No excuse for delays with heart attack treatment

The Medical City

Posted at Mar 14 2019 12:39 PM | Updated as of Mar 18 2019 08:12 PM

Here’s the scenario: You’re feeling nauseous, light-headed, with a slight tightness in the chest and having difficulty breathing. You may think it’s just a bad case of fatigue or maybe a heartburn—but in fact, it’s already heart attack.

Contrary to what we see in movies, most heart attacks don’t just occur with a crushing chest pain or without any warnings. Signs such as pressure, heaviness, or tightness in your chest, extreme shortness of breath, nausea, and dizziness can be detected days (or even weeks!) before the attack. It can happen to anyone—even the most healthy and active people. 

A heart attack is caused by a blood clot in a coronary artery, a blood vessel that supplies the heart muscles. This deprives the heart muscle the much-needed oxygen to allow blood to flow to the rest of the body. And without oxygen and other blood nutrients, the heart muscle stops functioning, you lose blood supply to the brain, and consequently fall unconscious. To be able to survive this, you must get medical assistance right away.

According to Dr. Paolo Prado, Director of the Acute Myocardial Infarction (AMI) Clinical Care Program of The Medical City’s Cardiovascular Institute (CVI), the guiding principle for heart attack is “time is muscle.”

“If the artery is not opened quickly, more muscle death occurs and less can be salvaged. If one survives a heart attack without the appropriate and timely treatment, the muscle becomes scarred and there will be complications like heart failure. Appropriate treatment needs to be administered as fast as possible through rapid reperfusion,” said Dr. Prado. 

In 2012, TMC launched the AMI Clinical Care Program, an integrated, multidisciplinary program to decrease mortality of patients who are admitted to TMC with a heart attack, and to enhance the quality of life of heart attack survivors.

The Cardiovascular Institute heads with The Medical City Senior Management: (From left) TMC Cardiologist Dr. Rene Reyes, Chief Medical Officer Dr. Rafael S. Claudio, CVI Director Dr. Gregorio S. Martinez, Jr., TMC President and CEO Dr. Eugenio Jose F. Ramos, Chairman Emeritus Dr. Augusto P. Sarmiento, Chairman of the Board Jose Xavier B. Gonzales, CVI Manager Beda Galicia, Dr. Carlos Esguerra, Head, Section of Adult Cardiology, and Cardiologist Dr. Hans Albert Bautista

Time is muscle – the guiding principle of the Acute Myocardial Infarction (AMI) Program. When an artery is blocked, the heart muscle it supplies will die.

Dr. Prado added that the AMI Clinical Care program was established so they can treat AMI or heart attacks effectively and rapidly. It is the first and only one of its kind in the Philippines and ranked 8th worldwide among similar programs. It is also the only one in the country accredited by the Joint Commission International (JCI), an international accrediting body that accredits world-class programs at par with the highest standards in health care in terms of quality, patient safety, and patient outcomes. TMC received its first certification from JCI for its AMI program in 2015. The program was re-certified in October 2018.

“A heart attack is a medical condition with high mortality, so through the program, our primary aim is to save people from dying using highly specific care and strategies,” added Dr. Prado.

He said the foremost strategy is through “rapid reperfusion,” where a balloon is inserted and a stent implanted to open the patient’s blocked artery in the quickest fashion and time possible after arriving in the Emergency Room. “The artery must be opened within that time (60 minutes), not the next day. It really cannot wait,” he said.

Once successful, Dr. Prado said secondary steps are taken such as medical therapy, cardiac rehabilitation, education regarding lifestyle changes including diet, exercise, smoking cessation, and attainment of one’s ideal body weight. These measures decrease the chances of having another heart attack in the future. 

The cardiac rehab’s exercise program helps the patient return to work, play, and restores quality of life. There’s also the psychiatric assessment for depression, which is common to heart attack patients, to help avoid trauma and anxiety. 

Cardiovascular disease is still the No. 1 killer in the country, Dr. Prado said, but rapid and effective treatments through a Catheterization Laboratory is still concentrated in Metro Manila and getting to one is still difficult due to factors like traffic. There are also times when the decision-making is a limiting factor to move on with the treatment. People should be educated to be aware of the signs and symptoms of an ongoing heart attack so they can seek medical attention right away. 

“That’s what we’re doing with the AMI program; we are creating more awareness to educate people about the importance of rapid, emergency treatment like angioplasty to help save the patient. The important thing is not to waste time,” said Dr. Prado.

About The Medical City Cardiovascular Institute

The Medical City Cardiovascular Institute fully integrates all the elements of a patient-centered cardiovascular care - from wellness, prevention, diagnosis to treatment and rehabilitation, making it a respected leader in cardiovascular medicine in the country.

Aside from its AMI program, distinct to TMC-CVI is its Cardiac Catheterization via the radial (wrist) artery. TMC is one of the first hospitals in the Philippines to offer this which is safer, leads to less bleeding, and is much more comfortable for patients, who can ambulate after the procedure and be discharged a few hours later. TMC Catheterization Laboratory currently uses transradial access in almost 90% of its coronary procedures. This is the highest percentage, by far, of all the Cardiac Catheterization Labs in the country and matches the leading centers in Europe and Japan. 

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