Management of Heart Attack in a Hospital

The technical term for a Heart Attack is Myocardial Infarction (MI). Its management can be divided into three phases-Pre-hospital, immediately in hospital and stabilization in hospital.

Pre Hospital Management means identification of pain that it can be angina. It includes taking rest, followed by Sorbitrate and if there is still no response then immediate and comfortable transport to the hospital.

In a hospital, oxygen is given first, so that in case of pain due to blockages hampering blood supply, more of oxygen reaches there. Then assuming Sorbitrate has already been given (given now, if not before) a tablet of Aspirin (to be chewed and not swallowed) is considered to lower the clotting rapidly.

Then Heart Attack is confirmed by ECG.

Pain if present is to be managed by strong intravenous pain killers, which to some extent is relieved by Sorbitrate also.

Also, very importantly intravenous B-blockers are given to limit the area of the damage by a Heart Attack and to prevent a dreadful complication of irregular heart rate – Arrhythmia.

Soon it is to be decided that the drug which has the ability to dissolve the clot can be given or not. This cannot be given to all, especially those who have had a stroke (paralysis), marked hypertension or acute internal bleeding like ulcers in stomach etc. Also, it is to be avoided in patients with known bleeding disorders, pregnancy, recent surgery and allergy to medicine. The medicines commonly used for this are Stretokinase and Urokinase.

Once stabilized, the patient is shifted out of intensive care unit where he is given comfortable conditions and proper nursing care, which include proper nutrition and sedation also.

Also the patient is put on regular blood thinners and other drugs which are commonly used like B-blockers, ACE-Inhibitors, Calcium channel blockers, etc.

Also, to be taken care of are complications, which are quite common after a Heart Attack. They can be Arrhythmia – where the rhythm of heart beat becomes irregular, warranting immediate intervention, pump failure – where the pumping power of the heart is reduced which may lead to severe breathlessness, even when lying down or Aneurysm- when a portion of the heart wall is weakened, which if ruptured may lead to death.

WHAT TO DO IN CASE OF PAIN?                         

Step I

First thing that should be done is to take rest. If you are taking a walk, then stop walking. Best is to lie down or one can at least stop walking and sit down.

Step II

In most of the cases rest will resolve the pain. If not then keep a tablet of Sorbitrate 5mg (Half tablet it is 10mg) under the tongue (Do not swallow it. Keep it under the tongue). Pain should subside.

Step III

If the pain has still not decreased, then another tablet of Sorbitrate (5mg) should be kept under the tongue after an interval of 3 to 5 minutes.

Step IV

If even this does not relive the pain then it can be a signal of something serious. It can be either

a.       Because of some cause other than Angina like acidity, etc or

b.      It can be a heart attack, which needs immediate medical attention.

 

Thus in such a case, the patient should not waste any time and take 4 teaspoons full of Antacid gel (Mucaine, Digene, etc) (use tablet if gel is not available) and meanwhile should proceed to the nearest hospital where an ECG can be done.

Hope you liked this article.

This article is written by Dr. Bimal Chhajer (Heart Doctor in Delhi)