Heart Attack Treatment: A Journey of A 100 Years

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1 DISCLAIMER: The views and opinions expressed in this presentation are those of the author. The slides in this presentation are prepared as talking points. It is possible that key substantive elements were delivered orally during presentation and are not present on the slides. The presentation is designed to provide the public with general information. The information in this presentation is not to be distributed, changed or altered in any way without expressed, written permission from the National University Heart Centre, Singapore. Heart Attack Treatment: A Journey of A 100 Years NUHCS The HEART Truth 2015 Dr Tan Huay Cheem MBBS, M Med(Int Med) MRCP(UK), FRCP(Edinburgh), FAMS, FACC, FSCAI Director, National University Heart Centre, Singapore Professor of Medicine, Yong Loo Lin School of Medicine National University of Singapore 1

2 Total No. of Deaths 17,222 17,10 1 % of Total Deaths , , , Cancer Pneumonia Ischaemic Heart Diseases Cerebrovascular Disease External causes of morbidity and mortality Hypertensive Diseases Nephritis, Nephrotic Syndrome & Nephrosis Singapore Major Causes of Death Urinary Tract Infection Chronic Obstructive Lung Disease Other Heart Disease

3 Plaque Rupture: 60 to 65% of Sudden Coronary Death Plaque Erosion: 30 to 35% of Sudden Coronary Death Virmani R et al Arterioscler Thromb Vasc Biol 2000; 20:

4 How Is Heart Attack Treated? Armchair Treatment of Acute Coronary Thrombosis 6 weeks of full bedrest (no self feeding/self bathing) Diet no salt 1200 calories/ day Cathartics and barbiturates No more than 8 cigarettes/ day No business visits Week 6 : 20 minutes of bedside chair Week 8: 5 minutes walk with assistance Week 12: Discharge home Week 16: Stair climbing or sexual activity In-hospital mortality from a New York City Hospital in the Year , was 47% of 394 cases 4

5 1950s:Frequent Death in Hospital Today Emergency Coronary Stenting Biodegradable Stent Angiojet Ultra Thrombectomy System LUCAS Automatic Chest Compressor Blanketrol Cooling Blanket Blanketrol placed under the patient. Set automatically to achieve a goal body temperature of 33ºC Cooling is done Maintain for 24 hour before rewarming 5

6 What To Do In Situations of Suspected Heart Attack? First Step: Recognise Symptoms. Avoid Delay Symptoms of Heart Attack Continuous crushing chest pain Pain radiates down left side of patient or to jaw Nausea, vomiting, sweating Dizziness, light-headedness, or fainting Not relieved by rest lsolated neck, jaw and/or arm pain (women) Shortness of breath (elderly) Pain in upper area of the stomach Second Step: Call Ambulance 995 Heart Attack Can Cause Cardiac Arrest In 2 Ways Extensive heart muscle damage Ventricular fibrillation (VF):Irregular, uncoordinated heart rhythm Third Step: Take Medicines What Medicines Can I Take for Heart Attack? Glyceryl Trinitrate (GTN) Chewable aspirin 300mg Inform doctor if you are taking Viagra or cocaine 6

7 Fourth Step: Learn Cardiopulmonary Resuscitation (CPR) Study in Singapore 80% of cardiac arrests occurred in home and 20% in a public place Nearly 90% of arrests in a public witnessed compared with <50% at home 8.5% of victims survived to be admitted into hospital 2.7% survived long enough to be discharged (Amsterdam 18%, Seattle 45% because of AED in public places) For every minute that nothing is done, the victim s chances of survival fall between 7 to 10% How To Prevent? 7

8 Tobacco is the only legally available consumer product which kills people when it is used entirely as intended The Oxford Medical Companion Cumulative tobacco-related deaths (millions) TOBACCO WILL KILL OVER 175 MILLION PEOPLE WORLDWIDE BETWEEN 2005 AND THE YEAR World Developing countries Developed countries Source: Mathews CD, Loncar D. Projection of global mortality and burden of disease from 2002 to PLOS Medicine, 2006, 3 (11):e442 What Is Normal Plasma Cholesterol? Mean LDL cholesterol level for Singaporean adults was 132mg/dL (3.4 mmol/l) 7 Ways of Heart Disease Prevention No smoking Exercise 150 minutes per week, moderate intensity level of activity Keep body weight BMI <25kg/m 2 Healthy diet- Be careful with 4 out of 5 followings: Fruits/vegetables, fish, fibres, sodium, sugary drinks Adult ideal total cholesterol level < 200mg/dl, children < 170mg/dl Keep blood pressure <120/80mmHg Ideal fasting sugar level < 100mg/dl 8

9 Conclusions Heart attack is a life threatening but preventable disease Reducing time to treatment is key to survival Attention to healthy lifestyle is better than sophisticated treatment 9