Heart Attack Risk Factors, Nitrate Therapy and Nutrition

A heart attack patient left untreated has a 30 to 50% chance of dying; treated promptly with a procedure or thrombolysis, that risk falls to around 5%. Saving the largest number of lives in the smallest amount of time, across the globe, is the reason and the motivation.

Jivo's international team manages the entire process end to end, from the visa process to ambulance transfer at the airport, and makes sure family members travelling with the patient are comfortable too. They first take the patient's details and advise on the right course of action, so the point of contact should be the international team, who will coordinate directly with BLK-Max.

Access is gained through either the radial artery in the wrist or the femoral artery in the groin. An angiography is first done through a catheter placed in that artery to locate the blockages, and a treatment plan is formed. A wire is then passed across the blockage, a balloon is used to open it, and a stent is placed. If there are multiple complex blockages that would need too many stents, coronary artery bypass surgery is recommended instead, decided by a heart-team approach. In an acute heart attack, PCI directly clears the thrombus, places a stent, and restores flow.

The need for heart transplantation has dropped drastically because of the medical and interventional therapies now available. Donor availability and financing also remain real constraints. In practice, the centre performs about two to three transplants a year, though the facility is available for extreme cases when a donor is available.

Sublingual nitrate (sorbitrate) is the treatment of choice since it acts quickly and is widely available, except in patients with inferior wall STEMI, where nitrates should be used cautiously. If sublingual nitrate doesn't relieve pain, intravenous nitroglycerin can be given alongside opioids for severe pain. On nutrition, the acute-phase approach is largely about hydration status: patients presenting late with severe breathlessness should be given a low-salt diet and IV fluids should be limited to avoid overhydration. For long-term management after an ACS event, high-fat and deep-fried foods should be avoided to keep cholesterol levels down.

Smoking (especially in the young), diabetes, hypertension, family history, sedentary lifestyle, lack of sleep, and pollution or temperature extremes.

Sublingual nitrate is first-line since it acts quickly, except in inferior wall STEMI where it needs caution; intravenous nitroglycerin can be added for pain not relieved by sublingual nitrate.