Heart attacks continue to affect many Kenyans. World Heart Day, celebrated last week, was aimed at countries to take stock of the gains made in the prevention of heart diseases, analyse the challenges and opportunities for the future.
How common are heart attacks?
In Kenya, 25 percent of medical admissions are due to cardiovascular disease which includes heart attack, stroke, and heart failure. These cardiovascular diseases (CVD) also account for 13 percent of hospital deaths.
What are the risk factors for heart diseases?
Risk factors for cardiovascular disease include hypertension, diabetes, elevated cholesterol, smoking, and advanced age.
What are the symptoms of heart attack?
When you develop a heart attack, focus is on saving the heart muscles from damage and ultimately saving the patient.
Chest pain: By the time a patient develops chest pain, a heart artery is blocked and blood supply to the heart muscle is reduced. The pain is a signal that the muscle is dying and releasing toxic substances that stimulate pain.
Pain in the middle of the chest: This pressure is like an elephant sitting on the chest. Sometimes it may feel like indigestion. Occasionally, the pain radiates to the left arm, to the back, or to the lower neck of the right chest.
Sweaty feeling and a sense of doom are very specific symptoms that the pain you are experiencing is from the heart. If you experience these symptoms, rush to the hospital as soon as possible because if a heart attack is confirmed, then a race begins to save your life.
What is the process of care for heart attack patients?
Once a doctor finds that the chest pain is originating from a heart problem, you will be immediately be taken to the acute room. At the Aga University Hospital, there is a chest pain protocol that includes the performance of an echocardiogram (ECG) and being given aspirin within 10 minutes of arrival.
This ECG will diagnose different types of heart problems— the most serious of which is ST-elevation myocardial infarction (heart attack).
If this diagnosis is made, then therapy with a clot-buster is administered within 30 minutes. By doing so, the clot is dissolved and this ensures restoration of blood flow to the heart muscle.
Why within 6 hours?
A clot-buster works most efficiently if the patient presents within 6 hours of developing chest pain. Outside this time window, the efficacy of clot-buster reduces, and the use of balloons and stents becomes the treatment of choice. Treatment of heart attacks for patients has improved significantly by the use of primary percutaneous coronary intervention (PPCI). If you present with sudden onset chest pain and have an abnormal ECG test, you are best treated with PCI as it has been shown to improve survival and myocardial salvage.
This should be offered within 60 minutes of arrival to the emergency room. To meet this timely obligation, the hospital has come up with a streamlined protocol from the emergency room to the catheterisation laboratory where heart attack patients are treated.
What care protocols has Aga Khan University Hospital put in place?
The catheterisation laboratory (Cath Lab) is always on standby and can be activated within minutes to provide life-saving treatment.
In rare cases, thrombolysis (treatment to dissolve clots in blood vessels) may be considered and is given within 20 minutes from patients’ arrival to the facility. Training is conducted regularly to ensure new teams are brought to speed on how the system works.
You will be admitted to the Coronary Care Unit for monitoring for about three days before discharge. Within this period, care includes medication, assessment on modifiable risk factors, and education on the identified risk factors, i.e. smoking cessation, obesity, diet, sedentary lifestyle among others.
Cardiac rehabilitation is also key for the patients and is available.
Dr Ngunga is an interventional cardiologist, Ms Nyabera is a Cardiac Services Manager and Ms Kinyua is a Cardiology Clinical Practice Educator at Aga Khan University Hospital Nairobi.