Self-diagnosis often leads to delays in reaching out to qualified emergency doctors, making it truly a matter of life and death
A 22-year-old came to the Apollo Emergency Care having suffered from “heartburn” for a day, which had by then become unbearable. What he thought was acidity turned out to be a “heart attack” and despite their best efforts, doctors could not save the patient as he presented nearly 24 hours after suffering his catastrophic heart attack.
Several young men and women under the age of 40 die every year of cardiac problems. Many do not believe they could have a cardiac problem at that age at all. “We often see the patients coming in with dried gelusil on their lips or balms on their chest because they mistake Myocardial Infarctions (heart attacks) for acidity or muscle spasm,” says Dr Dhavapalani Alagappan, Apollo Hospitals, Emergency Medicine, Chennai.
Though news of heart attacks leading to cardiac arrest amongst the young comes as a shock, Dr Dhavapalani says that the Asian and Indian profiles are different from the textbook descriptions that are predominantly based on Caucasian stereotypes. “Indians are at high risk due to our lifestyle, diet and genetic factors,” he explains.
Lack of enough sleep, working night shifts that affects the circadian rhythm, eating carb-rich food, smoking, lower physical activity and lack of exercise have increased the risk of hypertension and diabetes, making India almost a capital for these two diseases. These two conditions are key risk factors for heart attacks.
However, people ignore symptoms, assuming themselves to be too young to suffer from cardiac problems. Regular health check ups are also important as, many times, regardless of their age, patients present themselves with undetected very high blood pressure or sugar levels. “These are classic signs for a potential cardiac problem,” he points out.
While poor access to emergency healthcare facilities is one of the factors why they do not get timely help, other factors that influence the mindset of the people are affordability and the tendency to opt for home remedies before seeking professional help.
“If people reach out in time, it is possible to save lives,” Dr Dhavapalani adds.
The three most common conditions needing emergency care are cardiac problems, stroke and trauma. In all three, time is of essence; and in case of cardiac problems, time is considered muscle.
Explaining this phrase, the doctor says that when there is a heart attack, as there is a block in the blood supply to the cardiac muscles affected, there is muscle loss every minute there is a delay. Getting treatment on time can prevent this loss to a large extent.
“Each minute that passes by leads to death of the muscle, attending to it earlier is better to maintain the functioning of the heart,” according to him.
Citing an example of a 50-year-old man with no prior cardiac history, Dr Dhavapalani says, “The person works in a large company nearby. He collapsed suddenly in the office and was brought to the emergency in a cab. But because he was here within 8-10 minutes, we were able to revive him.”
Of course, it was one of those rare occasions when the patient had to be given 13 shocks and resuscitation took 45 minutes, but we were able to save him, he says.
In another case, a 60-year-old man developed cardiac problems and changed to a healthy lifestyle, being careful about diet and playing badminton for 60 minutes every morning. One morning, he had a cardiac arrest while playing and was lucky to get bystander CPR - which is very rare in India. However, it must have been 20 minutes by the time they could bring him to the emergency, by when, though the heart was functioning, the patient was brain dead.
While the global gold standard from the time a patient is brought in to the operation theatre is 90 minutes in case of the heart, at Apollo, they try to do it in 45 minutes. For the brain, within 60 minutes of admission the patient should be taken for thrombolysis.
“Brain functioning is lost faster and therefore reaching the emergency earlier is even more critical,” emphasises Dr Dhavapalani. However, strangely, people take strokes more lightly.
“People can lose the function of various parts of the body depending on the location of the stroke, but many delay getting professional help as stroke is not perceived as a dire emergency by them. Being dependent even for daily ablutions can affect the self-esteem of the patients, or modify behaviours.”
In trauma, blood loss can lead to death and timely transfusion is essential to save the patient.
Dr Dhavapalani quotes these examples to stress on the need for timely access to medical care to increase the chances of survival. “The moment a patient walks in complaining of heartburn, we do tests to eliminate any serious, life-threatening condition. Though it may seem redundant, the focus of emergency care is to eliminate the worst case scenario,” he elucidates.
The difference between life and death sometimes is timely medical attention in many cases, and that is where emergency care plays an important role.