Health & Fitness

Managing heart attacks a race against the clock

attack

Man having a heart attack. FILE PHOTO | NMG

Summary

  • The fact that Kenyans in their 20s and 30s are now experiencing heart attacks means the risk is growing and threatens future health and well-being.

Heart attacks in Kenya are worrying. Studies show that 25 percent of medical admissions are due to cardiovascular disease with heart attack, stroke and heart failure contributing to the majority.

Cardiovascular disease (CVD) also accounts for 13 percent of hospital deaths. The fact that Kenyans in their 20s and 30s are now experiencing heart attacks means the risk is growing and threatens future health and well-being.

The heart is a muscle that pumps blood to the body including major organs like the brain and kidneys and also to itself.

The coronary arteries supply blood to the heart. Any sudden blockage of a major coronary artery results to a heart attack.

The most common causes of heart artery blockage is a blood clot. If the blood supply to the heart is not urgently restored, the heart may stop pumping and death follows.

Signs of attack

They include sharp pains in the chest with a sense of impending doom. The distress may also be felt in the arms, in the jaws and in the neck. Sometimes, it feels like 'gas' in the upper stomach, sweating and shortness of breath.

Diagnosis

Unfortunately, many heart attacks are not diagnosed and do not receive timely treatment in Kenya. This is because patients, or caregivers may fail to recognise the importance of the symptoms and not seek assistance. The other challenges are poor accessibility of acute medical services for the majority of the population and lack of facilities. At a minimum, this should be a hospital that can do an electrocardiogram (ECG), basic blood tests and administer medications known as thrombolytics or “clot busters”.

Improving diagnosis

Initiatives like the Heart Attack Concern Kenya (Hack) are moving to address these challenges with a protocol of "systems of care" for efficient management of heart attacks and integrated networks of facilities. The emphasis is to work with the government, ambulance services and medical societies to increase access to timely life-saving treatment.

The Aga Khan University Hospital, Nairobi (AKUH) has been granted the Clinical Care Program Certification (CCPC) by the Joint Commission International, making it a Centre of Excellence in the management of heart attacks.

To receive this certification, the Hospital developed systems and care pathways to allow easy implementation of protocols in the treatment of heart attack patients.

Managing heart attack

Once a heart attack happens, speed is of the essence as heart muscle begins to die within the first hour. The goal of treatment is to re-establish blood supply to the heart within 60 minutes.

To beat the clock, AKUH put up a highly organised team of specialised nurses and doctors that can make quick diagnosis and provide expert treatment using clot busters, or specialised catheters to open the blocked artery.

A care protocol includes a set of systems that enable early diagnosis, treatment and rehabilitation. For example, the medication required is kept in the Emergency Room (ER) and is given to the patient once the heart attack is diagnosed bypassing the need to go to the pharmacy for the medication. The care bundles ensure that no step is missed and only the critical aspects of care are adhered to.

Once a patient with chest pain is identified, the team responds and that there are timelines to get the ECG performed and interpreted.

The team knows where the medication is and how it is administered. The catheterisation laboratory (Cath Lab) is always on standby and can be activated within minutes to provide life-saving treatment.

Mzee Ngunga, Interventional Cardiologist, Cardiology Fellowship Training Director, and Head of Cardiac Care Unit, Aga Khan University Hospital Nairobi