Live Discussion with Dr. Vikas Thakran
Questions doctors asked during the Jivo Masterclass on Diagnosis and Management of Acute Coronary Artery Disease, taught by Dr. Vikas Thakran, Consultant, Interventional Cardiology, BLK-Max Super Speciality Hospital, New Delhi, India, on . Written by Jivo Healthcare from the transcript of the session, drafted with AI assistance and edited by the Jivo team.
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?
Asked by Dr. Paul
Our international team organises everything, from the visa process to the transfer, with ambulances at the airport, and makes sure that even the family members are comfortable during their stay. The international team manages all the travel issues and helps in every possible way for the best outcome of the patient. They first take the patient's details and then consult us on the right course of action.
Answered by Dr. Vikas Thakran
How is a PCI (angioplasty) actually performed?
Asked by Dr. Williams
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.
Answered by Dr. Vikas Thakran
In terms of statistics, how many heart transplant cases have you handled?
Asked by Dr. Paul
Over the years, the need for heart transplantation has dropped drastically because of the medical and interventional therapies now available. Donor availability and finances also remain a problem, even in our setting. In numbers, it would be two or three transplants a year, not more, but the facility is available when an extreme case requires it and a donor is available.
Answered by Dr. Vikas Thakran
At what stage do we administer nitrates in managing ACS, what is the best source, and what are the nutritional considerations in ACS management?
Asked by General Dimma, Ghana
Sublingual nitrate is the therapy of choice because it acts quickly, and sublingual sorbitrate is widely available. Care should be taken in patients with inferior wall ST elevation MI: in those patients nitrates may not be good management. If the patient is not getting relief, an intravenous nitroglycerin infusion can be given, along with opioids in cases of extreme pain. On nutrition, because these events are acute, the nutritional approach is largely decided by hydration status. If a patient presents late with severe breathlessness, we give a low-salt diet and avoid IV fluids and overhydration. For long-term management after an acute coronary syndrome, high-fat and deep-fried foods should be avoided to keep cholesterol levels down. In short: sublingual nitrate, except in right-sided (inferior) STEMI, with intravenous nitroglycerin if pain is not relieved; and in patients with breathlessness and poor function, avoid salt and high fluid volumes.
Answered by Dr. Vikas Thakran
In ICU and HDU care, nutrition is often neglected because specialists are overwhelmed. Should dieticians be part of the team managing these cardiac patients?
Asked by General Dimma, Ghana
In our setting, patients admitted with a heart attack are often discharged within 36 hours of the procedure, so it is a very quick process. We have strong support from our regular dieticians: it is hospital policy that every patient has a dietician consultation, and they help manage each patient's specific needs according to their ejection fraction and risk factors. Dietician support is of paramount importance, and I fully agree.
Answered by Dr. Vikas Thakran
What are the main causes of acute coronary syndrome?
Asked by Moderator
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.
Answered by Dr. Vikas Thakran
What is the role of cardiac defibrillation?
Asked by Moderator
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.
Answered by Dr. Vikas Thakran
What are the expected complications of an angioplasty procedure?
Asked by Moderator
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.
Answered by Dr. Vikas Thakran
What motivates this line of work?
Asked by Moderator
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.
Answered by Dr. Vikas Thakran
In This Series: Diagnosis and Management of Acute Coronary Artery Disease
- 1.Acute Coronary Syndrome
- 2.Heart Attack ECG Localisation: Which Artery Is Blocked?
- 3.STEMI vs NSTEMI Treatment: Protocols, PCI and Recovery
- 4.Live Discussion with Dr. Vikas Thakran