fast abnormal ventricular rhythms (see separate knol on Implantable Cardioverter-Defibrillators).

ICD & Pacemaker

pacemaker

An Implantable Cardioverter-Defibrillator (ICD) is a device combining a cardioverter (Cardioversion is a medical procedure by which an abnormally fast heart rate (tachycardia) or cardiac arrhythmia is converted to a normal rhythm using electricity or drugs) and a defibrillator (Defibrillation consists of delivering a therapeutic dose of electrical energy to the heart with a device) into one implantable unit.

It is thus a small battery-powered electrical impulse generator that is implanted in patients who are at risk of sudden cardiac death due to ventricular fibrillation( Ventricular fibrillation (V-fib or VF) is a condition in which there is uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly) and ventricular tachycardia (a rapid heart beat that arises from improper electrical activity of the heart presenting as a rapid heart rhythm). The device is programmed to detect abnormal heart rhythms and correct them by delivering a brief electrical impulse to the heart.

The process of implantation of an ICD is similar to implantation of a pacemaker. Similar to pacemakers, these devices typically include electrode wire(s) that pass through a vein to the right chambers of the heart, usually lodging in the apex of the right ventricle. The difference is that pacemakers are more often temporary and are generally designed to correct bradycardia, while ICDs are often permanent safeguards against sudden arrhythmias.

The process of implantation of an ICD is similar to implantation of a pacemaker. People who have an implanted cardioverter-defibrillator can live full lives. Usually the ICD improves the living conditions of a patient significantly. As with a pacemaker, however, living with an ICD does impose some restrictions on the person's lifestyle.

Almost all forms of physical activities can be performed by patients with an ICD. All forms of sports that do not pose a risk of damaging the ICD can be undertaken by the patient. Special care should be taken not to put excessive strain on the shoulder, arm and torso area where the ICD is implanted.

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