Senior Consultant & Unit Head, Interventional Cardiology, BLK-Max Super Speciality Hospital, New Delhi
Series overview · 8 articles
Acute Coronary Syndrome
June 2, 2024
Acute coronary syndrome, the medical term for a heart attack in progress, is a race against time where the right first steps determine whether a patient survives. Dr. Vikas Thakran, Senior Consultant & Unit Head, Interventional Cardiology at BLK-Max Super Speciality Hospital, New Delhi, used his Jivo Masterclass to walk through how coronary artery blockages develop, how ECGs are used to classify and localise a heart attack, how STEMI and NSTEMI are managed differently, how angioplasty (PCI) is actually performed, the realistic complication rates involved, and how critically ill patients are evacuated internationally for treatment.
What this series covers
This series works through the pathophysiology of plaque rupture and how stable angina becomes an acute event, how ECG findings classify a heart attack into STEMI, NSTEMI or unstable angina and localise which artery is involved, the different management protocols each classification demands, how PCI (angioplasty) is technically performed and when bypass surgery is preferred instead, the real complication rates of angioplasty, the major risk factors for coronary artery disease, and how international patients in a critical condition are evacuated to hospital in India.
This article is based on a Jivo Masterclass session conducted by Dr. Vikas Thakran, Senior Consultant & Unit Head, Interventional Cardiology, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
Looking for a cardiology or heart attack consultation? Get in touch with the Jivo team
This guide is based on a live Jivo Masterclass: Dr. Vikas Thakran taught doctors across Africa on June 2, 2024.
FROM THE LIVE Q&A
Dr. Paul
For a patient with anterior wall MI who has also fainted and is in a critical condition, how do you manage evacuation to an Indian hospital?
Dr. Vikas Thakran
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.
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Frequently Asked Questions
How is a PCI (angioplasty) actually performed?▼
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.
In terms of statistics, how many heart transplant cases have you handled?▼
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.
At what stage do we administer nitrates in managing ACS, what is the best source, and what are the nutritional considerations in ACS management?▼
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.
What are the main causes of acute coronary syndrome?▼
Smoking in young patients, diabetes, hypertension, a family history of cardiac disease, a sedentary lifestyle, and lack of sleep are the major risk factors. Pollution and extremes of temperature can also precipitate an event.
What is the role of cardiac defibrillation?▼
During an acute coronary event, external defibrillation is used for life-threatening ventricular tachycardia or ventricular fibrillation, whether at presentation, during the procedure, or post-operatively. On longer-term follow-up, patients with poor heart function (a low ejection fraction) may need an ICD, a device similar to a pacemaker, implanted to protect against these arrhythmias.
What does this masterclass series cover?▼
How coronary blockages develop, ECG classification of heart attacks, STEMI vs NSTEMI management, how PCI/angioplasty is performed, complication rates, risk factors, and international patient evacuation logistics.
Who is Dr. Vikas Thakran?▼
Senior Consultant & Unit Head, Interventional Cardiology at BLK-Max Super Speciality Hospital, New Delhi.
In This Series: Diagnosis and Management of Acute Coronary Artery Disease
- 1.Acute Coronary Syndrome
- 2.How a Heart Attack Develops: From Plaque to Complete Blockage
- 3.STEMI, NSTEMI and Unstable Angina: Reading the ECG
- 4.Managing a Heart Attack: STEMI vs NSTEMI Protocols
- 5.How PCI (Angioplasty) Is Performed, and When Bypass Is Better
- 6.Angioplasty: Complication Rates and Why Fast Treatment Matters
- 7.Heart Attack Risk Factors, Nitrate Therapy and Nutrition
- 8.Hospital Facilities and Evacuating Critical Patients Internationally