Acute myocardial infarction (AMI)
|Fast defense for heart attack
In a do-or-die situation, only “do” can save lives.
, a condition commonly known as a heart attack, is a major cause of death for Thais and those from many other nations. The Central Chest Institute of Thailand reports that during the period 2003 to 2009, an average of 1,185 Thai people a day were admitted to the hospital due to heart disease, and of these around 470 were cases of AMI. While AMI is often as dangerous as it sounds, a good understanding, and prompt counter measures, can demonstrably increase a patient’s chance of survival. In this issue of Better Health, we met with Dr Chaianan Chaiyamanon
for advice that will help us better understand this disease.
Cause and condition
“Myocardial infarction is usually an acute ailment,” says Dr Chaianan. “When coronary arteries narrow, there is a higher chance that one or more may be blocked. It is impossible to predict when or where this will happen. I have seen many patients spend a healthy day on the golf course with friends, but suffer from chest discomfort at night.
Although there is no knowing when a blood clot will block an artery, depleting blood to the cardiac muscle, there are certain tell-tale warning signs.
“When a blood clot blocks the artery, a not-to-be-neglected chest tightening will follow,” Dr Chaianan explains. “Please note that I don’t use the word ‘pain’ but rather ‘tightness or discomfort’. The condition usually occurs at the center of the chest, persisting for over one minute. If you also experience an excruciating ache in your jaw or your shoulder, especially the left side, then you can be almost certain you are facing cardiac problems. Some patients may not experience chest tightening; they may instead suffer from exhaustion and if there is also intense perspiration then the artery is probably obstructed.”
Dr Chaianan further explains that various factors contribute to acute myocardial infarction, such as diabetes, hypertension and hyperlipidemia. These ailments are known to lead to AMI and such patients are advised to undergo regular heart check-ups. Evidence also shows that smoking and severe snoring with obstructive sleep apnea that deprives patients of oxygen will also damage the arteries and raise the chances of a blood clot blockage.
Aside from patients who have already suffered a heart attack, or are known to be in danger from the above risks, there are others whose arteries are persistently narrow but the blood supply is not cut off entirely.
“This category of patient will have conditions present only when their hearts are going through intense labor such as an exertion strong enough to substantially increase heart workload, or who have influenza or high fever. An effective treatment for these patients is to control the risk factors and to use prescription medications. If the condition is more severe, angioplasty may be required. If too many arteries have narrowed, bypass surgery may be necessary.
“What we need to accept is that when cardiac muscles are no longer healthy and your heart is weakened, your fitness will never be the same. If you want your heart to recover and return at least part way to its healthier self, then early treatment is needed. Do not be afraid to see a doctor and do make sure you find the specialist. What we have learned is that those who are aware of their symptoms and do not hesitate to get check-ups and treatment will considerably reduce the need for major surgery,” says Dr Chaianan.
When adverse conditions occur, the first priority is to get to a doctor as soon as possible. “The sooner the patient suffering a heart attack receives appropriate care from the doctor, the higher the chance of survival,” says Dr Chaianan. “Time is vital. Every minute that passes makes a difference to the patient’s future.”
When the patient arrives at the hospital, doctors and staff have a fast track for dealing with myocardial infarction. If a patient is suffering with chest tightening or exhaustion and coronary artery disorder is presumably the cause, an electrocardiogram can be performed to confirm the condition within five minutes.
Catheter with deflated balloon inserted in artery
Balloon inflated, plague compressed
Remove the balloon and keep the expand stent
“Here at Bumrungrad, we have what we call the Golden Period, a window of 60 minutes, during which our actions are critical for the patient.”
“If patients are aware of their anomalies and come immediately for treatment, we can quickly open the artery and save more of the heart muscle. These patients will be free of the risk from cardiomegaly (enlarging of the heart), and chronic heart failure, allowing them to return to their previous lifestyle or even better if they have a long history of coronary artery disease.”
Accept the truth
In an emergency, everybody knows that the best choice is to go to a doctor or to get the patient to the hospital as soon as possible. But when an emergency happens, there are few who can think and act quickly enough, and therefore medical help is unnecessarily delayed.
“I believe that if we accept the truth as it is and deal with it accordingly, it will lead us to prompt and proper actions. When there is a suspicious condition and you are aware you have health problems, don’t just keep wondering and doing nothing. You need to find out if what is happening is cause for concern. Health and illness are not superstition and only truth will help you make the right choice.”
“You can consult with a doctor even if it’s just something minor like exhaustion, because treatment is sure to be of benefit one way or another. We have ways to know the causes and to categorize those that can wait, and those that cannot and need further examination. Don’t believe anything that is based on just rumor or hearsay. There are many cases in which patients are told, and then believe, that this supplement, or that, can help with heart disease. They then stop coming to the doctor and thus may not receive urgently-needed treatment. This could greatly affect the quality of life should they later experience, and survive, a heart attack.”