Last week I was sharing professional stories on the sidelines of a conference at Lucknow with a friend of mine from Chennai. My friend who is a reputed Cardiologist was unhappy about a patient story he had experienced a few weeks ago.
Mr. SA, 43-year male presented with a history of chest pain of one-hour duration
to emergency room (ER). The ECG taken at ER revealed a massive heart attack. My friend was immediately called to the ER and he has discussed in detail about the patient problem and further treatment needed – emergency coronary angiography and angioplasty-stent as the best treatment strategy in a heart attack.
Patient friends accompanied him from his office where he suffered heart attack. His family stays in a suburb and his wife was shattered when informed about her husband condition. In that moment of grief she said I can’t take a decision on my own, “Let me discuss with my father-in-law” was her response. She reached the hospital 60 minutes later and during this time she was informed the alternate option of giving a clot dissolving medication for managing heart attack. But she was indecisive and wanted to do the best for her husband. Meanwhile her father-in-law was also tense and wanted to consult his brother in law whose friend had recently suffered a heart attack. The wife had to postpone the decision for another 30 minutes, as the “recent” patient could not be accessed. When they finally could contact him he told them that bypass surgery is a good option for heart attack as after angiography his doctor has advised him bypass surgery. The family got further confused; as they are not keen for the patient to undergo by pass surgery at a young age. The dilemma continues till 150 minutes after arrival in ER.
My friend who is a Cardiologist was waiting for the family to take a decision and finally had to candidly talk to the wife and the patient father on telephone requesting to expedite the decision and explained the need for emergency angiography and stent placement. Finally the family could be persuaded to agree and angioplasty-stent done successfully. But he was very unhappy with himself that he could not persuade immediately and gave them freedom to take a decision on their own. The unhappiness is due to the fact that despite a successful angioplasty-stent the pumping function of the heart became very low.
This loss of pumping ability of heart is due to delay in restoring blood supply to heart and it could have been easily averted. I promised that I would educate the general public through my blog that “Time is muscle”. If heart muscle is damaged due to heart attack it is permanent. Any delay in instituting treatment leads to heart failure and multiple hospitalizations and increases death rates.
General public should be aware of the following timelines for the best results in getting a heart attack patient treated.