Docs Not Giving Best Post-MI Prevention Care?

Its a worrying finding for patients.

A significant percentage of patients with coronary artery disease (CAD) still aren’t being prescribed the recommended secondary prevention drugs that could save their lives, a new analysis confirmed.

About a third of CAD patients enrolled in a national registry were not taking a combination of beta-blockers, statins, and ACE inhibitors/angiotensin receptor blockers (ACEI/ARBs) after having a heart attack or undergoing percutaneous coronary intervention (Angioplasty/ PCI) or coronary artery bypass grafting (CABG/ bypass surgery).

And compliance with the secondary prevention drug recommendations varied greatly from practice to practice, researcher Thomas M. Maddox, MD, of the VA Eastern Colorado Health Care System in Denver, and colleagues, wrote online Oct. 30 in the Journal of the American College of Cardiology.


The researchers examined data from the American College of Cardiology’s PINNACLE Registry, which is the first national, prospective, outpatient-based cardiac quality improvement registry of patients being treated in cardiology practices in the U.S.

Patients treated at 58 PINNACLE practices between July of 2008 and December of 2010 were included in the analysis.

Among 156,145 coronary artery disease (CAD) patients treated at 58 participating practices, 66.5% were taking beta-blockers, statins, and ACE inhibitors/angiotensin receptor blockers on their first post-event visit, and only slightly more (69.7%) had been prescribed these recommended medications a year later.


This is worrying that one-third of the patients are not getting the necessary drugs to  prolong survival.  This is despite the fact that most of the doctors have now access to latest medical information and guidelines due to availability of smart phones and internet access. If this is the situation in the western world, it would be worse in the developing countries.

In an editorial published with the analysis, L. Kristin Newby, MD, of Duke University, wrote that efforts to increase the use of optimal drugs for secondary prevention should focus not only on cardiologists but also family practice physicians, internists, gynecologists, and advanced practice providers such as nurse practitioners and physician’s assistants.


via Docs Not Giving Best Post-MI Prevention Care?.

Heart Attack!

Heart Attack! A medical condition which evokes fear in the patients and their relatives.


What causes heart attacks? Are they fatal? Are there any measures which can save your life? What are the treatment options? What medicines to take after a heart attack? These are some of the common questions which most of us have regarding a heart attack. So let’s answer them!


What is a Heart Attack?


A Heart attack is a term applied to injury caused to the heart muscle due to sudden blockage of the artery carrying blood to the heart. The heart is a pump which pumps blood to the whole body. For this the heart needs oxygen which is supplied by three small blood vessels called coronary arteries. When one has sudden blockage of one of these arteries, it is called a heart attack. During the heart attack the artery gets suddenly blocked almost 100% by a blood clot and thus there is less blood supply to the heart. This causes damage to the heart muscle and can be fatal if it is severe.


What are the symptoms experienced by the patient?


The blocked artery causes damage to the heart muscle. This causes severe chest pain in the center of the chest. Some times the pain can radiate to the arms, back, upper part of the tummy and the jaw. Some patients may experience giddiness, palpitations, shortness of breath and sweating. Some patients may experience burning in the chest and stomach with nausea and vomiting. They may delay treatment thinking that it’s a gastric (acidity) problem.


Are all heart attacks fatal?


No. Most of them are not fatal. However, 25% of patients can die if the heart stops suddenly. This is called as Sudden Cardiac Arrest. Majority of the patients survive a heart attack but it needs to be treated promptly.


What can you do at home?


  1. Remain calm. Do not panic. Do not run. Rest and wait for the ambulance to arrive OR.
  2. Visit the nearest hospital with an ICU facility by a vehicle. Do not walk down to the hospital.
  3.  If you are breathless, sit upright.
  4. Chew 300 mg of Aspirin tablet. Or powder it and keep it below your tongue. Do not gulp it down with water
  5. If you have chest pain, place a 5 mg tablet of Sorbitrate below your tongue. Ensure that you are in a sitting position and do not stand if you are feeling giddy. One can place a maximum of 3 tablets below the tongue at 5 minute intervals. Do not take Sorbitrate if you are feeling giddy.
  6. Get an ECG immediately and report to the doctor.


How is a Heart Attack Diagnosed?


A Heart Attack is diagnosed by an ECG and a blood test called Troponin. Your ECG will show changes suggestive of less blood supply to the heart. A positive Troponin blood test also suggests decreased blood to the heart.


What are the treatment options?


A heart attack is caused by sudden total (100%) block of the coronary artery. So the main treatment goal is to open the artery. There are 2 ways by which one can open the artery.


1. Angioplasty. During angioplasty, the block is directly opened with a balloon and then a stent is placed in the artery.


2. Clot Buster Injection: This is the medical option called Thrombolysis. Here a Drug is administered intravenously to dissolve the clot and restore the blood supply to the heart. These vary in their charge from INR 2500 to 35000/-. Some of the drugs used are Streptokinase, Tenecteplase (available as Elaxim or Metalyse), and Reteplase etc.).



What other drugs are required subsequently?


Once a patient is stabilized, majority of them will be on the following drugs:

  1. Blood thinners: like Aspirin to improve blood flow.
  2. BP medicines: to control the blood pressure and decrease load on the heart.
  3. Statin: these are medicines to reduce cholesterol levels and prevent heart attacks
  4. Diabetes medicine: to control your diabetes.

All patients need regular follow up with a Cardiologist and Life-long Medications!

Take care of your heart! Chao!