When and what to treat a heart attack.

I was working in the office. I suddenly started having chest pain. I was sweating. My colleagues took me to the emergency department of a nearby hospital without delay. An ECG showed that I had suffered a major heart attack. The doctors realized from the type that the major artery was blocked. The most effective and modern treatment in such a situation is to do an emergency angiogram, immediately remove the block, and place a stent, i.e. a ring, so that the normal blood flow to the heart can be restored. This is called primary PCI. But in most cases, it is too late to take the patient to the hospital; sometimes the patient's relatives delay in making a decision. They think that if the situation is stabilized with medication immediately after the heart attack, an angiogram can be done later. But this is a completely wrong idea. We divide heart attacks into two types according to the type of ECG. The first is ST-elevation myocardial infarction (STEMI). In this case, a heart attack occurs when a large blood vessel in the heart is completely blocked by a blood clot, cutting off the blood supply to the heart. The patient's condition begins to deteriorate rapidly. If the blocked blood vessel is not opened quickly, the heart muscle can be permanently destroyed. Various serious complications including heart failure and cardiac arrest occur. The second is non-STEMI. In this case, some blood vessel in the heart is completely or partially blocked, causing damage to the muscle. Usually there is one or more blocks and often some natural bypass is created to maintain some blood supply. This type is slightly less risky. There are also two types of treatment. Treatment 1. In the case of a STEMI heart attack, the suddenly blocked artery must be opened as soon as possible. The most modern and effective way to do this is to perform an angiogram on an emergency basis, identify where the blockage is and remove it. To remove the block, a narrow metal mesh pipe or stent (known as a heart ring) is placed through an angiogram. This is called primary angioplasty. In this case, the success rate is about 95 percent. The heart muscle is saved in this treatment method. The pumping capacity of the heart is maintained. It protects the patient from heart failure later. However, emergency angioplasty facilities are not available everywhere. Therefore, sometimes in remote areas or if the distance from the patient to the hospital is more than two hours, the block must be opened with medication first. In this case, tenecteplase is the most effective drug. An alternative to this is streptokinase. However, regardless of which one is used, an angiogram must be done within 2 to 24 hours of pushing. If the presence of a block is detected in this, it must be removed and a ring must be worn. 2. Non-STEMI heart attacks are relatively less risky. However, if prompt action is not taken, a heart attack can occur again. In the case of such a heart attack, an angiogram must be done as soon as possible to determine the location, size and extent of the block and subsequent treatment must be given. Why is it not always possible A major crisis in the medical system is the lack of trust. It is important to provide appropriate advice, a thorough explanation of the disease and treatment. The people on the patient's side also have no less responsibility. If the patient is taken to the hospital quickly and decisions are made quickly after a heart attack, it is possible to save the patient. Dr. Mahbubur Rahman, Senior Consultant, Interventional Cardiologist and CCU In-Charge, LabAid Cardiac Hospital, Dhaka