Take an Ambulance, Not a Rickshaw


Hearts are the same everywhere.  So it’s no surprise that the message out of a Cleveland Clinic-co-sponsored symposium in Madras, India, is also applicable to Americans, Europeans, Africans, and everyone in between: “When you have chest pain, you need to be in a medical center.”

The event was the 6th Advanced Cardiovascular Therapeutics 2011 symposium organized jointly by Madras Medical Mission and Cleveland Clinic.  Three of India’s leading cardiovascular experts were on hand for the symposium, joined by faculty that included Steven Nissen, MD, chairman of Cardiovascular Medicine at the Miller Family Heart & Vascular Institute, and colleagues Stephen Ellis, MD, Ravi Nair, MD, and Mehdi Shishehbor, D.O.

Indian press coverage of the symposium showed that while hearts are the same everywhere, heart care isn’t.  Although India has many fine ambulance services, the Deccan Chronicle reports that “90 per cent of heart attack victims get to hospital by public transport or a private vehicle. Only 10 per cent use an ambulance.  Over 42 per cent of those who suffer a heart attack travel to hospital via bus, train or autorickshaw, wasting precious minutes.”

According to the newspaper The Hindu, Dr. Nair “explained that many people succumbed to heart attack; about 40 per cent never reached the hospital. It is absolutely essential to educate people about the need to reach hospital at the earliest.”

The Hindu wrote that cardiovascular disease was reaching epidemic proportions in India, “owing to a surge in other conditions such as diabetes, hypertension, dislipidemia (high cholesterol), a sedentary lifestyle, and smoking. In addition, pollution is also a risk that affects the arteries, not only of the heart, but also other organs and limbs. This is called peripheral arterial disease, explained Dr. Mehdi Shishebor, interventional cardiologist, Cleveland Clinic. It also has a significantly high mortality.”

Why is it so important for heart attack victims to get to a medical center so quickly?  Curtis Rimmerman, MD, (who was not at the symposium) writes in his book The Cleveland Clinic Guide to Heart Attacks, says that it is so “clot-dissolving medications – thrombolytics – can be administered to open clogged blood vessels.  These agents are effective in restoring adequate blood flow in the coronary arteries of up to 80 percent of the patients who receive them.”

Cleveland Clinic experts emphasize that thrombolytic treatment needs to be started within 90 minutes of the onset of chest pain (preferably within 30 minutes) to gain maximum benefit. The longer it takes you to receive such treatment, the more you are at risk for tissue damage, enlargement of the heart, aneurysms, and other complications.