Category Cardio vascular system/ Family Practice/ Clinical guidelines

We all know that as high 40% victims of 1st STEMI succumb within 1st hour. How the patient is managed is of paramount importance. More important for primary care practice is prevention of such a terminal event and following new guidelines definitely help!

Team@CMHF

Each year an estimated 500,000 Americans have a STEMI. Treating this type of heart attack requires fast action because if blood flow is not restored to the heart within 20 minutes permanent damage will occur, said Elliott M. Antman, M.D., professor of medicine at Harvard Medical School and director of the Samuel A. Levine Cardiac Unit at Brigham and Women’s Hospital in Boston. While some heart muscle can be
saved if patients are treated later, more of it is lost with every minute treatment is delayed.

Speedy treatment not only means the difference between life and death, but also between disability and a return to an active lifestyle after a heart attack.

“The message that we are trying to get across to patients is this: They need to enter the medical system much more rapidly than they are currently,” said Antman, who chaired the writing committee and the ACC/AHA task force that drafted the new practice guidelines.

Many patients say they delay seeking treatment because “they’re embarrassed; they worry that they are crying wolf” because the symptoms may be caused by indigestion or other non-heart attack conditions. “Women in particular delay longer because many still adhere to a message of the past identifying men as those primarily at risk for heart attacks.”

Antman said earlier guidelines weren’t always helpful to physicians who needed to make fast decisions about treatment. The new guidelines have been organized so that all medical personnel—emergency medical technicians who are first on the scene, emergency department staff, and the cardiologists treating the patients—can quickly identify the most appropriate treatments.

Decisions to be based upon:

• How much time has passed since the onset of symptoms?
• How great is the risk of dying?
• How great is the risk of bleeding in the brain if clot-busting drugs are used?
• Realistically, how much time will it take to get the patient into a cardiac catheterization lab for stenting?

The guidelines also include clear instructions about medical treatments after heart attack. For example, the guidelines recommend that patients should take aspirin daily and receive beta-blockers (to reduce the risk of irregular heart rhythm) after heart attack.

“We also strongly endorse the use of angiotensin-converting enzyme (ACE) inhibitors for all patients to improve heart function,” Antman said. “For those patients who cannot tolerate an ACE inhibitor, we suggest an angiotensin receptor blocker
(ARB).”

The new guidelines also recommend that heart attack patients with levels of “bad” low-density lipoprotein cholesterol (LDL) of 100 milligrams per deciliter (mg/dL) or higher receive cholesterol-lowering statin drugs upon hospital discharge. The goals
should be to reduce LDL to “substantially less” than 100 mg/dL.

“Based on the results of large clinical trials of statin drugs, we’re finding that the lower the LDL, the better. This change in practice could significantly improve outcomes for patients recovering from heart attack.”

Read More: http://www.mombu.com/medicine/heart/t-new-guidelines-for-treating-heart-attacks-heart-aspirin-stomach-cardiac-cholesterol-9879576.html