Don’t ignore body’s warnings

Professor, why do doctors speak of a «golden» hour after a heart attack? Because it is in that first hour that we have the greatest loss of life – about 40 percent of deaths. If patients manage to get to hospital immediately and into intensive care, they survive. It’s not like it was in the past, when people died in the street of apoplexy. We didn’t know the term «heart attack,» which we learned in 1910, and we became even more aware in 1950 when the use of electrocardiograms in hospitals became widespread. Since 1960, when intensive care units went into operation, tremendous strides have been made. We have learned how to reopen arteries and how to insert balloons. Thrombolytic drugs have improved and, in the past two or three years, we have been using 2b-3a blood platelet retardants with great success. In the case of a serious arrhythmia, of the type that causes death, a patient who has managed to get to the intensive care unit can be saved by external defibrillation. How can one tell that a sharp pain is caused by heart failure? The difference between a stroke and a heart attack is that a patient suffering a heart attack calls for help, whereas with a stroke somebody else must observe it, because the patient is dizzy and doesn’t know what is happening. Most heart attacks don’t come silently. Something happens suddenly, and this is felt as a tightening or burning, with pain in the chest or the back. It is not so important whether the pain is intense but the noise it makes, which warns that something bad is going to happen. If it is a typical heart attack, the pain fills the chest and often spreads into the left shoulder, or the right arm and elbow. There may be a warning a day or two before, two or three hours before, of a just a few minutes, which some people pay no attention to, even though they have been disturbed or woken up. But if you are 40, 50 or 60, and you get woken up by something like that for the first time in your life, then the best thing is to take an aspirin and go straight to hospital – in a cab if there isn’t a spouse, friend or relative to take you. Better to find out nothing is wrong than to unnecessarily risk your life. The symptoms are often attributed to stomach upsets. That’s wrong, because the stomach doesn’t disturb people suddenly in that way. But even if that is the case, it’s still better to go to hospital where a diagnosis can be made quickly and easily. Just recently – in 2002 – the European Cardiological Society made a recommendation that should reach all cardiologists. Three factors are taken into consideration for a diagnosis: pain, signs in the cardiograph and high levels of troponin, for which there has been a quick, easy test since 1998. According to the society, the presence of two of these three factors shows there has been a heart attack and the doctor must act accordingly. Sometimes it isn’t pain that brings patients to hospital, but weakness, exhaustion or collapse. This happens because at the time of the heart attack, instead of contracting powerfully, the heart contracts less than it should, which means less blood in the system. This may cause dizziness, perspiration and malaise. If troponin levels are high and the cardiograph positive, then it is unquestionably a heart attack. Can the seriousness of the situation be assessed immediately? From the outset, in the first few minutes, we check other indicators by a simple blood test. If BNP peptide is high, it means the myocardium is not contracting properly and that the heart has suffered serious damage. Another indicator, called CRP, shows the extent of the inflammation. This test is used not only in the case of a heart attack but in everyday practice. People who have elevated CRP, which can be tested anywhere, and high cholesterol, must be careful because there is a strong likelihood they will have a heart attack in the near future. We and other units have reached a high state of preparedness so that in many cases we can go ahead, without drugs, and do an angioplasty for the purpose of opening an artery and restoring blood circulation at the time of the pain. This is the best prognosis, because less of the myocardium dies and the heart contracts better. But for the more difficult cases, those that require a bypass procedure, there has been great progress, mainly in transplanting arteries, which have fewer narrow parts and blockages than veins, which we used in the past. Are you satisfied with these developments? Do you think you have achieved optimal results? No, because what we have achieved is that heart attacks occur about 10 years later, at 60 instead of 50, 70 instead of 80 and 80 instead of 70. But heart attacks aren’t inevitable, and we want them not to happen at all. If we manage that, then people can live to 100. But technology can defeat death. Defibrillators have become small and easy enough to use and cost so little that defibrillation can be done anywhere. In fact, defibrillators do save lives by means of electroshock in intensive care units, but they are bulky machines. Now there are ones that fit into a suitcase, cost only 2,500 dollars and are starting to be used in high-stress areas like airplanes and casinos. American Airlines carries them so that planes don’t have to alter course because of an incident. The machine is fitted onto the passenger who has the problem and when required, the defibrillator discharges, using electroshock to get the heart going again.