Acute Heart Failure

Management of acute Heart Attack

If you are having pain suggestive of heart attack see your physician or report to a hospital as soon as possible. During last decade the treatment of heart attack changed dramatically. Now a days only 7 to 15% of patient die due to acute heart attack. The most alarming part of heart attack is sudden death and the patient may die before reaching hospital or doctor. Almost half of all victims of myocardial infarction die before they reach hospital. This type of death is due to electrical disorder of heart which is preventable. So, see your physician as soon as possible.

One of the major advances in clinical medicine over last few years has been the realization that most acute heart attacks are caused by a clot in one of the arteries supplying blood to heart. When a clot forms at a narrowed area, total obstruction of blood flow occurs resulting in a heart attack. We now know that we can minimize the damage to the heart muscle during a heart attack by reopening the artery as soon as possible by injecting clot dissolving drugs or by emergency PTCA. Thrombolytic medicines dissolve the clot within the coronary artery and restore blood flow. It has been demonstrated through numerous studies all over the world that prompt administration of thrombolytic agents reduces both the short and long term mortality rate.

Both thrombolytic therapy and primary angioplasty are successful in restoring blood flow in the affected artery. But which modality is the best was not yet proved conclusively. Possibly immediate PTCA is more advantageous than thrombolytic therapy but it is expensive and requires very high technology and expertise. Both angioplasty and thrombolysis are effective in restoring blood flow in most patients with heart attack. Since the rates of short term survival appear to be similar with both treatments, the preferred treatment is the one that can be applied more quickly, safely and expertly. For most patients, this continues to be thrombolytic therapy. In general, thrombolytic treatment is prescribed for patients experiencing an unequivocal acute heart attack with specific ECG changes presenting within 6 hours of their chest pain. The amount of heart muscle that can be saved is highly dependent on the time delay between the onset of the symptoms of a heart attack and the measures taken by a physician to restore blood flow through the artery of the heart. Therefore, the earlier thrombolytic treatment is begun, the greater the benefit in terms of reducing damage to the heart muscle. Patients with suspected acute infarction, pain for 6 hours or less, aged 75 years and younger and with no risk factors for serious bleeding (no history of previous stroke, recent bleeding or surgery, uncontrolled blood pressure) are good candidates for this type of therapy. It is presumed that if patient can be identified and treated very early after the onset of symptom the heart attack process can be essentially aborted. First few hours are regarded as the golden period for giving thrombolytic injection. The excellent outcome associated with very early administration of thrombolytic drugs has several implications. It can reduce the size of the heart attack and can reduce the fatality. The time delay between chest pains to seeking medical care is very important. The vast majority of patients are still at home at the end of the first or golden hour. If treatment can be started within one hour of pain mortality can be reduced by 47% and within 3 hours by 23%. But thrombolytic drugs can be used up to 12 hours of onset of pain with significant benefit.

This drug can dissolve the clot and reduce the fatality. Administration of this drug does not require any high technique and expertization. Even a nurse of paramedic can give this injection. The currently used thrombolytic medicines are Streptokinase, rt-PA and APSAC. Out of these medicines Streptokinase is widely used. Usually 1.5 million unit of streptokinase is given as a 1 hour intravenous infusion. During this time, the patient is closely monitored for any clectrical instability of the heart which may occur when the occluded artery begins to reopen. Streptokinase directly disintegrates the clot and reopens the blocked artery. Though this drug is very effective in heart attack but it carries a little risk of brain hemorrhage, about 0.3%.

Emergency PTCA may be done as an alternative to thrombolytic therapy in acute myocardial infarction only if performed in a timely fashion by individuals skilled in the procedure and supported by experienced personnel in high volume centers. Otherwise, the focus of treatment should be the early use of thrombolytic therapy.