Try to Understand What the Heart says this World Heart Day

This World Heart Day, Dr. N. Krishna Reddy, Cardiologist from Care Cardiac Centre of Durgabhai Deshmukh Hospital, guides us on avoiding heart attack and preventing risk factors on clot formation.

Hyderabad: Chest pain, heart attack, heart failure, etc. although they seem to be different problems, they all have the same source! Clot formation in the arteries that supply blood to the heart. It starts with chest pain and gradually increases the risk of muscle damage by a heart attack laying the seed for heart failure. The good thing is that these can be avoided at any stage. Avoiding heart attack risk factors can prevent most plaques from forming. Even if clots form or you suffer a heart attack, medication and lifestyle changes can take care not to damage the heart muscle further, not to slide into heart failure, and not worsen the problem, through awareness.

The heart is also a muscle that supplies blood to all the organs and muscles. It needs adequate blood supply to function. Three main arteries in the heart (coronary arteries) are involved in this task. As long as these work smoothly there is no problem. The problem is only if there are obstacles within. The inner lining of a blood vessel is very tough, without any spaces in between. It acts as a protective shield for blood vessels and ensures the smooth flow of blood. If this goes wrong, gaps will form and excess cholesterol will start to seep into the blood attracting macrophage cells, which capture the fats and turn them into foam particles. These gradually develop into fatty deposits. The cysts enlarge and begin to block blood flow, causing chest pain, heart attack, and ultimately heart failure.

High blood pressure, high blood glucose, high cholesterol, smoking, tobacco use, and a family history of heart disease lead to plaques and are risk factors for 95% of heart disease sufferers. It is noteworthy that all these are related to our eating habits, our physical activities and our physical ability. Diabetes, high blood pressure and high cholesterol can be avoided if you are careful about these.

They also prevent the process of plaque formation, the cause of heart disease. People who already have heart disease risk factors can prevent heart attacks with statins. In case of the formation of clots, it can be saved with the help of aspirin, we can prevent it not only in the beginning but also in the advanced stage is in our hands.

Chest pain-heart attack:Clots in the arteries of the heart do not always cause chest pain. There may not be any problems until the problem is advanced, which misleads many. The inner course of the heart's blood vessels is about 3 mm, if it closes a little there will be no problems. Halfway closure reduces the blood supply to the lower limb. If the same 70% is blocked, chest pain starts while walking and doing things. If the blood vessel is 95-99% blocked, chest pain occurs even when resting, indicating that the sediment has increased suddenly due to the movement of blood and the clotting of blood. The inner layer of the blood vessel keeps platelets from sticking together and prevents formation of blood clots. If its function is impaired, there is a risk of platelets sticking together.

Smoking, sudden increase in blood pressure, severe mental stress, and inflammation triggered by infections can all cause this. When clot is removed, the blood vessel membrane is also ruptured. Immediately, the platelet cells arrive there. The blood clotting process starts to stop the bleeding. Then the plaque can grow and occupy the entire blood vessel, stopping the blood supply to the heart muscle, leading to a Heart Attack.

If the chest pain does not subside after 15 or 20 minutes, it means that a heart attack has occurred. Air pollution is no less important in this. Like cigarette smoke, the toxins in polluted air can stimulate the inflammatory process and cause blood clots to form. Studies clearly show that there is a link between air pollution and increased cases of heart attacks.

Do not delay:Chest pain should not be delayed. People with risk factors like diabetes, high blood pressure, and family history should not be neglected. Any discomfort in the chest should be suspected as a heart attack. If the pain spreads over the left jaw and shoulder to the arm, go to the hospital immediately. Many people make a mistake here.

It is believed that pain occurs due to acidity or heavy work. If you can identify the place of pain with your finger, if the pain increases when you press on it, if you turn to one side, the pain increases and if you turn to the other side, the pain decreases, then you can think that it is not a heart attack. Apart from these, any other uncomfortable symptoms should be considered as a heart attack. The risk increases with delay.

Diagnosis-Treatment:ECG is the easiest test to diagnose a heart attack. Within half an hour of a heart attack, changes in the ECG can be seen. If no changes are seen in the first ECG, they are tested again after 20 minutes. If the changes are still not evident, troponin I and troponin T enzymes are tested. These are very accurate results. Doses of these enzymes remain high for 2 to 3 hours after a heart attack. These may not show up in the blood if someone comes after three hours, so they tested after six hours.

• When a heart attack is diagnosed, blood thinners like aspirin, clopidogrel, and blood clot-dissolving drugs like streptokinase, urokinase, TPA, and RTPA will give good results. Tenictiplace is also available now. It can also be given in an ambulance. If the ambulance has an ECG facility and it is confirmed that a sudden cardiac arrest has occurred, it can be given immediately. It dissolves the blood clot. This type of treatment can prevent the problem from getting worse if it is done before reaching the emergency room. However, these drugs cannot be said to work equally well for everyone. If medication fails, the clot is completely removed by angioplasty or stent placement. Some may need emergency bypass surgery.

Early prevention:People with risk factors for heart disease like high blood pressure and diabetes should be alert beforehand and control it with medication and weight management. Fats, salt, and sugar should be reduced. Exercise regularly. There are also websites available online that predict the risk of a heart attack based on details like high blood pressure, glucose levels, age, weight, and family history, anyone can predict the risk of having a heart attack in ten years. A threat of 30% means high risk. Less than 10% suggests no danger. Cholesterol-lowering statins and blood-thinning aspirin may work better for those at high risk if taken regularly as per the doctor's advice.

Heart failure:A major complication of a heart attack, due to heart muscle damage, is heart failure. As a result, the heart cannot pump enough blood to the body, not meeting the needs of the body. As a result, symptoms such as tiredness, fatigue, weakness, and muscle stiffness begin.

Sometimes, even though the heart is pumping enough blood, blood from the lungs can enter the heart at high pressure causing congestive heart failure. As the filling pressure increases, fluid leaks out of the tiny blood vessels and into the surrounding tissue accumulating water in the lungs and decreasing dilatation, leading to fatigue. If the right side of the heart is damaged, parts like the legs may swell.

Prompt treatment is key:The sooner the treatment starts, the better. When blood supply is cut off during a heart attack, the muscle in that area is damaged and eventually dies in about 6 hours. If the treatment is started in the meantime, the muscle can be protected from further damage and the problem from getting worse. That's why it is considered the most valuable time. Because once dead, tissue is difficult to regenerate. Removing the plaque immediately after a heart attack can ensure that the muscle is not damaged at all. If the same is removed after 3 hours, only 50 percent can be saved. And removing it after 6 hours is not of much use.

It is very important to consult a doctor immediately after the onset of chest pain. It is not to be thought that they have only formed deposits in other blood vessels, so there is a risk of complete blockage by clots. Therefore, if the treatment is started promptly with blood thinning and blood clot-dissolving drugs, it can prevent another heart attack and further damage to the muscle.

Before coming to the hospital...Aspirin is very useful in preventing muscle damage in the early stages of a heart attack. This medicine can be given safely by a general physician and ambulance staff. A water-soluble aspirin is even more beneficial. This alone reduces the risk by 20-25%. Giving it with something like clopidogrel is even more effective. Aspirin doesn't do much harm even if it's not a heart attack.

Medicines should be used regularly:No matter how good the medicine is, it is important to use it in the right dosage and regularly. Once diagnosed with heart failure, the average life expectancy was only 3.5 years. With the availability of advanced medicines and treatment methods, many people are living comfortably even after 15 years. But due to lack of awareness about the use of medicines, inability to bear the cost and inability to tolerate medicines, only 40 out of a hundred people use them. Proper dosage and regular use of medications can prevent end-stage heart disease, making it necessary to take medicines regularly.

If treatment is delayed...If there was a delay in coming to the hospital and getting treatment, the heart muscle is already somewhat damaged. There is still a chance to save the heart. Beta-blockers and ACE inhibitor-type drugs can also be used to prevent full heart failure. If heart failure starts, beta blockers along with renin-angiotensin system inhibitors and ARNI-type drugs are very useful. With these, the problem does not worsen and the heart does not become weaker.

Sudden cardiac arrest:With a heart attack, some people experience sudden cardiac arrest, mostly due to heart rhythm disturbances or due to excessive and chaotic responses of the heart's electrical system, it collapses and dies. Sometimes a heart attack can also lead to an irregular heart rhythm.

Imagine a sudden blockage of a blood vessel and some damage to the heart muscle. Normal muscle and damaged muscle lie side by side. As a result, the electrical impulses go wrong, which kills many who die within an hour of a heart attack. Due to reduced pumping capacity some go into shock and die within 24 to 48 hours. If the same heart rhythm is damaged and stops functioning, death occurs immediately. The best way to prevent this is to prevent a heart attack by reducing risk factors like diabetes, and high blood pressure, avoid smoking, and if necessary, take statins.

• Implantation of a defibrillator device may also be beneficial in some patients with heart failure. These are used for people with very slow heart rates, electrical system defects in ECG or Holter test. It not only keeps the heart from slowing down like a pacemaker but also detects when the electrical system is out of sync and delivers a shock as needed, correcting the heart rhythm. These are useful for those who are lucky enough to survive sudden cardiac arrest.