What is a heart attack?
Dr Paul Chiam discusses the importance of seeking treatment quickly in the case of a heart attack
Heart attack is a condition where the artery in the heart supplying the heart muscle suddenly becomes completely blocked, Dr Chiam says. “So whatever is downstream to the blockage, the heart muscle starts to die because there is not enough oxygen.”
We know from studies that once this has occurred, the muscles that are down stream to that artery blockage will be completely dead in about 12 hours. That’s why when a patient comes in with a heart attack; we need to do things as quickly as possible.
In the old days, the treatment to reopen the artery was to give a very powerful blood thinner - what we call a fibrinolytic agent - to open up the artery in about two thirds of the cases. The downside of this therapy is that it increases the risk of bleeding quite significantly in many patients and that includes the risk of bleeding in the brain, which in itself can be fatal.
Nowadays what we can do for these patients is an emergency angioplasty, whereby we transfer them quickly to the angiographic lab and we perform an emergency ballooning to reopen the artery and reestablish flow. The earlier we open it, the more heart muscle we save, and thereby the term time equals muscle comes in, because if you do it very late, 8, 10, 12 hours, you’re saving very little heart muscle. The earlier we get to the patient, the more heart muscle we save.
If everybody understood that, we could actually do a lot more good for patients that came in earlier with heart attack.
Dr Paul T.L. Chiam is a consultant cardiologist with a subspecialty interest in interventional cardiology. He is in private practice at The Heart and Vascular Centre at Mount Elizabeth Medical Centre in Singapore and can be reached at +65 6735 3022.
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