Question 1

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 · Accepted Answer

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.

Question 2

How is a PCI (angioplasty) actually performed?

Dr. Vikas Thakran · Accepted Answer

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.

Question 3

In terms of statistics, how many heart transplant cases have you handled?

Dr. Vikas Thakran · Accepted Answer

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.

Question 4

At what stage do we administer nitrates in managing ACS, what is the best source, and what are the nutritional considerations in ACS management?

Dr. Vikas Thakran · Accepted Answer

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.

Question 5

What are the main causes of acute coronary syndrome?

Dr. Vikas Thakran · Accepted Answer

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.

Question 6

What is the role of cardiac defibrillation?

Dr. Vikas Thakran · Accepted Answer

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.

Question 7

What are the expected complications of an angioplasty procedure?

Dr. Vikas Thakran · Accepted Answer

Angioplasty is roughly 95 to 98% safe. The complications that can occur are access-site bleeding from the hand or groin, and rarer complications related to the coronary arteries themselves, such as stent thrombosis (a blocked stent) or, in difficult vessels, a perforation.

Question 8

What motivates this line of work?

Dr. Vikas Thakran · Accepted Answer

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.

Diagnosis and Management of Acute Coronary Artery Disease

Questions Doctors Asked Dr. Vikas Thakran