Myocardial infarction: time + money
In the coronary artery, often preliminarily narrowed atherosclerotic plaque, a blood clot (thrombus) is formed. This is how myocardial infarction (MI) develops, or a heart attack. To carry out revascularization, expressed in medical terminology, means to restore blood circulation in the area of the heart muscle, which ceased to receive a sufficient amount of blood due to overlapping of the thrombus of the coronary artery. And the sooner the reperfusion (re-back, perfusion-flow) therapy is started from the beginning of a pain attack, the less likely the development of complications, and hence, the reduction in the duration of stay of the patient with MI in the hospital, the reduction of disability, and of course, Risk of death. At certain time periods, most of the myocardial lesions are reversible. If you have time to do such procedures in the first 40 minutes - the infarction will not develop, in the first 3-6 hours - the infarction may not develop if within 12 hours - the heart attack develops, but with a smaller lesion zone.
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| COLUMN ANGIOPLASTIKA | THROMBOLISIS |
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("Angio" - vessel) A catheter, 3 mm thick, at the end of which a balloon is located, is inserted through the femoral or subclavian artery, is fed to the coronary arteries and a contrast agent is injected into them. After a series of X-ray photographs, the place, degree and number of narrowed arteries is established. The catheter is brought to the site of constriction, an inert gas is supplied to the balloon, and the clot is crushed together with the plaque. The cost of angiography is from $ 500 thousand. Naturally, carrying out such a procedure requires the purchase of expensive supplies, special training for a team of highly professional specialists. The duration of the procedure is 20-60 minutes, performed in an angiographic laboratory |
("Lysis" - dissolution) The most effective for the first 6 hours. Still this period of time is called a "golden hour". In the form of a dropper or conventional intravenous injections, drugs based on genetically engineered technology that dissolve a thrombus are administered. These specific drugs are not expensive, the cost is about $ 1 thousand, but the price is fully paid off by the results of further treatment: thrombolysis performed in a patient with a heart attack still in the prehospital period, that is, at home, saves precious seconds and increases the likelihood that the myocardium damage zone will be significantly less , Or it will not develop at all. Only qualified cardiology team can perform thrombolysis. The duration of administration depends on the preparation: from 5-10 seconds, up to 2 hours. |
There is a lot of debate among the doctors of emergency cardiac care about the choice of the strategy for treatment of myocardial infarction: thrombolysis or primary angioplasty? Which method is more economically feasible? Probably, the future will be to unite these methods. And how advanced methods of treatment of MI are realized in Ukraine?
It turns out that doctors from different countries treat differently even such a common disease as myocardial infarction. How does this happen? So…
INFARCT ... IN AMERICAN
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In America, when a heart attack occurs before the age of 55, it is considered abnormal. At the slightest suspicion of coronary atherosclerosis, a diagnostic angiographic examination is immediately performed and treated to prevent a person from leading to a deadly stroke or heart attack. For the state, preventive measures are cheaper than providing emergency care. Yes, the whole American nation now does not eat, does not sleep - everyone is struggling with excess cholesterol. This struggle has already become a national way of life. And, by the way, they have a curve of statistical indicators of mortality from cardiovascular diseases long creeping down.
Dr. Sunil V. Rao of the Institute for Clinical Research in North Carolina, conducted a comparative analysis between income and the risk of death from MI in patients with acute coronary syndrome, given the same quality of inpatient care in this state.
"In this case, for the first time, the income was directly analyzed, not indirect indicators of socioeconomic status, for example, such as the level of education. 45% of participants had low incomes (less than $ 20,000 per year), middle income 43% ($ 20-60 Thousands of a year), high - 12% (more than $ 60 thousand per year) .In patients with low incomes, more frequent chronic pathology, and the condition of admission is usually heavier. However, even after adjusting for clinical features , Low income, is still independently associated with the worst short- and long-term prognosis, "- write American researchers in the Journal of the American College of Cardiology.
Result of the study: the risk of death from a heart attack after discharge from a hospital in patients with a heart attack is higher in the poor than in the more affluent. And this is in view of the fact that there were practically no differences between the levels of hospital treatment for the poor and the rich.
DISEASE OF MEGAPULES
New Yorkers are 55% more likely to die from a heart attack than residents of other cities in America. This sinister phenomenon extends to visitors to the city - the probability of dying from a heart attack among visitors to New York is 34% higher than that of tourists coming to other cities in the United States. Scientists explain this by the fact that New York gives a full set of sensations - ecstasy, depression, tension. All this leads to stress, and for many such experiences end badly.
INFARCT ... IN WESTERN EUROPEAN
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It should be noted that, despite the differences, the effectiveness of American and European therapy MI is almost the same. And this, of course, is the most important. It should be noted that the territories of Western European countries are small, and the maximum distance that must be overcome to the nearest intensive care center is not such a large kilometer, and this also explains the shortest time of hospitalization, which allows to restore the patency of the coronary arteries in the early periods - In the first 2 hours from the onset of the disease.
MUJE, BURGUNDY!
International statistical studies conducted in several dozens of countries in Europe and America on a single program, revealed the secrets of the "French paradox", which consisted in the fact that people who do not observe special diets, do not run jogging, etc., residents of the southern regions of France several times Less likely to suffer from myocardial infarction and strokes than, for example, Americans actively involved in sports. The essence of the phenomenon lies in the fact that the French traditionally, for centuries, systematically drink dry table wines, while Americans and residents of the northern regions of France and Europe prefer strong spirits and wines containing a large amount of alcohol. Reason for pride: in Ukraine, too, has its own national drink! But the results ...
INTELLIGENTSIA NOT SUPPORTED
American professor Angel Kiss, classic cardiovascular epidemiology, compared mortality from myocardial infarction with cholesterol in the blood, the nature of work and nutrition among citizens of seven countries, and received a tremendous result: the highest mortality was found in ... Finnish loggers! It would seem that always in motion, in the fresh air, excellent food, and - such a deplorable result. This study is of great practical importance: a high physical load dramatically increases the level of cholesterol. People of heavy physical occupations should not eat fatty and high-calorie food before the most intense physical exertion, and moderate loads can be used for rehabilitation after a heart attack and prevention. But the results of the study can be even more globalized: it turns out that educated people are sick less. They are more conscious about their health, drink less and smoke less, go to gyms, although they do some kind of physical training. And in people with little education and physical labor - a disregard for health. As a consequence, they get sick more often.
PRICE OF HEALTHY HEART - HEREDITY
17 days after fertilization, the human embryo has blood cells, and after 18 - the heart, which starts irregularly and slowly from day 24, and regular and rhythmic strokes begin next week. Up to 1.9% of newborns have various forms of congenital heart defects that have arisen as a result of disturbances in the formation processes in prenatal development. The most common defects are interventricular (30-40%) and interatrial (7%) partitions.
FANS FAN IS NOT THREATENING?
On the day of the final meeting between France and Brazil at the World Cup in 1998, the number of deaths from a heart attack in France fell sharply. On average, 33 men die of a heart attack on an average day in the country, but on this remarkable day, only 23 French people died of a heart attack (in women this ratio was 28-18). Statistics on mortality from a heart attack for the same day in Brazil, alas, no.
INFARCT ... BY-UKRAINIAN
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Important debate in court ... Suddenly, among the "full health", the lawyer is struck by a sudden pain in the left side of the chest, as if someone, for no apparent reason, stuck a needle there ... He tolerates and continues his speech. Nemeth the chin. Invisible chains tighten the chest. Cold, sticky sweat. The lawyer completes his monologue and at the same time feels how his left hand begins to grow numb, nausea rolls to his throat ... I have to apologize and go home, with the certainty that I was just "overtired". At home, no medicine, including "cordial", does not help ... Feeling of fear and own vulnerability: "It turns out that I'm not any stronger or healthier than others ..." nevertheless they are forced to call an ambulance, but precious ones are lost clock…
DIAGNOSTICS
How many patients suddenly become ill go to hospitals with a diagnosis of myocardial infarction? It turns out that not so much. Annually, Ukraine registers 46-49 thousand heart attacks a year, which is 4 times less than in Italy. It is easy to guess that such positive data are far from objective and understandable: these are the indicators of patients who managed to see a doctor and were diagnosed correctly. And how many people do not ask for help at all or get it out of time? Alas, there is no exact data ... The address to the doctor is delayed from several hours to several days. The last fact is explained by different circumstances: the mentality of our society, ignorance, ignorance, etc.
The difficulty in diagnosing an acute myocardial infarction directly at the patient's bed also has an explanation, and the reason is rather trivial: the lack of proper financing, when a call to a patient with a suspicion of MI comes not by a cardio, but by a usual team, without an electrocardiograph and defibrillator. While in the developed countries, thrombolysis and angioplasty with MI has already become the standard, for the overwhelming majority of Ukrainian citizens this luxury is not yet available: thrombolytics can afford units of citizens, with the exception of some Ukrainian cities (Kharkov, Zaporozhye), where drugs are purchased centrally ; Invasive methods of treatment - angioplasty and stenting - are conducted in four centers in Kiev, and urgently, that is, by ambulance delivery - in only two.
TREATMENT
One of the important aspects is the ideology and psychology of the doctor. The status of a cardiologist requires continuous improvement of his knowledge, quick and decisive actions. The problem of choice for a doctor today is that assigning the patient - cheap generics or expensive original drugs. In one of the clinics in Kiev, a precedent was recorded when, after enalapril (a drug that lowered blood pressure) was prescribed to patients, the expected result was practically not observed. Subsequently, it was found out that the content of the active substance in the preparation was only 25% of the indicated dose on the package. It can not be said that all, without exception, generic drugs are ineffective. For the doctor, in order not to be responsible for prescribing an insufficient dose of the medicine, especially when the patient's borderline between life and death, when there is no time for meditation, it is necessary to have preparations in the arsenal with a quality guarantee close to 100%. Happiness, that in Ukraine there are such doctors for whom constant self-education and introduction in practice of the newest technologies, - a way of life. These people are not simply called "cardiologists", but, with a well-deserved honor, they are. And the fact that a doctor should receive a salary according to his qualifications is certain.
INFORMATION FOR MEDITATION
Perhaps for a well-to-do person, under the circumstances of emergency cardiovascular care in Ukraine, there is a way out: to have a modern thrombolytic in a trusted doctor who will not let you down, and will provide qualified help on time ?!
PREVENTION
Every year the population of Ukraine is reduced by 1%. Infarctions and strokes reduce the population of Ukraine by 190 thousand people per year (accordingly 50 and 140 thousand people). The main reasons for such indicators - smoking, obesity, adynamia, high blood pressure, stress, high cholesterol, untimely referral to doctors. In America and Western Europe, by eliminating these underlying causes, while improving the quality of treatment, it was possible to reduce mortality from cardiovascular and cardiovascular diseases by 30%. Let's hope that the Ministry of Health will fully promote the wider introduction of endovascular procedures and the introduction of thrombolytic drugs, and will also come to a more rational organization of urgent cardiac care for patients, which will help to save money and use the human resources more intelligently. For this, it is necessary to introduce standards (not to be confused with recommendations), which imply mandatory implementation, and this, of course, is impossible without adequate funding. Recommendations for the use of thrombolytics in Ukraine exist, but there is no funding, and therefore, there are no standards. So, perhaps, through the efforts of the public, by increasing literacy and circulation, it is possible to influence the state apparatus, so that it increases the budget financing of the medical industry?
Ways to improve emergency cardiac care - the problem of society and the state. But I would like to appeal to every citizen of Ukraine: you do not have to wait until your condition worsens dramatically, you should not expect that the doctor will take you by the hand and lead you to his office. The initiative must come from you. Throughout the world it has long been considered unjustifiable to hear chronic patients, in all developed countries the self-interest of a person in personal health has become self-evident. Let us, everyone will start developing the civilized relations in our state! Prevention is cheaper than treatment!
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