Doctors treat heart attack at 9,000 feet, call it a significant development in Valley's healthcare system

Doctors in Kashmir performed a successful thrombolysis at an altitude of 9,000 feet in a makeshift medical tent on an Amarnath pilgrim who had suffered a heart attack. Thrombolysis is the breakdown of blood clots by pharmacological means and commonly called clot busting.

Doctors say if done within the first hour of myocardial infarction (MI) or cardiac arrest, the patient usually survives. Doctors described it as significant development in healthcare system of the Valley. "It is primary angioplasty result achieved in primary healthcare through thrombolysis in the golden hour. This is a step forward in pre-hospital thrombolysis and an important step in the management of the myocardial infarction," said Dr Khalid Mohideen, consultant at Government Medical College Srinagar and well-known cardiologist. Dr Mohideen said thrombolysis was better than angioplasty in this case as the patient was at 9,000 ft and would have needed six more hours to reach a hospital where the latter procedure could be performed.

A health department spokesman said the thrombolysis was performed by Dr Nasir Shamas. The official said on the intervening night of July 16, a 43-year-old pilgrim from Agra was brought to the doctors at the primary healthcare centre at the Baltal base camp. "The patient showed symptoms of hyperglycaemia and severe breathlessness and was diagnosed as a case of heart attack and an urgent thrombolysis was performed," he said.

He said after the patient stabilised, he was referred to Medical Institute Srinagar for further evaluation. "He is doing well in the institute," he said. Director Health Services Kashmir Dr Saleem ur Rehman said thrombolysis, which is usually performed at premier institutes, is only possible at such temporary hospitals if they are equipped with emergency and modern equipment and trained staff.

As the Shri Amarnath cave is situated at 13,500 feet, the high-altitude trek to the cave involves exposure to extreme cold, low humidity, increased ultra violet radiation and reduced air pressure. Pilgrims are at risk of developing acute mountain sickness (AMS), which affects the brain and lungs, and is known to occur when one ascends to an altitude of over 8,000 feet.

Apart from AMS, pilgrims are warned about symptoms of highaltitude cerebral oedema (Haco), high-altitude pulmonary oedema (Hapo) and other high-altitude sicknesses, and are asked to report to doctors if they develop breathlessness. Dr Rehman said his department has provided high-tech medical equipment, including hyperbaric chambers (Hapo bags), defibrillators, oxygen concentrators, automated chest compression systems, multi-parameter cardiac monitors, pulse oxymeters and other medical and surgical equipments.

"All necessary drugs, including lifesaving medications and diagnostic kits, have been made available. All the medicos and paramedics deployed on yatra have been given high-altitude management training by specially trained trainers. These endeavours have brought down mortality and morbidity drastically," he said.