மாரடைப்பு என்றால் என்ன? அறிகுறிகள் என்னென்ன? உடனடியாக என்ன செய்ய வேண்டும்? What is heart attack?

மாரடைப்பு என்றால் என்ன? அறிகுறிகள் என்னென்ன? உடனடியாக என்ன செய்ய வேண்டும்? What is heart attack?


This scientific health channel is aimed to educate public for a healthy life Also, we aim to educate regarding common diseases So, let us discuss about heart attack – called as myocardial infarction What is the commonest cause of death world wide? I’ll give you four options. First option: Road traffic accidents. Second option: Cancer Third option: Heart diseases. Fourth option: Lung and kidney diseases What do you think? I think most of you would have guessed rightly Yes, heart diseases are the no.1 killers, especially heart attack Majority of these deaths are preventable What is meant by Heart Attack? Blood flow is essential for any part of our body to be alive, Just watch. I am clenching my right hand and holding the wrist with left hand tightly This blocks the blood flow. Now you can see that the hand has become pale because of absence of blood. If I retain this for some time within minutes, it would be difficult to move the fingers. soon it will turn blue. The tissues will start dying and finger tips will turn black If I remove the obstruction and allow the blood flow, hand would turn pink again Thus, hand escapes. Thus, every part of our body is dependent on the blood flow for survival Heart is the organ which sends blood to the entire body However, heart’s muscles also need blood to be alive and functional There are blood vessels that bring blood to these muscles – called as coronary arteries People using the term ‘narambu’ is a misnomer. It refers to nervous system. The blood vessels which brings blood to an organ is called an ‘artery’ The blood vessels that take the blood away from an organ towards heart is a ‘vein’ Blockage of the artery that brings blood to heart muscle results in heart attack This image shows heart. When it pumps, the blood is supplied to the entire body through a large vessel called aorta From the aorta, branches arise and supply the heart There is one on the right side and one on the left The left one divides into two, one supplying the front aspect and the other supplying the back Thus there are three arteries which supply the heart Suppose the artery blocks at this point… the small portion of the heart muscle will be afected If the block occurs a bit earlier, more area of the heart would be affected If the block is further earlier, the damage would be maximum All these are 100% blocks Thus the damage depends on the site of the obstruction to the flow A distal block would cause less damage while a proximal block would be more harmful In some individuals, there could be a block in the branch and not the main vessel They will have only that portion supplied by that branch affected Based on these, we use the term ‘mild attack’ or ‘major attack’ Those who have had mild attacks, survive the muscles of that area die, produce lot of pain… patient tolerates that….and subsequently with medicines he gets stabilized But a person getting the same block very early stands high chance of death Even if he survives, significant muscle damage could have occurred unless treated on time It will end up in a weak heart needed lots of medications for life long period Thus heart attack is the result of sudden stoppage of blood flow…. due to blockage in the arteries. A distal block results in less damage and a proximal block could be potentially life threatening Let me draw the arteries of three persons The first one has a 30% obstruction by cholesterol deposits The second one has about 70% luminal obstruction The third one has 90% block 30% block would produce no symptoms, that man would be leading a normal life He could walk, run and do all physical activities normally The one with 70% block will have… some difficult in climbing stairs or doing hard physical activities he would take some rest, will recover and continue his activity Thus, his day to day activities are not much affected A 90% block would cause much more symptoms… many a times, these individuals would subconsciously restrict their activities In all these three examples, there is blood flowing down to the muscles Hence, the muscles are alive If ECG is taken, it would normal for all these three people You can see that there is thin membrane over the cholesterol deposits This membrane should be intact so that blood flows down to the tissues Suppose, if the membrane cracks or tears at some place….. blood comes in contact with the cholesterol containing tissue…. Suppose there is a bleeding, we stop it by applying pressure.. our body forms multiple small clots to plug the tears in the veins or arteries This is a normal response of our body Clots occur at points of tears to arrest further bleeding When the covering membrane tears, body reacts…. it starts forming clots to ‘seal’ the tear The clot gradually increases in size… and that will result in complete occlusion of the artery Thus, this gentleman who had 30% block initially and was totally symptom free.. With plaque erosion or rupture, clot forms and he will present with severe pain.. The same thing happens with the other two examples too.. Thus, for the heart attack to occur, there would be some degree of cholesterol deposits in the arteries The degree of initial block could be as small as 10% or as large as 95% Severe blocks would have given some chest pain but the muscles were alive For the heart attack to occur, it should be a total (100%) occlusion The underlying tissue starts dying once there is no blood flow What should be done? Which one precipitated the problem? Clots… if we could dissolve the clots, these individuals would go back to their original stable status How to dissolve these clots? There are several good drugs available These clots are soft (slimy) initially It gets thickened with time After 3-4 hours, it becomes stony hard Thus we can understand, it becomes difficult to dissolve the clot with time If some one presents within half an hour or one hour of pain, the clot will be soft.. Injections would dissolve it easily and in few hours time he would become stable If the patient comes 4 to 6 hours later, injections do not work many a times That is the reason why one should seek immediate medical attention if heart attack is suspected These medicines are available in all major government hospitals Even many private nursing homes are also stocking these medicines Most of the physicians know how to administer these drugs Hence, if there is significant pain, ECG should be taken and if it shows heart attack… this clot dissolving drugs should be given at the earliest The medicines work only in about 50-70% of cases It does not work in the rest and the clot would remain as such If the clots are not dissolved, there is no forward blood flow Heart cannot improve unless the blood flow improves Is there any alternative? It is called coronary angioplasty If someone presents with heart attack to us, we will take him to cath lab and open up the artery We will suck out the clot using catheters We use balloon and stents to open up the vessel completely This gentleman presented with chest pain of 4 hours duration His heart rate was only 30/min and he was semi conscious We found that his right coronary artery was totally blocked We performed angioplasty that resulted in brisk flow to the muscles His pulse immediately improved to 70/min and he got stablized The hospitals with this facility are quite few in number So, one should go the near by hospital, get the emergency drugs, including clot dissolving medicine Thereafter they can come to hospitals like us to decide on the further treatment This is the treatment for heart attack Let me ask a question…What percentage of people who develop heart attack reach the hospital? Is it 70%? or 90% or 100%? It is just 50 to 60% Rest diet at home or on the way to the hospital Why does it happen? Where is heart located in our chest? Right or left? Everyone would immediately answer as ‘left’ It is not true. Just watch this image Heart is shown within the rib cage If we draw lines from the middle, you can see that heart is located in the center Except for a small portion in the left side of the chest, most of the heart is in the center So please understand that heart is in the central aspect of the chest and not in the left side Why should we know this fact? Most of the symptoms related to heart occur in the central chest People wrongly attribute it to gastritis and acidity Hence, there is a big delay in seeking the treatment What are the various expressions of heart attack? Only in about 50%, it shows up as ‘pain’ Many would just feel some vague discomfort It would be compressing in some…in somebody else, it would present only as nausea and vomiting Some would have some uneasiness and sweating It could rarely be burning…. Because of these varied expressions, all these things should be taken as warning signs Which are all the places where these symptoms could occur? Anywhere between the lower jaw and upper abdomen whether it is front or back, it could be heart attack Should that mean any pain in these area pointing to heart attack? No…. If it is heart attack, it would remain for more than 20 minutes and make you very uncomfortable If it goes off in 2 to 5 minutes, less likely that it is heart attack And, not every one should worry…. Only those who are predisposed to develop heart attack should worry For example, if a smoker feels heart burn for half an hour or so, he can’t take it lightly That simple ‘gas problem’ could actually be an manifestation of heart attack One of my friend used to belch after a walk or jog I asked him to get investigated with an ECG He couldn’t believe that it could be heart problem Why should belching be related to running? So, it could be a pointer of significant block in the coronary artery Why only 50% individuals with heart attack reach hospitals? Two reasons…. As I told earlier, once blood flow stops, the function of any organs stops With a major attack, the heart just stops pumping This happens a big portion of heart becomes functionless This results in immediate death We use the terms VT and VF, related the abnormal electrical activity At times, even in the so called minor attack…. that portion could alter the electrical activity… resulting in abnormally high and irregular pumping of heart Very fast pumping would result in no effective cardiac output and this results in death Thus one can die at home or office within seconds to minutes of onset of heart attack The next reason is – non recognition of the problem Absence of realization delays seeking of medical attention, develop some complication…. and die at home or on the way. Many of them would try some concoctions, home remedies etc That is why I am insisting …Heart is a central organ, it is not situated in the left side So, the ‘gas problem’ could potentially be heart attack Should that mean, everyone should worry if they have some ‘gas’ like pain? No. Heart attack can occur to any one. But commonly, it occurs to those who are predisposed Who are predisposed? First in the list…Smoking Any form of tobacco…whether one chews it or uses it as snuff Second in the list – diabetics People with high cholesterol levels…….Then those who have high blood pressure If there is strong family history of premature heart disease…. if your parents or your brothers have had attack, you stand a higher chance Obese individuals, those with sedentary life style… And, those who are in constant stress If we take care of these, we can prevent heart attack to a large extent So control your sugar and pressure..Be active, avoid prolonged sitting Take balanced diet..Stop smoking…. If you get some symptoms, please don’t ignore… When in doubt, seek the help…one or two ECGs would be taken Some blood tests would be done… Don’t worry about that small expenditure… After all the tests if the doctor informs that it was not heart attack, be happy! People worry about the money to be spent for ruling out…land up in trouble… could even lose life…. What should we do? If you are predisposed to develop heart attack, control the risk factor vigorously And, if some symptoms develop and lasts for more than half an hour or so, kindly don’t ignore Timely investigation and intervention could prevent a huge loss Timely treatment also could ensure a good life thereafter Hope you got a reasonably clear idea about heart attack obviously this short video can’t tell all facts about this disease So, in the next video, we will have Q and A session regarding heart attack Vanakkam