Heart attack patients should never miss the ‘golden hour’ of treatment.

New Delhi, Feb 2019: Statistics indicate that Indians are succumbing to heart attack about 8 to
10 years earlier than other ethnic groups due to a variety of factors ranging from bad lifestyle to
our genes. 1 What exacerbates this situation further is that many of those who suffer a heart
attack are brought to the hospital only after 3 hours or even more, which makes it difficult to
bring them back to normal health. They thus end up missing the “golden hour” of treatment –
that is the first one hour after a heart attack which is ideal in reducing complications and
associated mortality.
Many Indians do not identify the symptoms on time or seek appropriate intervention. The
Golden Hour is very significant for giving heart attack patients timely and lifesaving care. It is
imperative that any chest pain above the waist level is subjected to ECG and consultation by a
physician without further delay.
Speaking about this, Dr Rajiv Agarwal, Senior Director & Unit Head – Cardiology, Max Smart
Super Specialty Hospital, Saket, New Delhi said, “In the event of a heart attack, time is of
utmost essence. Many people tend to ignore a chest pain attributing it to acidity or indigestion.
However, any acute chest pain must be immediately checked by a specialist especially in people
who are genetically prone to heart problems. This includes an electrocardiogram and rapid
blood test to exclude heart muscle damage. At the outset, an accurate diagnosis should also be
established on the type of heart attack the patient is suffering from. STEMI or ST elevation
myocardial infarction is a bigger risk as it causes full blockage of the coronary artery and the
heart muscle supplied by that artery begins to die because of lack of oxygen. This blockage
must be removed quickly to prevent any complications, such as heart failure or abnormal heart
rhythms called arrhythmias, or they can prove fatal. Non-STEMI, on the other hand, leads to
partial blockage, but is also very dangerous requiring immediate admission to ICCU and
Some common symptoms of an acute heart attack are severe chest pain with sweating,
palpitation and breathing difficulty; feeling of blackout, sinking sensation, and cold extremities;
extreme lethargy particularly in diabetes patients; chest pain radiating to either or both arms,
jaw, and the back region; and severe vomiting or nausea with abdominal discomfort. Women
may experience difficulty in breathing, nausea/vomiting, and back or jaw pain.

1 http://shodhganga.inflibnet.ac.in/bitstream/10603/29165/2/prasanthipoli_chapter2.pdf

Adding further, Dr Agarwal, said, “The intensity of pain should not be the deciding factor. Some
heart attacks may be entirely painless and may manifest as sudden burning sensation in chest,
breathlessness, dizziness, uneasiness, vomiting or sweating. If a person experiences any
unexplained symptoms which could be due to heart attack, the ‘Golden Rule’ is to rush them to
a hospital with a Cath Lab within the ‘Golden Hour’. The damage to heart muscle can be
minimized if Primary Angioplasty is done immediately – this is the most effective treatment.”
Primary Angioplasty begins with emergency Coronary angiography in which the doctor inserts
thin catheters into the groin or wrist artery and generates pictures of the coronary arteries
supplying the heart. The blocked artery can then be opened by passing a wire and then a
balloon. Medicines can also be injected directly into the blocked vessel. A stent/ wire mesh
tube is inserted into the artery to keep it open. Nowadays we use drug-eluting stents (DES)
which prevent the arteries from getting blocked again by releasing an anti-proliferative drug.
DES can help prevent plaque buildup, promote good blood flow to the heart, and relieve chest
pain. They may also lower the person’s chances of having a heart attack. These can also help
the person get back to a regular life faster.
Some tips from preventing a heart attack
 Do not ignore unexplained heartburn, pain at unusual sites, persistent vomiting etc. as
this may be a heart attack
 If the first ECG and blood test are normal, doctors often ask the patient to wait and
repeat the test after 1-3 hours. Failure to do so may put you at risk
 You may take a tab of aspirin at home on suspicion of heart attack even before setting
out to hospital for suspected heart attack. This has saved many lives
 Prevention is better than cure. Adopt healthy life style with healthy diet and exercise
 Say no to smoking and tobacco. Control body weight by diet and exercise
 See a doctor for preventive check-up. Check your BP, blood sugar and control them.
Take cholesterol lowering medicines if doctor advises them.

– Ends –

Disclaimer: “Any and all the Information provided in the article are independent views expressed
by Dr Rajiv Agarwal, Senior Director & Unit Head – Cardiology, Max Smart Super Specialty
Hospital, Saket for general overview and educational purposes only.”