President, Cardiological Society of India
</b> I think it is very important if you really want to prevent heart disease in India which is the rising manners in India as well as in Asia and it is a world capital of diabetes as you already know. We are also the world capital of hypertension and metabolic syndrome and a time is going to come and it is going to be a very major problem. Interventional cardiology is no doubt is a revolution but only as a part of territory prevention. Our focus should be on primordial, primary and secondary prevention along with territory prevention that is the main area and I think we should know as a member of a public how to attack heart attack. The methods of heart attacks should be known, we must even launch STEMI care or attack heart attack very, very important module. So everybody should understand when can we use the app. The app should be smart heart app and the components of this smart app should be how to attack heart attack. For example if somebody get a discomfort in chest he is not use whether it is a heart attack or it is not a heart attack, so what e does, he will just go and take some treatment for gas or acidity or he may take some ajwain or some local treatment or call a GP or call a family member and the time is passed, so the best thing when we get the app it contains the first component what are the symptoms of heart attack. Is it a pain in the chest, is it a sweating, is it choking, suffocation or there is a breathing problem or there is a dizzy spell or there is extreme fatigability, everything is mentioned and if a patient has those symptoms he says yes, he may be landing up with a heart attack. He press the app and then you get a mobile van in the vicinity where he is of the first contact point, the van reaches there and then the second component is pressed, you may ask him to get an ECG done. ECG is done and then the ECG is transferred through a system or what you call as telemedicine to the heart station of the doctor concerned and he interprets the ECG and say O! here is a STEMI attack and the best thing is if there is a heart attack, we to give a clot buster. Our objective is to save the time. If you see in the United States only 20% of the patients undergo angioplasty or stenting as a treatment of the heart attack as a primary method that means 80% of the patients are deprived of primary PCI even in a place like USA. So in India if I see the overall data only 10% of patients are having access to the primary PCI. So 90% of the patients need something like a clot buster what we call is TNK or streptokinase. It is the TNK. The success rate of TNK is almost up to a tune of 96%. If any patient we do primary PCI after three hours of he attack, it loses its potency or power of salvaging the jeopardized myocardium. So our objective is golden hour, it is this golden hour which is very, very important. I think once we use TNK we can abort the MI, abort the heart attack or we can reduce it from transmural to subendocardial or we make a larger to a smaller infarct or we prevent the extension of the infarct or reduce the multiple infarcts. See the benefits, the potential of the TNK cannot be over emphasized, it is very safe. It is a bolus dose just in 30 seconds can be given by a GP, a trained physician or even a paramedical staff under the doctor’s supervision is very important because we cannot take it only on the paramedical staff, a doctor’s supervision or cardiologist supervision is must. A time has come ladies and gentleman, we have to improve our emergency services (EMS), everybody should know how to enhance the potential of EMS for a heart attack care. Heart attack care should be a part and parcel of protocol of EMS and this is very important we have to create integrated ambulance service, a network not only in Delhi but in whole India that is the only method. What can we do it. Every welfare association of a colony should have an ambulance service. Should hire a driver round the clock and should provide for a service. Similarly, we can take the help of organization like Rotary, Lions or Inner Wheel or various corporate organization like SHM or PSUs like Scope or FICCI, or chamber of commerce. All these organizations can be taken and this will be a very, very good service and the prevalence rate of so called 50% patients die with a heart attack at home will not be there. We will save many patients and many lives, so we have to be very productive and we have to make sure how to attack heart attack, but the best integrated methods of STEMI care which is possible and we are going to start very soon in India.