Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health

One of the most common reasons for a person to visit the emergency room of a hospital is discomfort in the chest.

Pain in the chest, either in the center or on the left side, left shoulder, left arm (right arm pain associated with a cardiac event is rare but not unknown) or left side of the jaw is not something that should be ignored. The pain is known as "angina" and could be the sign of a cardiac problem. It is often associated with an underlying ischemia of the heart muscle (reduced blood flow) caused by a narrowing of the coronary arteries.

There are multiple reasons as to why this may occur. If that is the case it is what is known as an Acute Coronary Syndrome, on in layman's terms, a heart attack. No one is immune to coronary problems. The elderly, diabetics, smokers, those who are obese, people with high cholesterol levels and those with a family history of coronary artery disease are more prone to suffering from a narrowing of the coronary arteries.

If you report to the emergency room with chest pain, the doctor on duty will ascertain your symptoms and then order an electrocardiogram (ECG). This is usually done within 10 minutes of arrival at the emergency room. If a diagnosis of a heart attack is confirmed, there are two factors that will determine the course of treatment you will receive. If yours is a case of NON_ST Elevation (a mild heart attack) you will be admitted to the hospital and started on a course of blood thinning medication. After further evaluation of your condition, a decision will be taken on whether you require an angiogram or if the condition can be managed by medication.

If yours is a case of ST Elevation, a severe heart attack, what is know as the "window period" is taken into account. This is the time between the onset of the pain and your arrival at the emergency room. Based on the window period, one of two courses of treatment may be started. If you have no active internal bleeding and no high risk of this bleeding occurring (there is a probability that the medication to be given may cause bleeding from the stomach or into the brain), intravenous medication will be given to dissolve any blood clots in your coronary arteries. Alternatively, a procedure called a Coronary Angiogram may be done. This consists of inserting a flexible catheter (tube) into the right hand or right side of the groin from where it injects a dye into the arteries supplying blood to the heart. This dye will make it possible to see the extent of narrowing of the arteries.

If significant narrowing of the arteries (greater than 70%) is found, and the affected parts of the arteries are amenable to angioplasty, a procedure called Coronary Angioplasty may be performed. In this, a coronary artery balloon is introduced to the narrowed parts of the artery and then inflated to cause them to open up. A stent (a thin metallic tube) is then inserted to prevent the artery from narrowing again.

If the intravenous medication to dissolve the blood clots is ineffective, if the chest pain continues and if ST Elevation condition remains, you may be advised to undergo a Coronary Angiogram with or without angioplasty. If multiple areas of narrowing in multiple arteries are detected, you may be advised to undergo a surgical procedure called Coronary Artery Bypass Grafting-CABG.

After discharge from the hospital, there will be periodic medical follow up to monitor drug compliance, evaluate the heart function and adjustment of medication as may be required.

Sticking to the medication prescribed for you and following the lifestyle modification advised will help to stop further narrowing of the coronary arteries and reduced heart function.

"With a healthy heart... The Beat goes on ..."

Article by Dr. Bhooma,
Senior Resident, Department of Cardiology,
Kauvery Hospital

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