CAN PUMPING POWER OF THE HEART BE INCREASED BY ANY MEDICINE?
Pumping power means the amount of blood that leaves the heart, for circulation into the body, after the heart contracts. It is also known as the Ejection Fraction (EF). Normal EF is 55-65% and can easily be estimated by a simple non-invasive investigation called Echocardiography. Usually, after a heart attack some part of the heart is damaged permanently and it is unable to pump efficiently and thus a drop in EF occurs. Yet, there are medicines which can increase the pumping power of the heart, but they have to be used with caution and not all patients can be given these medicines. Digitalis (Digoin/Lanoxin), a medicine derived from plants, has been used to increase the force contraction with which the heart contracts. Thus it is also known as a “Cardiotonic�. It can be given orally or intravenously.
Digitalis is used in cased of heart failure where blood pressure falls or in arrhythmia where the heart beat becomes irregular (though if used without caution it can itself lead to an irregular heart rate). It has to be used with caution in patients of hyper or hypo function of thyroid, heart attack, irregular heart rate, severe kidney disease or elderly patients. It interacts with Diuretics, Beta Blockers, calcium, channel blockers. Also a group of medicines called ‘Adrenergic agents’ has been used extensively for increasing contraction of heart in cases when fall in blood pressure is due to some other reason and not blockages like massive infection, loose motion, poisoning etc. They are Dopamine and Dobutamine. CAN STERPTOKINASE PREVENT PERMANENT DAMAGE? (WHAT IS THE GOLDEN HOUR?) As explained on the previous page the rupture of an internal membrane leads to a heart attack by clotting of blood and the doctor confirms a heart attack by an ECG. If this clot can be dissolved before permanent damage occurs then it will preserve the pumping power of the heart. These medicines act by promoting reactions involving dissolution of blood clot. One of the sub groups is known as Fibrinolytics. Examples of this are Streptokinase, Urokinase, Alteplase. Streptokinase is obtained from bacteria called Streptococci. Urokinase is an enzyme isolated from human urine and Alleplase is produced by recombinant DNA technology. These all have to be used at the earliest and have almost no effect on a clot which is 3 days old. At best, they can be used effectively within 5-6 hours. It is not necessary that it will be effective in all those to whom it is given. Being full of complications they are given intravenously, only under strict medical supervision and in an intensive care setup (ICU). They cannot be given to people where risk of bleeding is increased, such as recent trauma, surgery, biopsies, stroke or peptic ulcer. Thus any patient with a chest pain should not delay unnecessarily, because if initiated timely this can save permanent damage to the heart. Another subgroup of this medicine is Anticoagulants which is also given under supervision – Heparin, as injection or a new form of heparin called Low Molecular Weight Heparins (LMWH), which can be given at home. These all lead to decreased clotting of blood and decreased clotting keeps fewer harmful clots from forming. There is yet another group which is given orally and promote dissolution of clot known as Oral Anticoagulants. Coumarins, Phenindione or Warfarin. One of the popular market preparation is Acitrom. WHAT TO DO IN CASE OF PAIN?
Step I First thing that should be done is to take rest. If you are taking a walk, then stop walking. Best is to lie down or one can at least stop walking and sit down. Step II In most of the cases rest will resolve the pain. If not then keep a tablet of Sorbitrate 5mg (Half tablet if it is of 10mg) under the tongue (Do not swallow it. Keep it under the tongue). Pain should subside. Step III If the pain has still not decreased, then another tablet of Sorbitrate 5 mg should be kept under the tongue after an interval of 3 to 5 minutes. Step IV If even this does not relive the pain then it can be a signal of something serious. It can be either a. Because of some cause other than angina like acidity, etc or b. It can be a heart attack, which needs immediate medical attention. Thus in such a case, the patient should not waste any time and take 4 teaspoons full of Antacid gel (Mucaine, Digene, Etc) (use tablet if gel is not available) meanwhile should proceed to the nearest hospital where an ECG can be done. It should then be left to the attending doctor to decide about further management. Hope you liked this article! This article is written by Dr. Bimal Chajjer (Delhi’s Best Heart Doctor)