In cases of ‘Heart Attack with Heart Failure, doctors sometimes start heart failure medications early to help improve the condition. However, in the ICU, the situation can be a bit different. Here are 2 main problems and 2 strategies to consider:
️🩹Low Blood Flow: Even after tests like ECG (etc) show improvement and pain goes away, there might still be an underlying blockage causing low blood flow to the heart. Instead of starting heart failure medication right away, I prefer to increase the dosage of medications that help improve blood flow to the heart.
️🩹 Auto-Improving Heart Function: By enhancing blood flow, the heart can pump more effectively, which helps improve heart failure. How? The heart has many small arteries on its surface, and while one artery may be blocked, the flow medications can help open up these other smaller arteries. This allows blood to reach the damaged areas of the heart, aiding in healing.
️🩹 The main goal in the ICU is to revive the “Hibernating” areas of the heart muscle that are not functioning well due to low blood flow. These areas are like muscles that are “asleep” and need to be awakened. I find that many young cardiologists may not be patient enough to allow this recovery to happen.
️🩹 Once the heart is stable, I then start the heart failure meds, even after the patient is discharged. This process is called slow “Remodeling” the heart back to its normal function. It’s similar to a car engine: first, you need to clean out the fuel lines to ensure the engine gets the right amount of fuel, and only then do you fix the engine itself. This strategy helps the heart recover more effectively! And this strategy has paid me huge dividends in my ICU, which I have been running for 25 years.
️🩹 In UK, ICU-level Angiogram & Stent is very rare. Incidence of emergency “Primary Stent” in ICU, in UK is = 0.0003%. Overall, in Europe its low. Medical treatment of heart attack is good, if done as per protocol and understanding the underlying ‘Full Body’ mechanisms.
️🩹 In India, during ICU period of heart attacks, we STENT frequently and for slim reasons. Unfortunately, Commercial pressures to play a big role in this. But, if available and when rightly indicated, I do advocate this invasive costly stent procedure.
️🩹 But many, many, Indians cannot afford a Stent, and they still recover well. The reality is that very few need a Heart Stent in a RUSH. It can be applied much later. Yes, I do agree that each situation is different. So, get a 2nd opinion before Angiogram, Angioplasty & Stent.
Dr. R. Jayaprakash, Dr.JPs Cardio-Diabetes Clinic, Aditya Hospital Chennai.
