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The heart’s variety

October 14th, 2015


The heart’s variety

Over the past week, three patients came to see me because of myocardial infarction. Their ages ranged from 30’s to 40’s.

Myocardial infarction happens when the artery is suddenly blocked and blood cannot flow to the heart muscles. After 30 minutes, the heart muscles will start to die, causing heart attack. Usually, it is more common among men over 45 years old and menopausal women. Younger patients often fall victims to this because of smoking, genetic, high blood pressure, diabetes or family history of myocardial infarction at a young age.

The first patient was a 42-year-old businessman whose definition of exercise was limited to playing golf on weekends. He came to see me because he had felt tight in his left chest for a few days. That morning, the pain lingered for about 20-30 minutes, but gradually faded away on the way to the hospital.

He was free from risk factors such as diabetes, high blood pressure, smoking, high cholesterol level or family history of myocardial infarction. The only apparent risk was the fact that he did not exercise, which made his HDL cholesterol a bit too low.

Another patient was a 40-year-old monk from up north. He told me that in the past few months, he had spent most of his time meditating, which in turn reduced his sleeping time to just a few hours.

A week before he came to the hospital, he noticed a tight pain in the middle of his chest for about 5-10 minutes. The pain came and went, but he also noticed that he was unusually tired when he walked uphill to his temple. The symptoms became more and more severe, until one day he felt tired even when he was lying down. His relatives had to collect him from the hilltop temple and took him to the hospital.

His only problem was his slightly high cholesterol level, which was not properly treated because he lived far away from medical services.

The third patient was 32 years old. He appeared to be strong, but he admitted that he smoked a pack of cigarettes every day. He also did not exercise, and his father had passed away from heart disease, while his mother was diabetic, had high blood pressure and had myocardial infarction.

He said that there had been no warning signs. One day, he woke up in the middle of the night with a sharp pain in his chest. He was covered with sweat and he went very pale. After 3-4 hours, he decided to come to the hospital.

For these three patients, their symptoms spoke quite clearly that they had myocardial infarction. ECG test and enzyme results showed that my assumption was right; they were faced with acute myocardial infarction.

In the past, the way to treat it was to give medicine to disolve the blood clot that blocked the artery, so that blood could continue to flow to the heart muscles. However, it does not work on every case, and the medicine could pose serious side effects such as bleeding in the brain, stomach or intestine.

Today, the most common way is to use antiplatelets together with balloon angioplasty and stent placement. Balloon angioplasty in myocardial infarction patient is slightly different from treating narrowed artery disease, because the severity of clotting is different. Sometimes the blood clot has to be partially suctioned out to prevent blood clot to relocate to smaller capillaries.

For acute myocardial infarction or heart attack, the most important thing in treatment is to do it as soon as possible. The sooner we can get blood to flow to the heart muscles, the better the patient recovers and survives.

You don’t have to be a cardiologist to spot the difference between a heart attack and angina pectoris caused by narrowing of the artery. The first one happens suddenly and increases frequency and severity very quickly. This means you have to go to the hospital as soon as possible.

I treated all the three patients with balloon angioplasty and stent placement. They felt better and the pain was gone. They went home (except for the monk, who went to the temple) within a few days.

It wasn’t difficult to treat those cases, but it was more difficult to make sure it doesn’t happen again, especially if the patients were not on board with the idea. If they continued doing the bad habits, the chance of recurring is high.

For the first patient, I asked him to exercise regularly and “make” time for it (because “finding” time is often deemed impossible for such busy people). The goal was to exercise 30 minutes a day, so it means waking up 15 minutes earlier than usual, and going to bed 15 minutes later than usual.

For the monk, I asked him to rest properly and take medicine regularly. The last patient was a bit trickier. I told him to stop smoking and exercise regularly. I had actually expected him to protest against my recommendation, but he said he could easily do it. I was amazed, but also relieved, until he finished his sentence with, “because I’ve quit smoking many times already! Not difficult at all!”

Prof Nithi Mahanonda is consultant cardiologist and interventionist, Perfect Heart Institute.












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