Each year approximately 1000 people in Kathmandu suffer a heart attack, which is the leading cause of mortality. Yet only few of them get proper and timely treatment.

Heart attack is a condition where sudden complete occlusion of a coronary artery occurs. This rapidly leads

to death of increasing number of myocardial (heart) cells. More than two third of heart attack related deaths take place out side the hospital, many within first few hours of the onset of symptoms.

Recently, many new technologies have developed in the treatment of heart attack. Around the world the treatment strategies have changed completely. The most proper treatment of heart attack today is immediate administration of two tablets of aspirin and then opening up of the blocked artery preferably using a balloon catheter and stent (Primary or Emergency angioplasty). The alternative method (which, though is only half as effective) is to inject some clot dissolving medicine as soon as possible. Primary Angioplasty is an emergency process in which Coronary Angioplasty is done on heart attack patients as soon as they arrive in the hospital. Primary Angioplasty should be done within 90 minutes for better outcome. Each minute delay in the procedure may damage thousands of heart cells.

Immediate angioplasty during a heart attack leads to early opening of the blocked artery without the risk of bleeding or stroke. Also, there is less risk of second heart attack, lesser risk of death, faster recovery and better quality of life later on.

However, Primary angioplasty is not the practical option to all the patients. This is because it is expensive. Also the facility is not available in many hospitals (currently only at Norvic Hospital and Gangalal Hospital). If the facility is not available, the second best option is to give a clot dissolving medicine. This however is successful in little over fifty per cent patients only. Sixteen patients of heart attacks at Norvic Hospital have been successfully treated with this new technique (Primary Angioplasty). All of them got immediate relief from chest pain and survived. The recovery was very fast and they were back to their normal life within two weeks.

Even though this technology is expensive it is now available. It is important that people should know their options. Many patients, who can afford this treatment, might not get the correct treatment due to the lack of information.

Dr Bharat Rawat, Consultant Cardiologist, Norvic Escorts International Hospital (drrawat@wlink.com.np)

Dr. Saroj Dhakal, Medical Registrar, Norvic Escorts International Hospital (saroj083@hotmail.com)