Strategy for the Management of Heart Attacks


 Strategy for the Management of Heart Attacks

Establishing a network of Coronary Care Units all over the country
rather than building Institutes will help patients get better treated
in time with better outcomes

Prof. Emeritus Lt. Gen. Mahmud Ahmad Akhtar
Former Surgeon General Pak Army

The American College of Cardiology has recently emphasized that heart attacks are increasing amongst the younger age groups and obese people.ST segment elevation myocardial infarction (STEMI) is the severest and deadly form of heart attacks which occurs when one of the heart’s main arteries is completely blocked by plaque stopping the flow of blood to the heart muscle leading to the high risk of death/ disability.STEMI can be treated effectively with clot-bursting medication if used within half an hour of the attack or percutaneous coronary intervention (PCI) performed within 90 minutes of the attack.

To achieve this goal there is a need to establish a network of coronary care units all over the country so that the patients are treated in time with better outcomes. In Pakistan there is a concentration of cardiac institutes in the urban cities depriving small towns and the non-urban areas of effective emergency treatment. For an example there are three institutes in the Public sector in the RWP/ISB area, two in the private sector and many cardiac departments in the public and private hospitals/clinics. Likewise Karachi has many advanced cardiac tertiary units and cities like Peshawar, Faisalabad, Multan, and Hyderabad have tertiary units. On the other hand even on G.T. Road from Peshawar to Lahore on the way there are no effective units to deal with heart attack emergencies. The situation is far worse in the rural areas all over the country, worse in the Southern Punjab, interior of Sindh, Baluchistan, K.P.K., G.B., FATA etc. The coronary care units should be available all over the country so that the patients are treated within the stipulated time period to save the lives of the patients.

Instead of creating extremely expensive free standing mono-organistic institutes, coronary care units housed in the cardiac departments of general hospitals up to Tehsil levels, where other disciplines of medicine/ surgery are also available, for cost effective holistic patient care, both curative and preventive.Modern era is of integrated medicine for better patient care, physically and emotionally and not of mono-organistic care.

Many of these patients are also suffering from diabetes mellitus, hypertension, pulmonary, renal, G.I, emotional and nicotine addiction disorders which also contribute to the cause and disability hence need energetic treatment. These are neglected in the isolated mono-organistic tertiary units leading to poor patient care and outcome.Prevention is not only better than cure but is also the real answer to the menace of these lethal diseases.

Prevention both primary and secondary is the rock bed of the overall health care problems. Emphasis should be to keep overall ideal body weight fat less than 29% of males weight and less than 30% of females, BMI less than 23 in males and 21 in females but the most important is to avoid central obesity i.e. abdominal girth (central point between the lower costal margin and the superior iliac crest should be less than 35.5 inches in males and 31.5 inches in females- lessor in short statured individuals- a central genesis of atherosclerotic diseases like coronary heart attacks, strokes, peripheral vascular disease, metabolic syndrome- cluster of glucose intolerance, diabetes mellitus, hypertension, hyperlipidemias and dyslipidemias etc.

The diet  should be mainly plant based, consisting of five portions of vegetables and fruits, pulses/legumes(lentils, beans, peas) whole grains, nuts, seeds, unsaturated oils mostly monosaturated like canola/olive, lower in saturated oils/fats, low salt, no trans fatty acids keeping in view serum lipids. Regular exercise, relaxation, stress management and avoidance of tobacco etc.

Appropriate uses of aspirin,statins, , anti-platelet drugs, beta blockers and ACEIs/ A2A. Regular medical checkups, early detection and early management of risk factors and disorders like hypertension, diabetes mellitus, hyper/dyslipidemiasetc.

There should be emphasis on primary/ secondary health care measures i.e. prevention of disease and health promotion. Emphasis should be on basic/ primary education and creating public awareness about healthy life i.e. pursuing pro public health policies. The elitist ruler’s focus is on elitism, focusing heavily on tertiary health care, higher education (neglecting primary education) and on luxurious urban transport projects.

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