Global Health Asia-Pacific July 2022 | Page 35

us are not comfortable performing especially to a stranger . Good quality CPR involves pushing the chest hard , and pushing the chest fast . The depth and speed of the chest compressions are vital to give the patient the best chance of survival . It is important to allow proper chest recoil after each chest compression . This allows blood to fill the heart , and helps to increase the outflow of blood to the organs when the heart is compressed again .
Learning proper CPR technique is crucial in saving lives . Everyone should be trained to do Basic Life Support ( BLS ), and at least one member of each household should be proficient in performing C�� , especially if there are family members who are at risk of a heart attack .
The CPR Faculty in IJN organizes courses throughout the year for laypersons and medical staff . �or the public , there are the Basic Life Support ( BLS ) and HeartSaver CPR courses available . The American Heart Association ( AHA ) Advance Cardiac Life Support ( ACLS ) Course is available for medical personnel .
Treatment of Heart Attacks in IJN Heart attacks occur when at least one of the major blood vessels to the heart become acutely blocked , usually by a blood clot in an already narrowed blood vessel due to diseases such as high blood pressure , diabetes and smoking . Any patient with chest pain will immediately have an ECG performed within 10 minutes of arrival . Once the diagnosis of a major heart attack is made ( ST-Elevation Myocardial Infarction or STEMI ), the patient will be prepared for a treatment called Primary Percutaneous Coronary Intervention ( PPCI ). PPCI , which is also known as balloon and stenting , is the best treatment available for an acute heart attack . This treatment modality is available in IJN 24 hours in a day , 365 days in a year . Prior to PPCI , the patient will be stabilized and optimized in the Emergency Department ( ED ). The patient will be given medication to thin the blood ( antiplatelets and anti-thrombotic medication ). He or she will then be brought to the Interventional Cardiac Laboratory ( cath lab ) for the PPCI procedure to be performed . This is done very fast as Time = Muscle . Our aim is to bring the patient to the cath lab and perform PPCI within 90 minutes of arrival to the ED . With many years of experience , �J� have streamlined and perfected the flow of heart attack patients . In 2021 , our average time to perform PPCI from patient ’ s arrival to ED was 54 minutes . A small proportion of patients may not be suitable for PPCI . There are other treatment modalities available using medication called Fibrinolytics which can dilute the blood clot that was causing the blockage in the major blood vessel of the heart . Heart attack patients will be admitted to a Coronary Care Unit for further management and close monitoring .
24 Hour Heart Attack Centre To improve our services as a Heart Attack Center , IJN has established a partnership with First Ambulance Service ( FAS ) in April 2019 . The public has an option to utilize the FAS team , especially if they suspect of having a heart attack . A toll-free number can be contacted and the FAS ambulance crew will attend to the caller immediately . The paramedics will perform an ECG , which is shared immediately via email to the doctors in the Emergency Department , before the patient is brought to the hospital . If the diagnosis of a heart attack is made ( STEMI ), the IJN ED will activate the Cardiology team to prepare for PPCI . By the time the patient arrives to the ED , the Cardiology Lab team is ready and the process is expedited with minimal time spent in ED prior to going to the lab . This is one of the reasons why the IJN Door-to-Balloon ( DTB ) time of 54 minutes in 2021 was within the international standards for DTB time .
IJN has also collaborated with Hospital Kuala Lumpur ( HKL ) since 2015 , and established a network for heart attack patients presenting to HKL . This network collaboration has reduced the waiting time for HKL patients with an acute heart attack to receive PPCI treatment in IJN .
With all these initiatives and improvements , IJN has successfully recorded a decrease of mortality rate for heart attack cases from 15.8 % in 2009 to just 3 % in 2019 . This compares well with overall Malaysian data for in-hospitality mortality rate for heart attacks , which sits at 10.6 %.
Risk Factors The risk factors for heart attacks are many , and can be classified into ones that can be modified and those which cannot . �on�modifiable risk factors includes a strong family history of heart disease , increasing age and male se� . �isk factors that can be modified include smoking , obesity , diabetes , high cholesterol , hypertension and stress .
It is best to avoid a heart attack from happening . Thus , it is important for us to seek medical advice especially if there are symptoms suggestive of a heart attack , no matter how mild the symptoms are . IJN has an extensive team of experts in Cardiology , Cardiothoracic and Vascular Surgery , with many years of experience . Our Interventional Cardiologists are capable of performing high�risk difficult angioplasty , with the support of the Cardiothoracic team . We also have experts in Endocrinology , Respiratory Medicine and Nephrology to support the Cardiology Services . IJN is also equipped with state-of the art CT scans , Cardiac Magnetic Resonance Imaging ( MRI ), Positron Emission Tomography ( PET ) scans and even Nuclear scans .
For those without symptoms , having a regular medical checkup is also prudent , as many of us may have the risk factors of a heart attack without even being aware of it . It is important for everyone to monitor his or her weight , blood pressure , cholesterol level and blood sugar level . A baseline ECG and echocardiogram ( ultrasound of the heart ) should be done periodically . For those planning to take on more challenging activities , a more thorough check up should be done . An exercise stress test or a stress echocardiogram will be perfect to ensure that the heart is ready for activities that are more strenuous . The �ellness Centre in �J� offers affordable , comprehensive medical check-up packages that are designed to the patients ’ needs and condition .
It is never too late to take charge of our health and of our heart . Start by doing a medical check-up . Identify the risk factors , and slowly work to solve them one by one . Remember that ‘ Prevention is better than cure ’. Health is wealth .
Dr . Ahmad Suhailan Mohamad , Emergency Physician , Institut Jantung Negara ( IJN )
For those without symptoms , having a regular medical checkup is also prudent , as many of us may have the risk factors of a heart attack without even being aware of it .
GlobalHealthAsiaPacific . com JULY 2022