RECONSTRUCTIVE SURGERY IN LIMB TRAUMA

On June 30, 2025 I had the opportunity to share my experience with the students and teachers of Balaji Medical College in Chennai. Dr. Manimaran had organized the meeting and the audience hd MBBS and M.S General Surgery students. 

We divided the topic of Reconstructive Surgery in Limb Trauma into:

1. Limb Salvage surgery

2. Like for Like Tissue Reconstructions

3. Funstional Muscle transfers

4. Replants and Revascularizations

5. Dermal Substitutes

6. Documentation

7. Physiotherapy

As we were addressing the students and not our peers, at times we indulged in over-simplification. If you would like to see the presentation please click the following hyperlink / icon:

surajit batacharya 2.mp4

 

EVEN FOOD AND BEVERAGE HAVE A HISTORY

 

The roots of food and beverage can be traced back to ancient civilizations where early humans relied on hunting and gathering. As communities settled, they began to cultivate crops and domesticate animals, leading to more organized food production. This transition marked the beginning of agriculture, which laid the foundation for the food industry as we know it today. The history of food and beverage spans thousands of years, evolving from early agricultural practices to a complex global industry influenced by culture, technology, and societal changes. In one of my previous blogs I had traced the history of Biryani and you can read it by clicking: https://surajitbrainwaves.blogspot.com/2020/02/biryani-fantasy-dish-for-all-palates_32.html

When you are eating your favorite snack, do you ever wonder how it came into existence? Well, most of us don’t, right? But their history is often very interesting. A series of events may have led to the creation of a particular food item, so will it not be interesting to find out? Who was that genius who thought of making a sandwich for the very first time? Or who brewed the first beer? These are all interesting questions, and if you dig a little deeper, you would be surprised with the answers you get. Some of these food items have a bizarre history and some were discovered purely by accident.

1. Tea

Tea is undoubtedly one of the most famous drinks in the world. It’s stimulating and calming effects make it an ideal drink to have in the morning or in the afternoon. The English introduced it in India and cultivated it in the eastern province of erstwhile Bengal. The history of tea is replete with several myths and legends. According to Chinese lore, the history of tea began in 2737 BC when Emperor Shen Nong, an eminent ruler and a scientist, discovered tea by accident while sitting under a tea tree. The story goes that the emperor was boiling water and a few leaves from the tree fell down into his pot. When Shen Nong took a sip of the drink, he enjoyed the taste immensely. Later on, the emperor began researching the plant further and discovered the many wonderful medicinal properties of tea that eventually made its way into Chinese medicine before evolving into a modern drink. Though difficult to prove this story but it is a fact that the tea plant originated somewhere in southwestern China, Tibet, and Northern India.

 

2. Coffee

The story behind the origin of coffee is quite fascinating. While no one knows exactly how or when coffee was discovered, there are many legends about its origins. The most popular and widely accepted one is about its discovery in the ancient coffee forests on the Ethiopian plateau. The legend says that a goatherd called Kaldi was the first person to have found the unique properties of coffee beans. According to the story, Kaidi noticed his goats being unusually energetic after they ate berries from a certain tree. In fact, the animals were so energized that they couldn’t sleep at night. Curious to find out more, the goatherd reported his findings to the monks of a local monastery. They went on to make a drink with the berries and realized that coffee helped them stay up to perform their prayers late at night. Soon, knowledge of the energizing berries began to spread and coffee became a popular drink throughout the world.

 

3. Popsicles

Popsicles, the refreshing frozen treats, were discovered unintentionally by an 11-year-old boy in California named Frank W. Epperson. The year was 1905 and Epperson, while making lemonade soda on his porch, left it out and went to sleep. However, when he woke up the next day, he was surprised to find the stick he was using to stir the mixture had frozen upright in the liquid. The young boy, thrilled with his accidental creation, named it "a handled, frozen confection or ice lollipop." He applied for a patent for his unique discovery in 1924 and changed its name to ‘Popsicle’.

 

4. Potato Chips

This tasty and salty snack was invented by American Chef George Crum by accident in 1853. Back then, French Fries had become quite famous in the masses and were in high demand at the Moon Lake Lodge in Saratoga Springs in New York, where Crum worked. One day, an angry customer complained to the chef that his French fries were too thick.To pacify the man, Crum sliced a batch of potatoes really thin, fried and salted them, and sent them out. This time, the customer was thrilled, and in no time, the word about the crunchy fried potatoes had spread throughout the city and then the entire country. Thus, potato chips were born and went on to conquer the world.

 

5. The Sandwich

Sandwiches are loved so much because they come in so many varieties. While it’s impossible to say who was the first person to cut their bread and put a piece of meat or cheese between two slices of bread, the credit for the sandwich’s initial popularity goes to John Montagu, 4th Earl of Sandwich. Yes, you read that name right. Montagu was a British aristocrat who lived in the 18th century and was heavily into gambling.Interestingly, the earl didn’t like taking breaks while gambling, and during one intense gambling session, he ordered the cook to bring him some meat slices placed between two pieces of bread. He enjoyed this snack as the bread stopped his hands from getting greasy and he could continue playing the game without interruption. While many historians have questioned the legitimacy of this story, it is widely believed that Montagu's refusal to get up for a meal resulted in the discovery of the sandwich.

 

6. Corn flakes

This popular breakfast cereal was discovered by accident, too. The story goes that while working in a sanitarium in Michigan, W.K. Kellogg, the founder of the Kellogg Company, attempted to make granola as a healthy vegetarian treat for some patients at a sanatorium at Battle Creek that he ran with his brother.While making the dish, W.K. Kellogg and his brother accidentally left wheatberry cooking in the kitchen and found later that the kernels had flaked. The brothers kept on experimenting with cooking different grains and eventually flaked corn, thus creating a recipe for corn flakes that they really enjoyed. The cereal became the most loved morning meal worldwide and today its numerous variations can be found everywhere.

 

7. Nachos

The famous Mexican snack is credited to Ignacio “Nacho” Anaya who was the head waiter at a restaurant called the Victory Club in Piedras Negras, Mexico. One afternoon in 1943, a group of military wives from the US had crossed the border into Mexico from the Fort Duncan Army base to do some shopping.In the evening, they came to the Victory Club restaurant to have a meal but were disappointed to find that the chef had left. Anaya didn’t want the women to leave and decided to prepare something new - covering a plate of tostadas with grated cheese, passing it through an oven while heating the plate from above, and then adding a few sliced jalapeño peppers as a topping. The women adored the dish and one of them dubbed it “Nacho’s especiale” (“Nacho’s special”). Later on, it was shortened to just ‘Nachos’ and came to be the well-known snack we all recognize today.

 

8. Chocolate Chip Cookies

In the year 1930, an American woman named Ruth Wakefield was mixing a batch of cookies for her roadside inn guests when she found that she had run out of the baker's chocolate she generally used for making them. To compensate, Wakefield added broken up pieces of Nestle's semi-sweet chocolate instead. She hoped that the chocolate would melt and absorb into the dough to create chocolate cookies. The chips didn’t spread. However, when Wakefield removed the pan from the oven, she found that she had accidentally created chocolate chip cookies. The guests loved the chocolate chip cookies, and it became Wakefield's specialty, which she called "Toll House Crunch Cookies”. The recipe for the cookies was published in a Boston newspaper and shortly afterward, chocolate chip cookies became the most popular variety of cookies in America. It didn't take long for this delicious recipe to reach different parts of the world as well.

 

9. Beer

Beer is the oldest recorded recipe in the world! The brewing process was first documented by the ancient Egyptians on papyrus scrolls around 5,000 BC. These first beers were blended with a mixture of such ingredients as dates, pomegranates, and other indigenous herbs. Their taste is likely to have been quite bitter and harsh. It is said that the Egyptians consumed these beers during religious ceremonies. Even before the Egyptians, however, the ancient cultures of Mesopotamia are believed to have been the first brewers way back in 10,000 B.C. Historians say that when the Mesopotamians began storing grains for bread, their storage spaces would at times become damp, causing the grains to ferment. This fermentation process led to the creation of the earliest beer.

The history of food and beverage is thus a rich tapestry woven from cultural, technological, and societal threads. From ancient agricultural practices to the modern globalized market, the industry has undergone significant transformations, reflecting the changing needs and preferences of societies throughout history. Understanding this history provides valuable insights into our current food systems and culinary practices. By exploring the evolution of food and beverage, we can appreciate the intricate relationship between culture, technology, and the way we nourish ourselves.

Temples in ancient India always offered ‘prasad’ which was either a combination of fruits or even cooked food. The emergence of inns and restaurants in the 18th century marked a significant development in the food and beverage industry. The first known restaurant, opened by Boulanger in 1765, served restorative soups and laid the groundwork for modern dining establishments. By the late 18th century, restaurants began to offer menus and individual dining experiences, transforming the way people consumed food. 

 

The spice trade played a significant role in shaping global food culture, introducing new flavors and ingredients across continents. The exchange of culinary traditions was further enhanced by exploration and trade routes, which allowed for the sharing of diverse cooking techniques and food preservation methods. 

 

The Industrial Revolution in the 18th and 19th centuries brought transformative changes to food processing and preservation. Innovations such as canning, developed by Nicolas Appert in 1809, and pasteurization, introduced by Louis Pasteur, revolutionized food safety and extended the shelf life of products. These advancements facilitated mass production and distribution, making food more accessible to the growing population. 

 

The mid-20th century saw the rise of fast food chains and standardized dining experiences, catering to the demand for convenience and affordability. This shift marked a significant change in eating habits and the overall food landscape. Today, the food and beverage industry continues to evolve, influenced by globalization, health trends, and sustainability concerns.

FIGHTING DIVERSITY IS POSTPONING PROSPERITY AND DENYING DEVELOPMENT

When organizations like Maharashtra Navanirman Sena shout slogans against immigrants in Mumbai, beat up traders for not speaking Marathi and harass the taxi drivers from Bihar and Uttar Pradesh for taking up jobs that they think rightfully belong to the local Mumbai people, they forget that megapolis like Mumbai are not built by the local population, and do not belong to Mumbaikers alone, but to the entire world! Hate is no way to achieve national greatness. It, in fact, incurs enormous social and economic costs.

If we are not open to accept different languages, different attires, different cuisines, different appearances, and different way of life then how will we attract the best talent to our cities and how will our states prosper economically.  Nearly half of M.Ps who have represented Mumbai in the Parliament have been non-Marathis. Majority of the rich people in Mumbai are Gujarati, Jain, Marwadi, and Punjabi and they contribute the lion’s share of taxes. But that does not mean that the Marathis have not done well; Babasaheb Kalyani of Bharat Forge, Leena Gandhi Tewari of USV Pharma, Anand Deshpande of Persistent Systems, and Sanjay Kirloskar of Kirloskar Brothers are all institutions of success. Internationally, figures like Vivek Ranadive and Manoj Badale have made significant strides, underscoring global Marathi entrepreneurial influence. Additionally, historical Maratha families like the Gaekwads and Scindias have amassed considerable wealth, demonstrating entrepreneurial spirit through enterprises such as Bank of Baroda.

Mumbai grew into a metropolis over centuries as it offered hope. And still does. Outsiders' of yesterday and today are insiders of tomorrow. Dev Anand, Anand Bakshi, Dilip Kumar all arrived from the Punjab that is in Pakistan today. Bimal Roy, Hrishikesh Mukherjee, Sharmila Tagore, Biswajeet, Hemant Kumar , Salil Chaudhary came from Bengal and Sachin Dev Burman from Tripura and enriched the cultural melieu of Mumbai. The Ambanis are from Gujarat, Jindals from Haryana, Kirloskar from Karnataka but they are big job providers and wealth growers for the city.

Mumbai has one of the highest literacy rates in India (94.7%) which is significantly higher than the country's average. The official language of the state is Marathi; however, sixteen other major languages are spoken here including English, Marathi and Hindi. The city is the commercial and the entertainment capital of India and is also one of the most populous cities of the country. With a high number of migrants and diverse religious groups, Mumbai is truly a melting pot of cultures. Mostly, the inhabitants of the city comprise of Marathis, Gujaratis, Zoroastrian Parsis and Konkanis. Hindus, Muslims, Christians, Jews, Parsis, Buddhists, Sikhs and Jains comprise of the total population of Mumbai. If suddenly this vibrant and happening melting pot is stirred by language / culture / religious chauvinists for the sake of votes, every once in a while, they do incalculable harm to the reputation of the Maximum City.

Not only from India, Mumbai has attracted people from all over the world and several foreigners come to work in the film and television industry, InfoTech industry and food and hospitality businesses. The city is home to a small population of Bene Israelis who migrated from the Gulf several decades ago for mercantile reasons. Mumbai is also home to many South East Asian communities and a small percentage of Europeans such as the Portuguese and French. 

 

Who is the original Mumbaikar?

The original fisher folk inhabitants of the city were the 'Kolis' who gave the city its name. They are historically an Indo-Aryan race of people believed to have migrated from Uttar Pradesh, Rajasthan, Gujarat and other parts of Maharashtra. Most Kolis were Hindu, but later, many converted to Buddhism, Islam and Christianity under the reign of the Mauryan, Mughal and British empires respectively. They got their tag as fish folk because that is what they did for sustenance. Today, the Koli population in the city has reduced considerably, to about 48%. Though predominantly fishermen, Kolis are a mix of different communities with different professions such as fishermen, agriculturalists and water carriers. Have these people ever grudged the appearance of a constant stream of migrants to their home town Mumbai? Then why do they, who came to this city much later, stir trouble before every election?

Hate has a high cost

Economist Michael Martell cites a shooting incident in a Gurdwara in Wisconsin that left six dead. Not only the gurdwara but the local mosque and the Hindu Temple all upgraded and spent more on their security. Terrorized immigrants curbed their curbed their movements, affecting local businesses. In the U.S the estimated cost of hate crimes in 2019 was USD 3.4 billion! Immigrants are crucial for keeping the services running specially in countries  which have unsustainable birth rates. Just as European countries need the North African immigrants to run their factories, U.S and the U.K need Indian scientists, doctors and engineers, India too needs immigration for both investment, education and up gradation. Xenophobia has no place in the interconnected world we live in.

 

Why is diversity important?

Diversity signifies that the city is open, inclusive and welcoming to all, and the best talents of the world get attracted to it. That is how a city grows into a metropolis and a metropolis into a megapolis! Being tolerant to an alien culture or a new idea is not enough, you have to learn to enjoy and celebrate diversity. Then only the city, state and nation can prosper.

The most diverse cities in the world are:

1.      London, UK

2.      Melbourne, Australia

3.      Brighton, UK and  New York, USA

4.      Los Angeles, USA

5.      Chicago, USA

6.      Madrid, Spain

7.      Barcelona, Spain

8.      Bangkok, Thailand

9.      Johannesburg, South Africa and Cape Town, South Africa

10. Montreal, Canada, Medellin, Colombia, Kuala Lumpur, Malaysia and San Francisco, USA

All these are large and thriving metropolitan cities, very successful in attracting the best talents of the world and are relentlessly progressing. I have been to all of them and stayed for a significant time in the two list toppers. All these cities attract people for business, tourism and academic pursuit. People do not hesitate twice before deciding to go to these cities because they invariably feel safe and welcomed. If a city fails to give this assurance then those who have options would start avoiding it. Cities have to be friendly and where diversity and inclusivity are welcomed.

Melbourne is a thriving metropolis that prides itself on being highly liveable, with cool neighborhoods and streets that are home to various cuisines, communities and cultures. Let’s not forget the culinary influence of Melbourne’s many international communities. Box Hill is known for its abundance of fantastic Chinese restaurants, while Footscray boasts some epic bánh mì spots thanks to its large Vietnamese population. Oakleigh is the Greek heartland for souvas and gyros, and recent waves of migration from Ghana, Nigeria and Cameroon have culminated in a mushrooming of West African eateries. The city is filled with lush green parks and has many sporting options. It invariable has a stacked line-up of festivals and events, a proud and ever-growing queer community (Melbourne was even voted the fourth most LGBTQIA+-friendly city in the world in 2022), and a thriving nightlife scene.

London is the epicentre of diversity where everyone is welcome to show up and be their most authentic selves. So an Englishman with his coat and hat is seen rubbing shoulders with a Bengali in a Dhoti-Kurta, a Pakistsni in a Shalwar Kameez, a Jew with a skull cap and a Somali in his own dress and no one raises an eyebrow or a pointing finger.  The city is one of the most ethnically diverse and multicultural cities in the world. Around 37% of London's population was born outside the UK, and over 300 languages are spoken in the region. However, the extent of ethnic diversity across London boroughs varies significantly. Ten of London’s 33 boroughs have a majority non-white population, with Newham being the most diverse borough. The city has 37% Anglo-Saxon British, 14% Black, African or Caribbean, 19% South Asian, 5% Middle Eastern and North African, 5% Europeans, 3% Chinese, and 1% Jewish and Latino and the remaining belong to the rest of the world, and everybody proudly call London their home.

Closer to home, even Kuala Lumpur is a wonderfully diverse capital city. The city has long stood out as a shining example of a diverse place that works – and is in fact strengthened by its diversity. Malays, Chinese and Indians are the major ethnic groups, with Islam, Buddhism and Hinduism as the dominant religions. A street food heaven, in KL the Chinese also use Indian spices in their dishes. They combine different tastes and cooking methods to create a uniquely Malaysian flavour. American, Italian, Spanish, Chinese, South Indian restaurants are plenty and equally plentiful are the places of worship. No wonder KL is posing a stiff competition to a much more cosmopolitan Singapore.

The role of cities in shaping human history and society goes beyond their physical structures and economic prowess. Many cities across the world are deeply intertwined with religious and cultural identities, and these connections have shaped their development for centuries. In India, cities like Varanasi and Amritsar stand as living testaments to the power of religion and culture in urban landscapes. These cities are not just urban centers but are hubs of spiritual significance, cultural heritage, and religious tourism. The unique intersection of faith, culture, and urban development offers us a fascinating glimpse into how religion and culture can influence and transform cities over time. These cities are attracting tourists but few businesses and industries. The latter will gravitate towards more diverse and cosmopolitan cities like Mumbai, Delhi, Chennai, Bangalore, Hyderabad and Ahmedabad. If these cities don’t open their arms to embrace an outsider with a brilliant idea and great skill, he/she will gravitate towards a more welcoming city. This will only deprive our mega-cities of the best people and brightest talents.

REMEMBERING PROF. MANSOOR HASSAN BY HIS LECTURE ON MYOCARDIAL INFARCTION

Whenever one thinks of Prof. Mansoor Hassan, the image that comes to our mind is that of an extremely soft spoken, wise, pious and profoundly knowledgeable person steeped in Lucknavi tradition of tehzeeb and tameez. By his very appearance in all whites he radiated an aura of gentle grace and divinity that was simply unmatched. He was loved by students, held in absolute awe by his residents, and literally worshiped by his patients. Whether his patient was a minister or a labourer, his behavior towards them was always the same – gentle, reassuring and loving. Every patient considered him to be a member of their extended family and knew that in his presence and under his treatment they were getting the best treatment in the world.

 

We, the under-graduate students, were convinced that he was specially gifted, and had he been in the Indian Foreign Services, there would have been no wars. Though he was invariably surrounded by a swarm of sick patients and a hive of their anxious relatives, Prof. Mansoor Hassan never lost his cool, never raised his voice, and the ever-present smile never left his face. His presence among his patients was almost like that of a peer or saint among his disciples, pious, somber and always reassuring.

 

Prof. Mansoor Hassan was awarded the Fellowship of Royal College of Physicians of London and Edinburgh. He was extremely sophisticated in his demeanor and a very well read person. He could quote with effortless ease from Vedas, Shrimad Bhagwat Geeta, Quran and Bible and mesmerize his audience with his treasure trove of Urdu Shairi. We all knew great things awaited him and he went on to establish the Lari Cardiology Centre, a comprehensive cardiac diagnostic and therapeutic service and started the superspeciality DM Cardiology program of King George’s Medical College there.

 

Being one of the best cardiologist in Lucknow, he has joined Divine Hospital with a mission and project to make the finest cardiology services available to the state of UP at an appropriate and yet affordable cost. His keen interest in Preventive and Rehabilitative Cardiology is evident from his intimate involvement in various social and outreach programs. 

 

I had a very long association with him even after he superannuated from King George’s Medical College. We were together in Sahara Hospital and during this time the Government of India decorated him with Padmashree. The recognition came late but for a person of his stature and popularity the Award was blessed by being associated with him. Prof. Hassan taught us Cardiology and we had to rush to his class to take the front rows because he spoke so softly that he was often not clearly audible at the back. There was usually pin drop silence, lest we miss what he was saying. This is one such lecture on Myocardial Infarction, which I could salvage from my class notes.

 

If anyone wakes up in the middle of the night with chest pain, his mind might automatically think he is having a heart attack. After all, it’s the number one killer disease. And the number one symptom is the vague term “chest pain”, which can be misleading because it’s not always painful nor always in the chest. In most cases, people imagine they will have severe chest pain and dismiss the actual symptoms of a heart attack, go back to sleep and suffer one. So, it is vital to understand the symptoms your patient will and won’t feel if he/she is having a heart attack This should be clearly understood by all who are at risk of a heart attack so that they know exactly what to do, and when to seek immediate medical attention.

 

Who is at risk of a Heart Attack (Myocardial Infarction)?

1. Older Age

The older you get, the more you are at risk of a heart attack. Although you can have a heart attack at any age, the risk increases significantly after age 45 for men and after menopause, i.e. around age 50 for women.

2. Gender

Heart disease is the number one killer of both men and women, however, men have a greater risk than women of heart attacks. At older ages, women are more likely than men to die from a heart attack. The women get it less frequently, but tolerate it poorly.

3. Heredity

The risk of a heart attack increases with a family history of heart disease. Race also has an impact on the risk. This has been studied in the U.S and African Americans, Hispanic Americans, and American Indians have higher risks than Caucasians of heart attacks.

4. Smoking

One out of five deaths from a heart attack is due to smoking. Smoking cigarettes can double to quadruple the risk of having a heart attack. Risk is higher for smokers because smoking limits the amount of oxygen to the heart, increases blood pressure, damages blood vessels, and increases the likelihood of blood clots. So every patient, who is a smoker, must be advised to quit smoking immediately.

5. High Blood Cholesterol

Cholesterol levels in the blood can be affected by uncontrollable factors, but there are things we can do to make sure the cholesterol level stays within healthy limits. Increasing the dietary fiber intake, eating healthy and low-fat foods, and exercising can help lower cholesterol levels.

6. High Blood Pressure

High blood pressure is a very common risk factor of heart disease. When the blood pressure is high, it makes the heart work harder. This can stiffen the heart muscle and lead to heart attacks. Anti hypertensive drugs, proper exercise, a low-salt and low-fat diet, limited intake of alcohol, healthy weight, and stress management, can lower the blood pressure.

7. Physical Inactivity

Lack of physical activity can lead to many problems, including heart disease. On average, people should exercise at least 30 minutes a day.

8. Obesity

Excess body fat can contribute to higher blood pressure, higher cholesterol, and a higher risk of heart attacks. A healthy diet and proper exercise are essential for getting to and maintaining a healthy weight.

9. Diabetes

Diabetes can have a damaging effect on heart, especially if it is not controlled. Nearly 68% of diabetics over the age of 65 die from heart disease. Diet, drugs and exercise I judicious combination, can help in managing diabetes.

10. Stress

A negative response to stress can increase the risk of a heart attack. Physical exercises, non-competitive sports, breathing exercises, better inter-personal relationships and better time management can all contribute in de-stressing..

 

How chest pain from a heart attack feels?

The typical pain described is a feeling of tightness, squeezing or heaviness in the chest. The Latin term angina pectoris, meaning sensation in the chest, is a more accurate description. This pain has been described as feeling like a band or weight is being tightened around the chest. The pain is often on the left side and above the bottom ribcage, although it’s often difficult to determine its exact location. Other typical symptoms include:

·        Shortness of breath

·        Cold sweating

·        Nausea

·        Anxiety

·        Pain in the left arm, jaw or neck

·        Light headedness

·        Racing heart

Some atypical symptoms of MI are:

·        Pain not on the left side but is located on the right, center or top of the abdomen

·        Abdominal pain and indigestion

·        No pain – some people don’t experience pain and only feel shortness of breath.

·        Pain is often referred to other areas of the body – neck or throat, shoulders, upper back – between the shoulder blades, left or right side of jaw and left or right mid to upper arm.

 

How long should the chest pain last?

The next indication of whether you are suffering a heart attack is pain duration. Consider the following 3 factors:

1.      Heart-attack-related chest pain comes on over several minutes and not suddenly. Sudden severe pain is a reason for concern, but it is not consistent with angina.

2.      The chest pain lasts for at least 5 minutes and doesn’t last continuously for more than 20 to 30 minutes.

3.      Pain that comes on during rest, or doesn’t go away after exertion, also indicates a heart attack.

 

What it shouldn’t feel like

Some chest pain is not consistent with having a heart attack.

·        Sharp and brief pain – stabbing pain that lasts only a few seconds is not coming from the heart.

·        Persists for hours – heart attack chest pain will last for 20-30 minutes at the most and typically ends with a heart attack.

·        Gets worse with movement – the sort of pain that worsens when pressed on is usually from chest bone or muscle pains and not the heart.

·        One can pinpoint the pain with a single finger – heart chest pain tends to be difficult to locate exactly.

But, when in doubt, treat a chest pain like heart attach, unless proven otherwise by investigations.

 

Investigations

Tests to diagnose a heart attack include:

• Electrocardiogram (ECG or EKG). This is the first test done to diagnose a heart attack. It records electrical signals as they travel through the heart. Sticky patches (electrodes) are attached to the chest and sometimes the arms and legs. Signals are recorded as waves displayed on a monitor or printed on paper. An ECG can show ST elevation or T wave inversion.
• Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can be done to check for these proteins (cardiac markers) - creatine kinase-MB (CK-MB) and lactate dehydrogen-ase-1 and -2 (LDH-1/2).
• Chest X-ray. A chest X-ray shows the condition and size of the heart and lungs
• Coronary Angiography. A long, thin catheter is inserted into an artery, usually in the Femoral artery in the groin, and guided to the heart. Dye flows through the catheter to help the arteries show up more clearly on images made during the test. The coronary arteries – Rt. Coronary A. and Left Main Coronary A. are examined for blockage

 

Treatment

Each minute after a heart attack, more heart tissue is damaged or dies. So urgent treatment is needed to fix blood flow and restore oxygen levels. Oxygen is given immediately. Specific heart attack treatment depends on whether there's a partial or complete blockage of blood flow.

Medical Treatment

Medications to treat a heart attack might include:

• Aspirin. Aspirin reduces blood clotting. It helps keep blood moving through a narrowed artery. 300 mg Aspirin should be given at home before transporting the patient to a hospital.
• Other blood-thinning medicines. Heparin may be given by an intravenous (IV) injection. Heparin makes the blood less sticky and less likely to form clots.
• Nitroglycerin. This medication dilates the blood vessels. It helps improve blood flow to the heart. Nitroglycerin is used to treat sudden chest pain (angina). It's given as a pill under the tongue, as a pill to swallow or as an injection. Again it should be given at home, before transporting the patient to the hospital.
• Morphine. This medicine is given to relieve chest pain that doesn't go away with nitroglycerin.
• Beta blockers. These medications slow the heartbeat and decrease blood pressure. Beta blockers can limit the amount of heart muscle damage and prevent future heart attacks. They are given to most people who are having a heart attack.

Surgical Treatment

• Coronary artery bypasses grafting (CABG). This is open-heart surgery. A surgeon takes a healthy blood vessel , usually the Great Saphenous Vein from the leg and use it to bypass the blocked Coronary Arteries and create a new path for blood in the heart. The blood then goes around the blocked or narrowed coronary artery. It may be done as an emergency surgery at the time of a heart attack. Sometimes it's done a few days later, after the heart has recovered a bit.
• Balloon Angioplasty. This is now being practiced in the Western countries and will soon be available here. A thin, flexible catheter is passed into the narrowed part of the heart artery. A tiny balloon is inflated to help widen the blocked artery and improve blood flow. A small wire mesh tube (stent) may be placed in the artery during angioplasty. The stent helps keep the artery open. It lowers the risk of the artery narrowing again. Some stents are coated with a medication that helps keep the arteries open.

 

Complications

The complications of Myocardial Infarction are:

·        Arrhythmias

·        Heart Failure

·        Heart valve issues

·        Stroke

·        Sudden Cardiac Arrest

·        Cardiogenic Shock

·        Depression and Anxiety      

 

That is how our class on Myocardial infarction ended. Those were the days when there was no echo-cardiography, Heart MRI, Heart CT, MUGA Scan, and Nuclear Heart Scans – SPECT or PET. Even Troponin T test, ACE inhibitors and statins were not there. Good history taking, physical examination, ECG and a good clinical sense was all that was there at our disposal. But teachers like Prof. Mansoor Hassan were patient with us and taught us the highest standards of clinical medicine.