Education
Health Education and Updates
The primary goals of health education remains the same.Healthcare professionals must be prepared to meet diverse patients needs function as leaders and advance science that benefits patients and the capacity of healthcare professionals to deliver safe quality patient care.
Health Education and Updates
The primary goals of health education remains the same.Healthcare professionals must be prepared to meet diverse patients needs function as leaders and advance science that benefits patients and the capacity of healthcare professionals to deliver safe quality patient care.
Heart Failure Health Education
The hawk pumps blood to all parts of your body. Your heartbeat is the heart pump moving blood throughout your body. Heart failure means your heart is not pumping as well as it should. Heart failure does not means your heart will stop working, but it does means you need to see treatment soon. A hard care team including doctors, nurses and others will help you to manage your heart failure
Why does heart failure happen?
The two main causes of heart failureBlockage in a heart artery, leading to heart attack, and or damaged heart muscles,
Many factors increase the risk of these blockage
- smoking
- high cholesterol
- high blood pressure
- diabetes
- age
- family history
Other reasons of heart failure
Having high blood pressure for a long time, this overwork the heart muscle and makes it stiff.
Problems in the heart electrical system, making the heartbeats too fast or too slow
- Some cancer treatments can cause heart failure
- other diseases
- excessive alcohol use
- some infections
- agevalves in your heart that do not open and close correctly
Heart Failure Health Education
The hawk pumps blood to all parts of your body. Your heartbeat is the heart pump moving blood throughout your body. Heart failure means your heart is not pumping as well as it should. Heart failure does not means your heart will stop working, but it does means you need to see treatment soon. A hard care team including doctors, nurses and others will help you to manage your heart failure
Why does heart failure happen?
The two main causes of heart failureBlockage in a heart artery, leading to heart attack, and or damaged heart muscles,
Many factors increase the risk of these blockage
- smoking
- high cholesterol
- high blood pressure
- diabetes
- age
- family history
Other reasons of heart failure
Having high blood pressure for a long time, this overwork the heart muscle and makes it stiff.
Problems in the heart electrical system, making the heartbeats too fast or too slow
- Some cancer treatments can cause heart failure
- other diseases
- excessive alcohol use
- some infections
- agevalves in your heart that do not open and close correctly
CASE REPORT
Acute Myocardial Infarction Identified in a Peripheral Clinic and Treated with Urgent Surgical Revascularization: Door to Knife in Less than Three Hours
RD Rampersad, CK Toussaint, N Rahaman, GD Angelini
INTRODUCTION
According to the World Health Organization, coronary heart
disease kills more people each year in high, middle and low income countries alike than any other disease. The 2012 PanAmerican report for Trinidad and Tobago showed a 51% raised risk for non-communicable lifestyle disease and the concomitant risk of cardiac disease in the 25–64-year age group with a reported increased rate of obesity, hypertension
and diabetes
(1). The urgent management of the patient with acute coronary syndrome is dictated by the need to prevent irreversible damage and infarcted myocardium
(2). The question of the advancement of technology and the availability of healthcare as it relate to service that is needed, cost of the service and the overall economical benefit, is forever being asked. Even though they are considered developing countries, Trinidad and Tobago and the wider Caribbean have kept up with the advancement of technology in early diagnosis and treatment of heart related problems. However, in Trinidad and Tobago where cardiovascular disease is reaching epidemic proportion, more work is required to educate the general public as well as providing a 24-hour integrated cardiac service. This will be possible only with a clear and committed service delivered as a joint effort between the private and public sectors.
Keywords: Bypass, cardiovascular surgery, myocardial
infarction
CASE REPORT
A 56-year old male, with a past history of hypertension and
dyslipidaemia, presented to a rural satellite cardiac clinic complaining of typical chest pain at rest. Of significance in his history, a stress echocardiogram performed one week prior to presentation was positive for ischaemia and showed
hypokinesia in the mid septal and mid anteroseptal wall
From: Caribbean Heart Care Medcorp, 18 Elizabeth Street, St Clair MedicalCentre, St Clair, Port-of-Spain, Trinidad and Tobago. Correspondence: Dr RD Rampersad, St Clair Medical Centre, Caribbean
Heart Care Medcorp, 18 Elizabeth Street, St Clair, Port-of-Spain, Trinidad
and Tobago. E-mail: rrampersad@hotmail.com
Upon review by the cardiologist, his electrocardiogram
(ECG) showed ST depression 2-3 mm in the lateral leads. He
was given aspirin 80 mg, clopidogrel 300 mg, nitroglycerine
patch 0.4 mg/hour and immediately transferred via ambulance to a private specialized centre.
The diagnosis on admission was of acute coronary
syndrome, non-ST segment elevation myocardial infarction
with positive troponin and within 20 minutes he was taken to
the catheterization laboratory after informed consent was
obtained for angiography plus possible percutaneous coronary intervention (PCI) or coronary artery bypass surgery.
Coronary angiogram showed a 95% severe distal left
main (LM) lesion, 70% middle stenosis of the left anterior
descending artery (LAD) and a 95% proximal stenosis of
first obtuse marginal (OM1) branch of the circumflex artery.
His right coronary artery (RCA) was occluded proximally
with collateral circulation from the LAD.
A decision was made jointly by the cardiologist and
cardiothoracic surgery team to transfer the patient immediately for surgery due to his ongoing chest pain not relieved
medically and ECG changes and the risk of sudden death
from the severe LM stenosis. The patient underwent off
pump coronary revascularization with a left internal mammary artery (LIMA) to the LAD and saphenous grafts to the
posterior descending and OM1 arteries. The time that
elapsed from diagnosis to start of the surgery was less than
three hours.
On completion of the surgery, the patient was transferred to the intensive care unit in a haemodynamically stable
condition and after an uneventful recovery was discharged
home on the fourth postoperative day. At one year of followup, the patient was asymptomatic, with negative noninvasive ischaemic testing and optimal exercise capacity.
DISCUSSION
This case exemplifies the need for early detection, diagnosis
and a readily available cardiac team to respond to a lifethreatening cardiac condition. The treatment of this patient
was an excellent example of guidelines implementa-tion,
where within the set time limits his acute ischaemia was
addressed with coronary artery bypass graft surgery (CABG)
when management by PCI was not feasible.
WIMJ Open 2014; 1 (2): 29
DOI: 10.7727/wimjopen.2014.023
Acute Myocardial Infarction with Urgent Surgical Revascularization in Less than Three Hours
Many patients are unaware of symptoms of cardiac
pain or are reluctant to call for early medical help. Patients
may be unaware of the emergency ambulance service numbers and rural hospitals are sometimes underequipped with
emergency vehicles (4). Often, hospitals are understaffed
and underequipped to properly meet the recommendations of
American and European cardiology guidelines (5, 6) of door
to ECG of 10 minutes and first medical contact (FMC) to
needle of 30 minutes in the case of fibrinolysis or FMC to
PCI of 90 minutes. In addition, the latter, in Trinidad and
Tobago, is limited to private institutions and can only be
accessed in the public sector at Eric Williams Medical
Sciences Complex but not on a 24-hour basis. Coronary
artery bypass grafting is available on an emergency basis
only in the private sector (3).
There is urgent need for structured plans to address the
critical issues of primary prevention and education of the
population on a healthier lifestyle. Implementation of a
structured framework is necessary so that the population can
be aware of the available facilities in case of an acute
coronary event. Institutional issues in medical efficiency and
best use of available resources must be addressed.
Finally, in a country where cardiovascular disease is
reaching epidemic proportion, a joint effort between the
private and public sectors could be a most efficient option.
REFERENCES
1. Ministry of Health Trinidad and Tobago. Trinidad and Tobago chronic
non-communicable disease risk factor survey (Pan American STEPS).
Final report [Internet]; 2012 [rev 2014 Jan 1; cited 2014 Jan 20].
Available from: http://www.health.gov.tt/news/newsitem.aspx?id=39
Esposito G, Dellegrottaglie S, Chiariello M. The extent of irreversible
myocardial damage and the potential for left ventricular repair after
percutaneous coronary intervention. Am Heart J 2010; 160 (6 Suppl):
S4–10.
3. Thomas C, Boodhoo L, Chacko M, Rampersad RD, Williams A,
Ramoutar P et al. The cardiac catheterization lab: implementing best
practice in Trinidad and Tobago. CMJ 2012; 74: 22–6.
4. Cooney DR, Wojcik S, Seth N, Vasisko C, Stimson K. Evaluation of
ambulance offload delay at a university hospital emergency department.
Int J Emerg Med 2013; 6: 15. DOI: 10.1186/1865-1380-6-15.
5. Task Force on the management of ST-segment elevation acute
myocardial infarction of the European Society of Cardiology (ESC);
Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C et al.
ESC guidelines for the management of acute myocardial infarction in
patients presenting with ST-segment elevation. Eur Heart J 2012; 33:
2569–619. DOI: 10.1093/eurheartj/ehs215. Epub 2012 Aug 24.
6. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M
et al. ACC/AHA guidelines for the management of patients with STelevation myocardial infarction – executive summary: a report of the
American College of Cardiology/American Heart Association Task
Force on Practice Guidelines (Writing Committee to Revise the 1999
Guidelines for the Management of Patients with Acute Myocardial
Infarction). Circulation 2004; 110: 588–636.
Submitted 04 Feb 2014
Accepted 12 Feb 2014
Published 15 Apr 2014
Online: http://myspot.mona.uwi.edu/wimjopen/article/56
© Rampersad et al 2014.
This is an open access article made freely available under Creative
Commons Attribution 4.0 International (CC BY 4.0). Users are free to
share, copy and adapt this work as long as the copyright holder (author)
is appropriately and correctly credited. See http://creativecom
mons.org/licences/by/4.0/deed.en_us for more information.
