Few golden rules post heart attack


-Dr. Sabyasachi Pal – Senior Cardiologist at Calcutta Medical Research Institute



Heart Attack or Acute Myocardial Infraction is as life-threatning as it is believed to be. It is one of the disorders with extremely high-mortality rate across the world and largely occurs when blood flow to the heart is suddenly cut off, causing severe tissue damage. This happens as a result of a blockage in one or more of the coronary arteries which prevent the oxygen-rich blood from reaching certain specific section of the organ. The choked-up part of the heart which is normally energized by the blood flow by the one or more arteries ,starts dying as the cells can’t replenish themselves  anymore.

Without a doubt, a heart attack is a deadly disease. Even in a developed country like the USA, 1/3 of heart attack patients can’t reach hospital on time, thus dying instantly. In India, because of lack of proper survey and research, we don’t have such strong statistics to support the rampant deaths caused by it. Many patients’ deaths are reported even after getting admitted to the hospital. Late diagnosis is mostly to be blamed for such deaths. It is important to remember that during a heart attack every minute is precious as early diagnosis and immediate treatment can avert the most possible dangers. For this common people should be made aware about the symptoms of the disorder and the consequences of late treatment.  Everyone must know that if any of the symptoms of heart attack is found in the patient, then without wasting another minute he/ she should be taken to the nearest tertiary care hospital where heart attack is treated with utmost urgency.

Heart attack is a critical disorder where a patient’s survival to a great extent depends on his/her awareness.  In Europe and North America due to evolutionary medical advancement the patients have more chances to survive. With the well-equipped ambulance facilities easily available, the patients are attended  straight away as the treatment starts from the ambulance ride to hospital itself, while in India a patient can only be treated when he is admitted to the hospital. Such emergency ambulance services with cutting-edge medical treatment facility is the only way of saving  a  patient’s life.


Causes and Symptoms

Myocardial Infraction is caused by acute coronary syndrome where blood flow to heart is reduced leading to muscles failing to replenish themselves and subsequently dying in the process. Without continuous blood flow, irreversible blood cells pass on very rapidly. In case of late diagnosis and treatment, more cells will die in the heart muscles as blood stops going into them which in turn lessens heart pumping and finally causes quick death by cardiac arrest.

There are two types of myocardial infraction depending on total or partial blockage of arteries  – ST elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). The arteries are clogged-up by the blood clots because of inadequate oxygen supply in that area. When there is complete blockage of arteries where no blood flow can reach the organ, then it is classified as STEMI. It is fatal since the risk of instant death is never ruled out.  While in NSTEMI the blood partially reaches the heart rendering the patient more chances of survival.

These are the following symptoms which indicate heart attack:

–          Chest Pain

–          Fatigue

–          Shortness of breath

–          Sudden sweating

–          Fainting

–          Nausea

–          Heart burn

–          Heart pounding

–          Restlessness

–          Extreme Anxiety

There are several risk factors which frequently turn into heart attack. They are Diabetes Mellitus, Hypertension, High Cholesterol level, High Blood Pressure, Stress, Obesity, Alcohol consumption and family history of blocked arteries. During youth, men are at higher risk of heart attack than women. Women suffer from heart attack late in life mostly after 50. The incidence of heart attacks dramatically increases after 60 in both men and women.


As discussed, earlier awareness about symptoms and causes of heart attacks are essential. In India, due to lack of proper understanding symptoms of this cardiac disease is regularly over-looked in the initial stage where people often mistake it for acidity or gas. Hence, most of the time is wasted and patients are only taken to the hospital when it is already very late. According to Dr. Sabyasachi Pal- Senior Cardiologist at Calcutta Medical Research Institute, “The fatality of the disease is determined by the artery under attack. If the vital arteries are damaged then it is difficult for the doctors to save the patient. The patient must reach hospital as early as possible so that he/she can ward off the alarming danger that comes with delayed diagnosis.”

In the periphery areas, outside metropolitan cities, there is hardly any provision for such thorough treatments. Neither they have ECG/ Chest X-Ray facility nor has proper care giver or technicians to attend the patient. So they usually give basic medications and transfer the patient to a tertiary type of a hospital or to non-tertiary city hospital. Till the time he/she reaches a multi-specialty non-tertiary hospital in the nearest town/city, it is already too late.

The primary steps of diagnosis are ECG, Chest X Ray, Angiogram and Blood tests. This entire procedure of diagnosis remains the cornerstone of way forward in the line of treatment.

Plan of Treatment

After starting off with ECG and angiogram, the condition of the heart is easily detected. But if already a lot of time has been wasted in bringing the patient to the hospital then it affects the whole treatment process. The best way to take a chance for a patient’s survival is to use thrombolytic therapy where an immediate agent called thrombolytic is used to dissolve the blood clot and set off blood flow once again, therefore, further preventing any damage to tissues.

However, it must be noted that thrombolytic agents have some definite side effects. This agent opens up the blood clot in the heart, wherein as a side effect it increases the bleeding tendency in a patient which varies from one patient to another. The dying cells of the organ suddenly regenerate themselves and start working soon after getting new gush of blood which is called arrhythmia/ deadly arrhythmia. It gives an erratic rhythm to the heart that is either very fast or too slow. Thus, such irregular beating of heart sometimes proves to be incurable and soon death occurs.

Moreover, because of late diagnosis, at times thrombolytic agent doesn’t work on the patient. Even after correct management of patient’s condition, often 20-30% of them die owing to not responding to the thrombolytic. And here the doctors, Para-medics and the entire hospital authority seldom face a dire situation when the patient’s family is not ready to accept the death since they believe bringing the patient alive in hospital is enough for his/her survival. Hence, they time and again create a ruckus against the physicians and hospitals, claiming negligence on their part which is absolutely untrue. This happens because there is radically lesser awareness about such cardiac diseases in India, where patients and their families don’t understand the lethal outcome they might face for bringing the patients so late.  As per general medical rule, in cases of emergency, one must bring the patient within 2hrs of the attack which is termed as ‘Golden Hours’ by the medical practitioners.

In conclusion Dr. Sabyasachi Pal of CMRI sums up, “It should be said that proper awareness campaigns should be created by the government and private medical organizations so that common people get to know the fundamental steps required at the initial stage of preventive or precautionary measures while taking care of a heart attack patient.  This will not only increase their knowledge but also reinstil their faith in the doctors and the medical treatment they offer, thereby making the process of holistic treatment smoother for both patients and doctors.”