Acute myocardial infarction is, today, the leading cause of death in the world, according to WHO data . However, in many cases, it is a problem that is reversible as long as it is taken care of in time.
“Being able to attend to the patient in a short time greatly reduces mortality, ” Pablo Jorge Pérez, president of the Association of Ischemic Heart Disease and Acute Cardiovascular Care of the Spanish Society of Cardiology , explains to 20Minutos : “For now, it is the only proven way to reduce damage ”
“If the time is prolonged, the tissue is no longer recoverable”
“Normally, when a heart attack occurs, it is because irrigation stops reaching a part of the heart,” explains Pérez, “due to an obstruction in an artery.” “They are like pipes”, he illustrates, “and when there is an obstruction, there is an area that the blood that is not reaching has to reach, that is, ischemia occurs , and it is infarcted”.
Heart attack, chest pain, older
“This is because they stop providing nutrients and oxygen that this tissue needs to function normally,” he continues. “If we delay in solving this obstruction, that area of the myocardium (the muscle tissue of the heart) to which the blood flow is not reaching will gradually weaken and die.”
“The cells of the heart have a tolerance time to ischemia. When the irrigation deficit is very prolonged, that area of the heart stops working, dies and is not recoverable.”
Pérez explains it in a very graphic way: “It is as if, for example, we blocked an important street in a city , such as Castellana or Gran Vía in Madrid. If we block it abruptly for a long time, people who lives behind the obstruction would be cut off, and would not be able to eat and live. The longer that obstruction is sustained and the larger the affected street, the more people will be affected. ”
“In the long term, the delay causes irrecoverable damage”
The consequences of this can be very severe. “In the short term”, Pérez develops, “when someone has a myocardial infarction and we are not able to solve it early, this causes a higher risk of arrhythmias , a higher risk of complications related to acute myocardial infarction”.
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“There may be mechanical complications such as breaks or perforations and there may be other complications that we do not see at the moment, which are those that carry a high mortality and a great dependence on the health system by the patient,” he adds.
Pérez gives an example: “If we have a person who suffers a heart attack and there is a delay of more than between six and eight hours in unclogging that artery, we will have irrecoverable heart tissue that in the medium and long term will generate weakness heart disease and it’s going to cause heart failure. ”
“Heart failure is an epidemic”
The expert highlights the dimensions of the public health problem that myocardial infarctions represent: “In the end it is a health epidemic because, although life expectancy in Spain is increasing and we have more treatments that allow them to prolong life With heart failure, if we do not manage to shorten the time of unblocking the arteries, we will generate, in the long term, more heart failure ; and heart failure generates dependence on the health system, exercise intolerance, frequent readmissions to the hospital and higher mortality “.
In summary, “we must shorten the times, or we will have more acute complications and more cases with chronic heart failure , in the long term.”
“The sooner the better”
The margin to act, in these cases, is very narrow. “The sooner the better” , sentence Pérez. “It is not the same to treat a heart attack of one hour of evolution than with five”.
Heart attack, chest pain.
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To estimate, “below six hours we are in a reasonable time, but everything that is more than six and especially twelve hours the myocardial damage is already often irreparable”, says Pérez. However, he insists that the message is that “you have to act as soon as possible , and you have to insist a lot on early consultation and that the health system does not delay in providing care. Ideally, everything should be attended to in less than 30 minutes”.
This is because, in the time that begins with the appearance of the first symptoms associated with the heart attack, the patient has to ” consult quickly , the system has to be able to refer him through the healthcare networks that exist in Spain (which are called heart attack codes) to a nearby hospital and the artery has to be unclogged with an angioplasty, with the implantation of a stent . ” That is, every minute counts when time is ticking.
“Reducing time is the only way to reduce mortality”
This is the only way to reduce the chances of the patient dying. “The only thing that has been shown so far that can reduce mortality and the development of heart failure is to reduce times,” says Pérez.
“If we are able to raise awareness and sensitize the population so that from the moment it detects the first symptoms compatible with a heart attack, it consults and does not delay it, we are already shortening time. contact with the patient until we achieve the opening of the artery to work within a period of about 120 minutes we will be doing things quite well . But this, many times, we do not succeed, “he details.
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Once the damage is done, Pérez admits that he has a difficult solution: “To prevent the subsequent development of heart failure there are several studies underway , some with stem cells, others with other experimental treatments to try to improve the scar from the heart attack that is already there. established … But this is not yet solidly developed to apply to all patients. ”
“Now we have oral treatments with some drugs, but these are long-term things. And with myocardial infarction, we don’t have to think about what we can do afterwards but what we can do now.”
“Any chest pain that does not subside should be consulted quickly”
To achieve that quick consultation that becomes so vital in the case of myocardial infarction, it is essential to know how to identify the symptoms. “Any oppressive, intense or unpleasant chest pain that does not relieve us for a few minutes and that has a slightly more generalized distribution throughout the chest (or even that extends to the arms or neck) should be consulted as a priority , in the first minutes “, clarifies Pérez.
“It may not be a heart attack, but if it is, we will already be doing things well . If not, we will see what is the referral that should be adopted with this patient,” concludes Pérez.