Speed saves: Fast response is critical for heart attack survival
When a heart attack strikes, quick action can be the difference between life and death.
Across borders and oceans, the devastation is undeniable. Ischemic heart disease – which covers chronic conditions such as coronary artery disease along with acute conditions which occur suddenly, namely myocardial infarction, the medical term for a heart attack – remains solidly near the top of the world’s leading causes of death.
Globalization is one factor behind the ever-increasing number of heart attack victims in recent years, as more of the developing world adopts the unhealthy habits of the developed world. Thailand is no exception; the annual number of Thais suffering heart attacks has more than doubled in just the past seven years!
Who’s at risk?
Heart attacks are more likely to strike people who already have a chronic medical condition such as diabetes, hyper-tension or obesity. But even if you don’t have another health problem, unhealthy lifestyle habits increase your odds for a future heart attack.
Lack of exercise, smoking, diets high in fat and choles-terol, and too much stress each contribute to an increased risk of heart attack. As with other life-threatening health conditions, surviving a heart attack – and minimizing the extent of permanent heart damage – often depends on receiving urgent medical attention.
The role of plaque
According to Dr. Visuit Vivekaphirat, a board certified cardiologist at Bumrungrad, plaque build-up in the coronary arteries is a leading cause of heart attacks. “Most heart attacks are caused by a blood clot blockage in a coronary artery that restricts blood flow to the heart,” Dr. Visuit explains. “These blood clots are formed by a hard substance called plaque that accumulates within the walls of the coronary arteries. Plaque is essentially a mass of cholesterolcells that may become lodged inside an artery. If the mass should rupture, the resulting bleeding can lead to the formation of blood clots.”
While chest pain is the most recognized heart attack symptom, many episodes of chest pain are easily mistaken for a heart attack. When chest pain produces a sensation of a heavy object pressing on the chest, or when the victim can’t identify the location of the pain, and the pain persists for more than 20 minutes, the likelihood of a heart attack is high, and urgent medical help is needed.
“When deprived of blood, the heart’s muscle tissues begin to die,” says Dr. Visuit. “Restoring blood flow quickly is critical to limit the extent of tissue damage. Cardiologists are fond of saying ‘time is muscle’ to remind us that treating a heart attack requires fast action. The more muscle tissue we’re able to save, the more likely the patient will survive. And preserving muscle tissue reduces the risk of future complications such as arrhythmia or heart failure.”
As soon as the heart attack sufferer arrives, the doctor will take his or her medical history and then proceed to diagnostic testing. Electrocardiography is typically used to confirm that the patient has indeed suffered a heart attack. Coronary angiography testing determines the specific location of the artery blockage.
With the nature and location of the blockage confirmed, the doctor will begin treatment to clear the blockage using one of the following procedures:
Thrombolysis: Also called thrombolytic therapy, this treatment uses medication to dissolve blood clots. Its usage depends on how much time has elapsed since the onset of the heart attack; it’s less effective the more time passes. The procedure also carries the risk of stroke, a side effect which occurs in about one percent of cases.
This procedure involves a catheter with a balloon at its tip being inserted into a patient’s blood vessel, where the doctor guides it to the area of the blockage. The balloon is then inflated, causing the obstructing clot to detach from the artery wall.
The angioplasty procedure sometimes includes the insertion of a stent to keep the artery open. The procedure has an outstanding success rate of 95 percent, versus 70 percent for thrombolysis. “The diagnostic and treatment procedures should be completed within 90 minutes,” says Dr. Visuit. “This requires that the full team of medical professionals – not only the doctors – has the expertise to perform electrocardiography within 10 minutes, while all necessary personnel, including a cardiologist and a radiologist, are summoned and ready in as little time as possible.”
While research continues to evaluate potential plaque-reducing medications, lifestyle modification remains the most effective way to lower one’s personal heart attack risk. “There are several key heart attack risk factors,” Dr. Visuit explains. “Along with having a family history of coronary heart disease, heart attack risk is often correlated to chronic diseases like hypertension and diabetes, and to lifestyle factors including smoking,of exercise and poor nutrition habits.”
“For those patients at higher risk,” Dr. Visuit continues, “I usually encourage them to regain control over their diets and to quit smoking, and many are good candidates for taking medication to lower cholesterol. There are a number of proven medications that work by limiting the absorption of cholesterol from foods such as dairy products, egg yolks, and animal fats from beef, pork and shellfish.”
Oxygen and exercise
Along with healthier eating habits, regular exercise prevents heart attacks. During exercise, the body goes through tiring periods of lactic acidosis and blood supply depletion, which prompts the body’s cells to increasetheir oxygen intake. This strengthens the ability of every part of the body, including the heart, to withstand any interruption in blood flow for longer periods and with less permanent damage.
“There are many things we can do to help prevent heart attacks and prolong life,” notes Dr. Visuit, “such as medication, bypass surgery, angioplasty and controlling diabetes. But exercise is probably the simplest, most effective means of prevention. Many people struggle to stick to their exercise regimen; after all, it takes effort and discipline. But the payoff in preventing heart problems is truly worth the extra effort.”