14/09/2017
A 39 year old male presented to this hospital with history of severe chest pain in center of the chest for the past 3 hours. Initially he thought it was acidity and he took some digene and when he did nt feel better, he decided to contact a doctor. There he underwent an ECG test and was told to have a heart attack. He was not sure, so he went home to take some rest and wait for his family members to came and take him to another doctor. They went to see one another doctor later in evening who agreed with the first diagnosis. In taking this opinion, he lost four additional hours.
He was referred for further treatment to our hospital.
On admission, he was immediately subjected to ECG and echocardiography and a blood test was done. After ascertaining the diagnosis and speaking to the family, immediate angiogram was performed and based on the result, treatment was offered in form of angioplasty to one of his arteries. ( attached are the films)
This young male is one of the several cases coming to our hospital with heart attack. On deeper interrogation following facts were forthcoming:
1. He had a strong family history of heart disease. Two of his uncles suffered heart attacks at the age of 40 and 42 respectively and one of them succumbed to his illness suddenly.
2. His family also had a strong history of high cholesterol and diabetes.
3. This gentleman was obese ( weighing 106kg) and was consuming a tablet called as ‘STANAZOL’( androgenic steroid) along with some ‘Whey protein’ powder given to him by his gym attendant.
This case highlights the problems seen so frequently now a days in our heart department.:
• A young male
• Smoker
• Obese
• Sedentary worker
o He would exercise only for two times a week, that too inconsistently.
• High cholesterol ( LDL 190mg%, TG 258mg%, HDL 23mg%)
o The bad cholesterol is very high in this case and with the strong family history ideally, all members of this family above 15 years of age must be screened for this risk factor.
• Strong family history of heart disease
• Taking steroids to build up muscles and lose weight?
o The steroids have a strong predisposition to developing blockages in the heart arteries.
• Wasted ample time to reach the hospital even after firm diagnosis.
o Remember that the first three hours are the best time in which we can salvage your heart the best.
o The later you present, the worse is the outcome.
o In this case, the heart function dropped to 35% even after the treatment offered, because of irreversible damage to the heart had occurred even before arrival.
4). If all of my mother’s brothers have heart disease, blocked arteries, what are the chances that I would have the same, being a male in my early 30s?
FAMILY HISTORY OF HEART DISEASE AND THE RISK OF HEART ATTACK
This young Indian needs detailed work up because a strong family history of heart diseases and deaths. The aim is to prevent the disease at a young age ( before it STRIKES). It’s a good idea to stop smoking and start regular physical exercises daily.
He needs the following tests:
• Sugar
• Lipid profile
• Homocysteine
• Thyroid profile
• Other general tests – LFT,KFT
• SPECEFIC CARDIAC TESTS:
o Stress Test
o CT Coronary Angiogram
• Assess the calcium score
• A high score means strong chances of blockages and may point to further evaluation.
• Coronary angiogram
• Many of the above problems are treatable and proper management results in marked reduction of cardiovascular risk. For example:
➢ Sugar, lipid profile, thyroid issues etc.
➢ Attain proper weight
• Start a proper exercise schedule
o In case if the disease is already setting in, then the actual treatment can be started.
Follow Up
The patient was gradually ambulated and counseled for a healthy life style. Over a period of next three months his heart function improved and he would do most of his activities normally. At 4th month, he missed his monthly follow-up and stopped all medications. He restarted smoking and pretty much went back to all bad habits.
He again presented to emergency after 2 months (6 months after angioplasty) with severe breathlessness and was noted to have pulmonary edema (water in his lungs).
He was stabilized on medications and evaluation revealed that his heart functions had dropped to 25% and had developed severe leakage of one of his valves. Again angiography was done which showed a blocked stent (due to stopping of medications).
The heart was severely damaged and the patient could walk for 100-200 meter barely.
Gradually his heart failure was managed and a pacemaker called as AICD was placed.
The device costs 3-5 lac. All this could have been avoided if proper attention was made to medical advice.
Lessons :
1. Never waste time once you are diagnosed to have heart attack and reach the nearest hospital immediately.
2. Never stop medications without medical advise.
3. Once the heart in damaged, the options are limited.
4. AICD is like an ‘Invertor’. The invertor works when the light goes off, does this device saves life only if the heart malfunctions.
5. This young patient would eventually be sent for Cardiac Transplant.
