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February 2010
The Golden Hour..When Seconds Count...
Dr A Gopi
The patient's survival and further quality of life depends on a window of opportunity called the Golden Hour

A heart attack can strike any adult, any time. But some of us, by virtue of our gender, age, family background, or other accompanying illnesses like hypertension, high cholesterol levels, and diabetes, and/or habits like smoking, are more at risk to a heart attack. But no adult is absolutely free from the risk of developing a heart attack. Hence, being aware of the symptoms of heart attack would help one to suspect it early, and seek medical help as soon as possible. This could make a difference between life and death.

A heart attack occurs when a narrowing in the arteries and /or a sudden blockage from a blood clot cuts off the nutrients and oxygen supply to the heart muscle. The majority of deaths from heart attacks occur suddenly and quickly. A third of patients never make it in time to the hospital for effective treatment. The patient's survival and further quality of life depends - to a large extent - on a window of opportunity called the Golden Hour.

Window of Opportunity
Golden Hour is a critical time, and time, is muscle. This is because the heart muscle starts to die within 80-90 minutes after it stops getting blood, and within six hours, almost all the affected parts of the heart could be irreversibly damaged. So, the faster normal blood flow is re-established, the lesser would be the damage to the heart.

To reduce the damage, it is important to get to the hospital as soon as possible. Other than the consequences of a damaged heart muscle, the most common killer in the early period is abnormal heart rhythms called ventricular tachycardia and ventricular fibrillation where the heart muscles contract at a rapid rate, but no effective pumping of blood from the heart takes place. This is why once the person reaches a medical facility (ambulance or hospital), they are immediately put on an ECG monitor to assess the heart rhythms so they can be given prompt treatment in case of an abnormal rhythm.

Once the patient reaches the hospital, the primary goal of treatment would be to dissolve the obstructing clot, and restore blood supply to the affected part of the heart. This is done, most commonly, by clot busting drugs. But of late, the preferred modality is mechanical dissolution of the clot by a procedure called as primary angioplasty. The only prerequisite is that it can be done only in hospitals, where a cardiac catheterisation laboratory and doctors well versed with this procedure, are available. Primary Angioplasty is a procedure that involves inserting a catheter tube through the blood vessels up to the heart. The location of the clot is identified with this, and dislodged with a balloon subsequently. The blood supply is thus re-established to that portion of the heart.

Importance of the Golden Hour
The earlier the blood supply is reestablished, the lesser would be the damage to the heart, and so, lesser the chance of death and of functional disability. In short, the earlier the patient reaches the hospital, the better the response to clot dissolution therapy. Thus, it is very important to call 1066 for an ambulance or to get to an Emergency Department quickly – within the Golden Hour - if you suspect that you are experiencing a heart attack. 1066 ambulances are fully equipped to handle heart attacks. Saving time right at the beginning can help save your life.

5 Warning Signs of Heart Attack
Many times, a person may not realise that he or she is having a heart attack, and quite a few who harbour doubts spend considerable time in self denial. The warning signs are:
  1. Chest discomfort
  2. Discomfort in the arm, neck, or jaw
  3. Shortness of breath
  4. Cold sweat
  5. Nausea or light headedness
If you think you have one or more of these symptoms, you need to call the emergency services of a nearby hospital, or get somebody to drive you to the hospital.
Dr. A. Gopi is Sr. Consultant - Interventional Cardiologist at Apollo Hospitals, Bangalore

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