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Heart Attack

Chewable aspirin 325mg tablet, if not taken previously.
Loading dose of clopidogrel tablets (another antiplatelet drug like aspirin).
Vitals are checked periodically (Blood pressure, pulse, respiration).
If there are no contraindications, then patient is immediately put on blood thinning treatment viz: streptokinase after obtaining due consent.
Sometimes ancillary treatment like artificial ventilators/IABP may also be required depending on the condition.
Blood thinners try to dissolve the clot in the occluded coronary artery. Practically they achieve success in only 25-30% of cases and there is always a chance of clot reformation which can lead to second heart attack.
Sometimes blood thinners can lead to bleeding complications also, some of which can be serious also like bleeding in brain.


Treatment in hospital Cardiac centre:
Patient should preferably be taken to a heart hospital if it is possible without losing time.
Reason for this is that heart hospital can provide definitive therapy in the form of primary angioplasty.
What is Primary angioplasty ?
Primary angioplasty means patient is taken up for coronary angiogram immediately with intention to open up 100% blocked coronary artery. Special catheter systems are available for clot (thrombus) removal. Then the baseline plaque (blockage) is compressed with a balloon which is dilated at the site of blockage and task usually needs to be finished by deploying a stent (small coiled wire mesh) which prevents the narrowing of artery again.
Requirements-24 hours cath lab and surgeon support.
24 hours dedicated cardiologist services.

Primary angioplasty is the preferred method why ?

Success rate is 95 -99%.

Baseline plaque (blockage )also gets treated at the same time, where as with blood thinners, it remains there and needs to be tackled at a later date in practically all the cases. So in the long run it turns out to be more cost-effective than blood thinners.

Angioplasty widens an artery to improve blood flow.
Angioplasty widens an artery to improve blood folw.
Expanded stent prevents a previously blocked artery from re-closing.
Reduced hospital stay (3-4 days) as compared to blood thinner (6-7days) therapy alone.

Small but definite risk of stroke (esp. in elderly people associated with blood thinners.) It can be avoided if patient is undergoing primary angioplasty.

Heart attack is a major emergency situation. Do not ever take it lightly. Rush the patient to nearest, best medical service center. Always remember time saved is heart saved.
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