The Best Test To Predict Heart AttackBy ManuPosted On 12-May-2017
Most of us would have lost somebody close to us or known to us to a sudden heart attack.The disease pattern of urban Indians have reached an almost same pattern as that of a westerner. As young doctors we were mostly dealing with diarrheas, tuberculosis , malaria, polio, etc. But after twenty years commonest admissions in our emergency departments are somebody with chest pain.
ATTACK AS A PROBLEM
A heart attack can best be compared to an internal accident. You will never see any cuts or bleeds outside. But actually it is happening inside. At the time of heart attack some portion of our heart change colour from normal to blue, our lung get flooded with stagnant blood and sometimes real bleeding into the lungs. There are around 600 heart attacks per day in the state of kerala and 20% of them, which means around 120 die even before he or she can reach a hospital.
FIRST SIX HOURS
Smaller hospitals avoid admitting heart attacks for the fear of complications, therby precious time being lost before getting sufficient care. Even if you reach a well equipped hospital with a cardiologist, an average treatment cost will be around 1.5 to 2 lakhs. And if the crucial first 6 hours are past, very unlikely that even the best cardiologist will be able to reverse damge to the heart. At the best he may be able to save our life.
If our heart attack treatments are not sufficiently successful most likely that heart function drops from normal of 70% to say 40%. After one or two failed or unattended such heart attacks we develop heart failure. Heart failure is a crippling situation.
WHY IT MAKE SENSE TO PREVENT ONE ?
In a country like India, the health expenditure on heart attack treatment can be reduced to one tenth if our public health resources are directed to preventive programmes. Unlike cancer sciences, cardiac sciences are well advanced and almost within the reach of most of our population. At an individual level a heart attack is fear on life, psychological trauma, financial crisis and crippling life from almost heart failure.
ANNUAL TMT TEST
Contrary to general perception among the public, an ECG is a useless test except at the time of an attack. At the time of an attack ECG definitely is the best firstline test. But todays ECG may be perfectly normal even if the person is going to get a fatal attack tomorrow. But an ECG taken while we are excercising for some ten minutes will surely show changes which give the suspicion of heart blocks. If these TMT test is positive, he or she has to undergo an angiogram and get suitable treatments.
WORLD HEALTH ORGANISATION RECOMMENDATIONS
WHO recommends TMT as the screening tests for heart attacks and advice everybody after 40 years with more than two risk factors for heart blocks. This test has to be done every year. A negative TMT test almost assure you freedom from heart attack at least for a year.
RISK FACTORS FOR HEART BLOCKS
- Continued stress
- Uncontrolled high blood pressure
- Uncontrolled diabetes
- Food habits
- Sedentary life style
- Family run
- Thyroid hormone deficiency
WHEN AND WHERE A TMT TEST ?
A person with severe blocks but no symtoms if start running on treadmill , may go unwell. TMT should be done in a proper set up under the supervision of a doctor. The TMT room should be equipped with all lifesaving equipments and in presence of a doctor capable of resuscitation.
Average cost of TMT is only around Rs.1500. A relative should accompany . Should not be on a full stomach. BP should be well controlled before.
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