In suspected cases of Acute Myocardial Infarction (AMI), prompt intervention can save lives. Prof. Dr. Bilal Mohydin, a renowned Cardiologist and Head of Department at the Punjab Institute of Cardiology, shares how cardiac biomarkers play a vital role in the rapid diagnosis of cardiovascular diseases.
With increasing incidence and the high cost of care for cardiovascular and metabolic diseases, early diagnosis and improved treatment options are vitally important to clinicians, healthcare systems and, above all, to patients. The rapid and accurate testing of cardiac markers is crucial, especially in acute events like heart attacks where every minute counts.
A heart attack or acute myocardial infarction (AMI), is a cardiac event in which the blood supply to an area of the heart muscle is interrupted, causing the muscle cells to die. When a heart attack occurs, the heart releases a protein called troponin into the bloodstream. Doctors use cardiac troponin tests to detect the troponin levels in the blood and ascertain whether a patient has suffered a heart attack.
With the rising burden of chronic diseases in Pakistan, emergency departments are getting busier. This is a major public health concern, not only because it overburdens already strained hospital resources but because of the grave implications it has on patient outcomes.
Prof. Dr. Bilal Mohydin sheds light on the high influx of patients he receives on a daily basis. “This hospital receives about 800 to 1000 patients daily in the emergency alone. We have our limitations of how many we can admit and how many should be kept under observation.” However, despite such a huge overload of patients, the protocol to check the troponin levels remains the same for each and every patient. “There are 3 things that we check for: history, ECG, and testing via troponin markers.”
Heart Attack: A Race Against Time
0 hour: Patient arrives
When a patient arrives in the Accident and Emergency (A&E) Department with chest pain, doctors have to determine whether the patient has a heart attack, which requires immediate action or if the chest pain is caused by other factors.
0.5 hour: Every minute counts
A heart attack, or acute myocardial infarction (AMI), is a cardiac event in which the blood supply to an area of the heart muscle is interrupted, causing the muscle cells to die. Every hour of delay from the onset of symptoms to treatment increases the risk of mortality in patients
1 hour: Fast and reliable diagnosis
The Troponin T-high sensitive test may help to shorten the time for heart attack diagnosis drastically, allowing patients to get treated earlier and make better use of healthcare resources.
The Troponin high sensitive test is a reliable indicator of heart attacks and the gold standard in cardiac critical care.
The test helps to save unnecessary procedures:
More than 50% of patients with chest pain do not have a heart attack.
The test helps to identify 20% more patients with smaller infractions.
What is Troponin?
Troponin is a heart muscle protein that indicates heart attacks. The more damage there is to the heart, the greater the amount of troponin in the blood.
Why is the rapid diagnosis of heart attacks crucial?
A limitation of the earlier generations of blood tests was the time required to detect the troponin release, sometimes requiring up to six hours with less sensitive troponin tests.
Rapid treatment is essential as every 30 minutes increases the risk of mortality by 7.5% in patients. The Troponin T-high sensitive test reduces the observation time needed to rule-in or rule-out a heart attack from 3-6 hours to just 1 hour. This test allows doctors to make treatment decisions rapidly, which can greatly impact outcomes and potentially save lives.
He adds, “Whenever we get a troponin positive result, it shows that the patient needs immediate treatment. Some require angioplasty, coronary artery bypass, angiography, surgery and so forth.”
In the case of suspected AMI, prompt treatment is essential. Every 30 minutes of delay between symptoms and treatment increases the 1-year mortality rate by 7.5%.
A high sensitivity test can detect subtle increases in troponin levels which allows earlier detection of heart attacks, shortening the time required for diagnosis by almost three hours. In addition, it also improves risk stratification of patients with elevated cardiac troponin levels with and without acute cardiac events.
According to Dr. Mohydin, “The cardiac troponin high-sensitivity test reduces the observation time needed to rule-in or rule-out a heart attack from 3-6 hours to just 1 hour enabling early diagnosis and initiation of treatment to ensure better outcomes and potentially save lives.”
High sensitive troponin tests are specifically recommended to patients who complain about chest pain if they have a family history of CVDs, previous history of high blood pressure, high cholesterol, obesity or diabetes.
Unlike other routine tests, this test requires absolute accuracy because in case of a false positive result instead of a negative result, the patient requires further treatment which is very costly. Similarly if a false negative result is given instead of a positive one, the patient could end up becoming even more critical as immediate medical intervention will not be done. Therefore, accuracy is the key.
Specifically, he notes, “There are certain limiting factors of the troponin test as well. You need to have a volume to make it cost effective. You need to have a team that is qualified enough to interpret the results accurately, and then the pathologists and lab technicians also have to be well-trained because if a sample is not properly received and managed, then the results will not be accurate either.”
Talking about the role of the Punjab Institute of Cardiology, Dr. Mohydin claims, “PIC is a tertiary care teaching center, we have our interns and doctors working in various hospitals. As a teaching hospital, we are there to educate, raise awareness and synthesize the latest scientific research into recommendations that cardiovascular professionals can use to provide patient care.”
Prof. Dr. Bilal Mohydin strongly believes that private and public organizations must work together to impart awareness about timely testing for cardiac diseases, given the high prevalence of CVDs in Pakistan. This makes it all the more important that prevention is made a priority.