“STEMI” or “ST-Elevation Myocardial Infarction” is a very serious type of heart attack during which one of the heart’s major arteries that supplies oxygen and nutrient-rich blood to the heart muscle is blocked. “ST-segment elevation” is an abnormality detected on the ECG (electrocardiogram).
A “STEMI” is caused by a sudden complete (100%) blockage of a heart artery (coronary artery). A “non-STEMI”, on the other hand, is caused by a narrowed coronary that is not completely blocked. The diagnosis of “STEMI” is made by an ECG. All heart attacks are potentially serious, but one type that is the most dangerous of all is known as “STEMI”.
The biggest risk for cardiac arrest and muscle damage is within the first few hours after a coronary artery closes. Research suggests, however, that if the vessel is opened (recanalised) within the first few hours of the blockage (“primary angioplasty”), the patient has an excellent chance of survival and, what is more, hardly any heart muscle is damaged in the process — the best thing that can happen!
The heart muscle is interesting – it doesn’t re-grow or regenerate such as the skin or hair. Once it’s damaged, there is no way of bringing it back. It’s very important that we open up the totally occluded artery by doing an urgent “primary angioplasty” to get the circulation going as soon as possible. It is so distressing to see patients land up with a lot of “scarred” myocardium (heart muscle) because they had a late (PCI) angioplasty. As of now, despite stem cell research, very little can be done to regenerate heart muscle once it is scarred. Menacingly, this acts forever as a weak point with the potential to lead to “negative remodeling”, heart enlargement and eventual heart failure.
If I ever have to suffer from a “STEMI” heart attack (God forbid!), what would I have wanted? I would have liked the EMS (emergency medical systems) to reach the place I am — racked in my bed of pain — without delay. I would have liked to be transported in an EMS ambulance rather than a private vehicle because one out of 300 patients with chest pain suffer a cardiac arrest during transportation. Additionally, the EMS can activate the nearest “tertiary hospital” so that I will be taken directly to the “cathlab” for a “Primary Angioplasty” in less than 90 minutes of the first medical contact.
There is another way to open clogged arteries in “STEMI” using expensive clot-buster medicines called “fibrinolytics” but it must be appreciated that the success rate is much lower and the incidence of complications much higher than with the miracle called “primary angioplasty” which is the in-thing.
I am so happy to inform my readers that recently a breakthrough discovery has been made and the results were presented at the American Heart Association’s 2018 Scientific Session in Chicago. In the study, 204 patients with chest pain received both a standard 12-lead ECG and an ECG through the “AliveCor app”. What is the “AliveCor app”? It is a novel smartphone app which can help determine if you are having the most serious and deadliest form of heart attack (STEMI) and could turn out to be a valuable tool to save lives. “The AliveCor app”, administered through a smartphone with a two-wire attachment, can monitor heart activity and easily determine if someone is having a “STEMI”.
The app has nearly the same accuracy as a standard 12-lead electrocardiogram (ECG), which is used to diagnose heart attacks. Besides speeding up treatment after a STEMI heart attack, the app, which is low on cost, can also make ECGs accessible in places such as third world countries where people have “smartphones” but expensive ECG machines are hard to find.
If somebody gets chest pain and they haven’t ever had chest pain before they might think it’s just a “bug” or “gas” and they won’t go to the emergency room. That’s dangerous because the faster we open the blocked artery the better.
Many trials have shown that PCI (“primary angioplasty”) is superior to “fibrinolytic therapy”: lower mortality rate, less reinfarction and fewer strokes at 30 days when compared to fibrinolysis. PCI (“primary angioplasty”) capability is, however, available at fewer than 50% hospitals even in the US and each 30-minute delay from symptom onset to balloon inflation is associated with a 7.5% increase in mortality at one year. The logistics of having a PCI-capable centre in each and every town in Goa are enormous. The GMC Cardiology department, where stellar work is being done to open clogged arteries by Dr Guruprasad, Dr Manjunath and Dr Michelle (who work beyond the call of duty with expertise and dedication) suffers from work overload and very few with STEMI patients succeed in getting a “primary angioplasty”. As a result, I am pained to see, while conducting “echocardiograms” post-heart attacks, that not a few patients who did not get their angioplasty in time are left with a lot of scarred (devitalised) myocardium.
In conclusion, I can only say that in case I suffer a “STEMI” heart attack I would wish for myself (and every patient too) a “primary angioplasty” in the nick of time. However, “if wishes were horses, even beggars would ride!”
(Dr. Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa)
