CLOTBUSTERS SAVE LIVES

Cardiac arrests might be taking their toll, but urgent medical attention is also saving the day in many cases

By Sushil Kutty

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Published: Fri 27 Feb 2004, 2:16 AM

Last updated: Thu 2 Apr 2015, 12:37 AM

Even as heart attacks continue to take a toll, advances in medicine are making an impact on the mortality of heart attacks, which today has been brought down to less than 7 per cent in the US.

"In Rashid and Dubai hospitals, I believe mortality rate has been brought down to 4.5 per cent. In Zulekha it is between 2 to 3 per cent. We are lucky, not smarter. But our patient population is younger, between 30 and 40," said Dr Amal Kanti Sen, cardiologist, Zulekha Hospital, Sharjah.

Dr Sen was speaking at a Synapse seminar - Zulekha Hospital's medical continuing eduaction programme - on the subject From Vulnerable Plague to Vulnerable Patient. He said that 19 million people worldwide experience acute coronary syndrome and 50 per cent of them have no prior symptom.

"In the US, 61.8 million people have cardiovascular disease, and in south east Asia and south Asia, it is like an epidemic," said Dr Sen.

Presently available clot breaking drugs have made a difference. Drugs like Streptokinase, Actilyse and Metalyse have brought down the mortality rate from heart attacks.

"We had a doctor who came in very soon after chest discomfort and an ECG confirmed a heart attack. He was immediately admitted and given a Metalyse injection. The chest discomfort went disappeared and he went home on the fifth day," said Dr Kishan Pakkal, the chief organiser of Synapse.

What is important is the time factor. All those advances in medicine will not stand a chance unless the patient is brought to the hospital immediately after he feels discomfort in the chest. Wait and it would be death.

"Hospital management of heart attack has advanced a lot. We have clot breaking drugs, catheters which can break the clot and anticoagulants like aspirin, plavix, low molecular weight heparin, direct thrombin inhibitors and statins. But even then 50 per cent of MI (myocardial infarction) die suddenly, do not reach hospital. The present need is to identify this group," said Dr Sen.

"Now we are developing tests to find out who is prone for a heart attack. Blood sugar, cholesterol profile, markers for inflammation like CRP, markers for increased blood clotting tendency like fibrinogen. We have invasive methods like thermography, intravascular ultrasound, angioscopy and non-invasive methods like multi-epectral CT and MRI. With proper use of these techniques, many of which are still developing, we can find the susceptible patient prone to a heart attack," said Dr Sen.

He said that once identified, such patients could be advised on living the right sort of lifestyle and food habits that would suit them the best, also prescibed preventive medicines like aspirin and ACE inhibitors.

Dr Sen said that such people should have set goals like maintaining blood pressure at less than 140/90, waist size less than 90 cm for men and 80 cm for women, Body Mass Index at less than 22 and blood sugar at less than 110 mgm. This should go with elimination of tobacco and increased physical activity.



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