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.