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Important time frames in treatment of heart attack

Time spent out of hospital and time taken to deliver the treatment after reaching a hospital are both crucial
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Dr. Saumitra Kumar

Consultant Cardiologist

Fortis Hospital, Kolkata


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Dr. Saumitra Kumar

</b>The issue at stake is totally ischemic time that the movement patient has the chest pain to the time that he gets effective treatment that is reperfusion as we said, be it thrombolytic therapy or primary angioplasty that is the total ischemic time. Now, here problems are basically under two fold, i.e., one time spent out of the hospital and the moment the patient lands in the hospital what is the time taken to deliver the appropriate treatment. Now, time out of the hospital has two major entities, i.e., first one is dependent on the patient’s awareness about the whole problem that I am having chest pain, is it cardiac?, I should not waste time beyond first 15 to 20 minutes. I should either report to the doctor I know the matter or I should get whatever transport is available to me and reach the nearest hospital that is competent enough to deal with the problem. So, that is one thing and other is the infrastructural problem, the kind of ambulance service and other services that we can provide so that the patient reaches the hospital in quickest possible time. Now, once the patient reaches the hospital that is the medicolegal entity that you raised that we should deliver the treatment in a time dependent fashion. Now, to take both the things into account, the out of hospital there is a term, now introduced instead of door-to-needle-and-door-to-balloon time, is the first medical contact to needle and first medical contact to door time so that the ambulance is also hospital’s responsibility. The ambulance takes the patient to the hospital and starts effective treatment. Once, the patient is in the hospital, if he gets within a reasonable timeframe, say the first three hours, if the hospital is not equipped enough to do the primary angioplasty, then probably lytic therapy still has a place, but if the patient comes much beyond that then probably the patient should be referred to the nearest PCI capable hospital. Regarding PCI, the time set after the patient reaches the hospital is 60 minutes, so we should try to deliver the effective treatment in 60 minutes and FMC2 angioplasty time is 120 minutes. So, all these timeframes are important because not much time should be wasted in the emergency department, your cath lab technician and other staff and the operator should be intimated as quickly as possible so that the process can be initiated in the quickest possible time.

  • Heart attack
  • Primary PCI
  • Angioplasty
  • Heart Failure
  • ECHO

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