Heart Attack Pt 2 / Medicines and Surgery / Dr. Vipin Gupta


Last week we talked about
what is heart attack and why does it happen? Today we will talk about
its treatment. So as you get any
cardiovascular symptom, like chest pain or anxiety, you go to the doctor. Doctor checks you BP,
pulse and does ECG, Echo and if need be
also do Angiogram. And then your situation i assessed. According to your condition,
you treatment is decided, Either you are given medicines,
or surgery- Angio-plasty or Bypass
is recommended. So first we will talk about
medicines. Cardiac blockade or heart attack has usually 4-5 kinds
of medicines. One is aspirin
to keep the blood thin, two, Statins are prescribed
to reduce cholesterol. Third, Beta Blockers to
set your BP. Fourth, Nitrates are given
to handle emergencies. And if there is a clot, then Warfarin
or any other enzymes are given. So these 4-5 kinds
of medicines, to be taken twice a day,
in total 8-10 tablets begin for each day. Now the problem
is that, don’t treat the disease
but just suppress the symptoms. That’s why these medicines
are to be taken regularly. If you improve your lifestyle a bit,
then you can stay okay, but if you didn’t pay attention
to lifestyle, then medicines increase, and eventually surgery becomes
inevitable. These medicines also cause
adverse effects of their own. Like Aspirin, which
you take to thin your blood, it thins the blood,
but sometimes the blood leaks in brain. leading to brain hemorrhage
or even death. The other medicine which is taken
to reduce cholesterol – Statins. We have discussed it’s problems before. And it’s major problem is that it causes neuro-muscular aging,
heart itself is a muscle, so it weakens the heart. The issue with Beta Blockers
is that, they work by reducing the supply of blood, they reduce the heart beat, hence blood doesn’t reach to
all body parts properly, especially fingers and toes, those who take Beta Blockers,
often complain of feeling cold or needles in these parts, so it compromises
the blood supply. You take medicines,
but if you don’t correct lifestyle, then your condition slowly
deteriorates, then Doctor will talk about
doing surgeries. So let’s also understand surgeries, There are two surgeries –
Angio plasty and Bypass surgery. In Angio plasty, from near your thigh
or your wrist, a spring like device called stent
is sent inside you. And it goes and expands in
the place of blockade in heart. This expansion helps
in resuming the blood supply. If your condition is worse, then doctor will talk
about Bypass, In Bypass, a blood vessel is taken from other
body part and it is put over or near the
heart block. In a way a bypass
arrangement is formed. and blood supply is
resumed from there. But both of these
have many problems, First of all, this is
surgery of heart, it is life threatening and sometimes
leads to death on operation table. Second, both are
quite expensive. Angio-plasty and Bypass Another problem associated with cost,
is that it is not a one time solution. In Angio-plasty, the earlier metal stents body would consider them foreign,
and deposit and block them again and the procedure had to repeated in
6-12 months. Then came
drug eluting stents, Some people are saying that
these are drug eluting and themselves increase
chances of heart attack, The third are now
bio-degradable stents, which means, the stent would
itself disappear in some days, Now the point is that, the plaque is present,
the stent has shifted it a bit, but when it will degrade
then what will happen of the plaque, this is a problem. So this is a fact that Angioplasty and Bypass are not
one time solutions and have to be repeated. Another issue is the
high corruption involved. Sometimes we hear that
hospitals perform these procedures needlessly to fulfill
their targets. The pricing of stent is also an issue sometimes 100-150 thousand are charged for something that costs 10-15 thousand. The government then formed a
committee regarding their prices, which has fixed the prices
between 7.5 – 29 thousand But news says that
the benefit is not reaching the patients, hospitals have found new
ways to increase the bill. Amidst all this,
two research findings have come, which has raised big question marks
on relevance of both. First research got published
in November, in a very reputed journal
called Lancet, then it was covered by British Medical Journal,
New York times and worldwide
media covered it. The research took place in
National Lung and Heart Institute
of London. Around 200 patients were divided into 2 groups, Half were put stents
through Angio-plasty, and other half were not put anything, but they were impressed
that stents were put in them too. The results were shocking,
both were feeling the same after the procedure, those who were put stents and
those who were not, the study concluded that, the relief in chest pain
and relaxation that patient feels, is actually a placebo effect! It is happening because
the patient is thinking like that, stent is doing nothing
to prevent the pain. Something more shocking than this
has come this January, This study was done in Japan
on around 300 people, in regard with Bypass
and other surgeries. Those patients were observed for
what issues they have in one year, During a heart surgery,
blood supply to your brain is
interrupted/ reduced for a while, which causes some damage, Earlier it was assumed that this
damage is temporary and reversible. Now it’s being found that in around 50% people this
damage can be permanent. Due to this damage,
within a year of surgery, delirium can occur. It means that for sometime,
a problem will occur in consciousness. In this short while you can get a stroke,
even cardiovascular death. The chances for stroke and
cardiovascular death pre-surgery and post-surgery
have a 300% difference. So, chances of this happening
increase 3 times. We need to think spending hundreds of thousands,
we get this dangerous procedure done. but for what? So that situation will improve,
chances of heart attack will decrease, but unfortunately, even after
spending so much money, situation is such that risks are
increasing. Now you may feel that
I am being pessimistic, that I have shook the hope
that was there on
medicines and surgeries. But reality must be
known. The matter of hope is, this problem can be solved
by lifestyle changes. No matter the blockade,
whatever problem may be there, If you correct your lifestyle,
this disease can go for ever. How to correct the lifestyle,
we will talk in next episode. Summary: Heart medicines only suppress
symptoms. Medicines and surgery
have their own risks. By changing lifestyle,
heart can be made stronger again.

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