The usual indication of coronary
artery disease / heart attack is chest pain, which is called angina pectoris.
Angina is usually the pain felt right in the middle of the chest, behind
breastbone, which can spread towards neck, jaw, left arm of wrist. It can feel
like handcuffs or tightening of chest. The pain may be prolonged more then 30
minutes and if associated with profuse sweating, nausea, vomiting and
palpitations is usually suggestive of heart attack.
ECHOCARDIOGRAPHY: - This is
basically ultrasonography of heart. This will tell us about functioning of
heart, its contractility, ejection fraction, any valvular blockage or leakage,
old or fresh heart attacks.
The angina pectoris may
come with exertion, walking up incline, after a heavy meal, after a strong
emotion, fright, and nightmare or smoking a cigarette.
The angina pectoris may be
a part of spectrum of acute coronary syndromes, which is heart attack or it may
come after exertion, which is usually called chronic stable angina. The
treatment options for both are different.
The evaluation for angina pectoris
consists of various lab tests. The usually performed tests for evaluation of
heart disease are ECG, Treadmill test (TMT), Echocardiography, Nuclear tests
and Coronary angiography.
ECG: - This is the basic test
for diagnosing heart disease. It is usually normal out side an angina episode or
unless patient already had an old heart attack, enlargement of heart chambers
or some conduction abnormality. It may signify a major heart attack or other
minor forms of heart attack. A normal ECG does not rule out presence of heart
disease.
STRESS TEST: - The patient is made to
walk on a treadmill and continuous ECG recording is done. The active angina /
heart attack should be ruled out before subjecting the patient to treadmill
test. The results of this test may be normal or may give clues about presence
of blockage in coronary arteries.
ECHOCARDIOGRAPHY: - This is
basically ultrasonography of heart. This will tell us about functioning of
heart, its contractility, ejection fraction, any valvular blockage or leakage,
old or fresh heart attacks.
It may be abridged
with a stress test, when it is called stress echocardiography. In this heart
functioning is seen at peak exertion, for any areas which are not moving or
working properly and signifying blockage in coronary arteries.
NUCLEAR SCINTIGRAPHY: - Nuclear test is done by
injecting very small, harmless amount of radioactive substance in blood stream
and taking images. Special gamma camera is used to take images of heart at rest
and after a stress.
CT CORONARY ANGIOGRAPHY: - This is a newer modality
for diagnosing blockage in coronary arteries. This is done by very high end CT
scanners like 64 slices or 128 slices. The importance of this test lies in its
high negative predictive value which means that if the test is negative showing
normal coronary arteries, it is definite and quite reassuring to the patient.
But if it is even slightest positive one should go for conventional angiography
and diagnosis should be confirmed.
CONVENTIONAL CORONARY
ANGIOGRAPHY: - This is the gold standard for diagnosing coronary artery disease. An
introducing sheath is inserted through a groin artery or arm artery and a
catheter is inserted and guided to coronary arteries, contrast dye is injected
and X- Ray films are taken. These will show any blockage in the coronary arteries
in form of filling defects, narrowing of lumen or irregularity of lumen.
The coronary angiography
is done to decide whether patient needs a coronary angioplasty or coronary
artery by-pass surgery or medical management only. The decision is taken only after
reviewing the coronary angiography results.
These days it has also
become relatively less invasive when it is done through arm i.e. Radial artery
route. Radial angiography is devoid of any bleeding complications and is very
comfortable for the patient. Patient can be discharged after a short hospital
stay and cumbersome leg straightening for six hours is avoided.
MANAGEMENT: - It is known that heart attack
occurs when there is total blockage of coronary arteries with a thrombus or
clot. The immediate treatment is addition to taking asprin tablet and other
medicines is dissolution of thrombus and opening up of the coronary artery,
which is causing heart attack so that damage to the heart muscle which is being
deprived of blood and oxygen is avoided well within time. The clot can be
tackled by immediate coronary angiography and removal by angioplasty procedure
or dissolving the clot by clot busting drugs given intravenously which is
called thrombolysis. The results of angiography and angioplasty, which is
called primary angioplasty are more favorable if done well in time. The
efficacy of clot busting drugs is maximum in first 3 hours. If the clot
busting drugs have not worked in a given patient than one should plan for
angioplasty procedure and opening of artery which is called rescue
angioplasty.
Actions needed to be taken
on suspicion of heart attack : - Chew a tablet of aspirin. Take nitroglycerin
as spray or sublingual tablet and repeat after 5 minutes maximum up to 3 doses.
Try to call and reach emergency services as soon as possible, do not deceive
yourself.
Dr TP Singh
Chief Consultant Cardiologist,
SGHS
Hospital, Mohali
E-mail id: tpsinghtp@yahoo.co.in
Mobile No : 09872421946
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