Fifty years back when I started my journey as a medical student, presence of heart attack patient was uncommon in medical wards. Treatment usually consisted of bed rest for 6 weeks, oxygen, morphine for pain , erratic use of nitrites and some physicians boldly used verapamil , prenylamine lactate and oxyfedrine. Essentially , emphasis was on bed rest and daily ECG recording, stay in CCU with monitoring with masterly inactivity. At the most, there was Masters’ test to unearth ischemia in those presenting with exertional symptoms of chest pain. In-mid seventies, bicycle ergometry and treadmill tests made an entry along with M-mode echocardiography. Late-seventies saw emergence of selectivecoronary angiography in India. Mid-eighties, angioplasty of heart arteries with balloon catheters gained ground in India and many centres simultaneously started performing these procedures and some training programmes were initiated by 1985. Stent implantation started started in early nineties but gained ground after seminal studies of mid-nineties. Today , treatment of heart attack according to best guidelines along with angioplasty and stent implantation is available in all district hospitals and is percolating down to moffusil hospitals. What a change ?
A lot of young and middle-aged persons are exreiencing angina and heart attack related issues and undergoing angioplasty with stent implantation. Following discharge, the subjects are prescribed medicines which they take regularly. However the patients have fears and many unanswered questions. For some who were initially in the pink of life and career, the episode comes as a bolt from blue and life gets tuned upside down. There are fears they can not discuss with spouse or colleague and doctors may not have enough time to answer all querries. However , a few things are clear. Most fears are unfounded. Most people can lead a normal life while they adhere to drug therapy. There is no need to limit activities after a week or two unless there are multiple health issues or advanced age. Young and middle-aged people can resume normal life in a few weeks time unless they are experiencing breathlessness or chest pain. Weakness and fatigue is a common symptom. Usually, it is a manifestation of underlying depression and anxiety. Moderately intensive exercise can be undertaken after a few weeks initially under supervision and later on unsupervised one the activity level is slowly ramped up. Sexual activity is not a taboo barring a very few cases wherein heart function is poor. Even these people can be passive partners or can indulge in oral sex. Sexual dysfunction is a common complaint. Again, it is not that much a physical issue as is psychological. Some drugs can cause erectile dysfunction which can be managed with better techniques , change of drugs or using other drugs in appropriate cases. Heart attack or angioplasty is certainly not end of the world. It amy slow you down and give you time to think about life in a different perspective. You might become a better human being, more caring and understanding.