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Image Source: Google
Image Source: Google

These, in turn, show up in people as raised blood pressure, elevated blood glucose and overweight and obesity, risks detrimental to good heart health.

When a 42-year-old patient complained of chest pain, his family rushed him to Ruby Hall Clinic, where Dr M.S. Hiremath and his expert team immediately wheeled him into the catheterization laboratory and performed an emergency angioplasty on him.

Therein, a thin tube was threaded into the blood vessels of his heart to remove the blockages. A few months down the line, he is fit as a fiddle performing all his daily activities.

He is one of the many young Indians to have been affected by a heart attack, and one of the lucky few to have received the correct treatment in a timely manner.

Drawing light on the statistics, Dr Santanu Guha Former President of Cardiological Society of India (CSI) and Program Chair for STEMI Guidelines of India says, “In India, around 3 million heart attacks occur every year. Of these, around 1.8 million patients do not receive any important therapy like urgent angioplasty or thrombolytic therapy.”

He added, “If these untreated patients can be offered lytic therapy by improving the set-up in the non-urban hospitals will immensely improve the care of heart attack patients in our country.”

However, strides have been made in the field of prompt treatment, so much so that mortality was as high as 14% just a couple of decades ago while today, that figure has been brought down to under 5%.

This World Heart Day, Dr Shirish (M.S.) Hiremath, Director, Cath Lab, Ruby Hall Clinic discussed the evolution of such life-saving procedures as well as draws a comparison with treatments offered in the west.

Dr Hiremath, said, “In mid-80’s the clot-dissolving medicines made a huge impact. These were effective if given in first 2-3 hours of the attack and even paramedics were encouraged to administer these in the ambulance, at home or in the helicopter used to transport patients from remote sites.”

He informed, “Then came an era of clot-dissolving medicines which were given in one shot, as a bolus, making them more effective and easier to administer. These clot-dissolving medicines were called ‘thrombolytics’. This era gave way to Primary Angioplasty (PAMI). In PAMI, the patient is taken directly to the cath lab and the blood flow is established with a balloon, thrombus aspiration and stent.”

When compared to thrombolysis, the re-establishment of blood flow from the blocked artery is guaranteed with PAMI.

This is a major reason why the entire western world has moved away from thrombolysis to PAMI and cath labs are kept open and busy 24×7.

Why then do practitioners in India still administer thrombolysis when PAMI is known to be more effective?

Dr Hiremath explained, “While ideal situations call for patients coming into the hospital within the first one hour — the ‘golden hour’, this may not always be possible especially in a country like India. Therefore, the concept of lyse (dissolve with thrombolysis) ‘now’ and angioplasty ‘soon’ was born.”

“This pharmaco-invasive strategy proves to be beneficial because thrombolytic medicines can be administered in very remote areas, thus salvaging the heart muscles and allowing the patient to stabilise, and then be shifted to a cath lab for an angioplasty. In fact, Indian data strongly advocates the pharmaco-invasive approach over PAMI,” he concluded.

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