Cardiovascular

Deadly Heart Attacks Need Quick Treatment

Many people are familiar with the general warning signs of a heart attack, but few realize that quick action can make all the difference in surviving the deadliest kind of heart attack.

This attack is total blockage of a heart artery, which can be fatal unless treated quickly in one of two ways: medication therapy to clear away a clot blocking the artery, or angioplasty, the insertion of a balloon to push the artery open.

In technical terms, the attack is called an ST-elevation myocardial infarction (STEMI), referring to a feature seen on an electrocardiogram (ECG or EKG). To fight this type of heart attack, treatments must be performed quickly – ideally, within 30 minutes for clot-dissolving medication treatment, and within 90 minutes for angioplasty.

The 90 minute ‘door to balloon’ time is the industry accepted treatment time for STEMI patients. ‘Door to balloon’ refers to the interval of time from patient arrival to inflation of the balloon catheter within a patient’s blocked artery.

The American Heart Association claims that fewer than half of all STEMI patients get the right treatment at the right time. The AHA also says that angioplasty is more effective than clot-busting treatment, even when transportation to a heart center is needed. Only 25 percent of U.S. hospitals have the catheterization facilities for emergency angioplasties.

A national program called “Mission: Lifeline” was introduced by the AHA last year to stress the importance of community-based initiatives aimed at quickly activating the appropriate chain of events necessary for opening a blocked coronary artery that is causing a heart attack.

As an example, physicians and staff at the Fred and Lena Meijer Heart Center have worked with a number of community hospitals in West Michigan to coordinate how heart attack patients are stabilized and prepared for transport. This kind of teamwork helps Meijer Heart Center staff prepare for incoming patients and expedites treatment once they arrive.

“There is a growing trend among regions of the country to coordinate the steps for treating this dangerous kind of heart attack,” said Richard McNamara, M.D., chief of cardiology at the Spectrum Health Fred and Lena Meijer Heart Center. “When everyone caring for a STEMI patient is working in unison to get that person to a center that performs emergency angioplasty, minutes are saved. Those minutes can mean the difference between life and death.”

In Kent County, EMS crews are able to perform EKGs in ambulances and determine en route whether a heart attack patient is suffering a STEMI, McNamara said. “The EMS personnel can transmit a copy of the EKG to us so we can prepare for that patient,” he said. “This kind of effort saves steps and lives.”

McNamara stresses the importance of calling 911 for emergency help when a person recognized the warning signs of a heart attack. “About half of all heart attack patients now drive themselves to a hospital or are driven,” he said. “People should always call 911 instead of getting a ride to a hospital because you need emergency assistance as soon as possible. Every minute counts.”

Like most heart centers in the U.S, reducing door-to-balloon time has been a focus at Spectrum Health among emergency department staff, cardiologists and staff at the Meijer Heart Center. In the last 12 months of data available, Meijer Heart Center’s door-to-balloon time was a median 58 minutes for STEMI patients. Hospitals performing this procedure are expected by national quality and accreditation agencies to have a door to balloon time of less than 90 minutes.

For most of 2007, the Meijer Heart Center averaged about 30 STEMI patients a month.

“Through the coordinated efforts of community hospital staff, EMS personnel, and staff and physicians at Spectrum Health, we’ve been able to greatly reduce our door to balloon times,” said McNamara. As other communities in Michigan continue to work to treat STEMI patients, I hope to see treatment times drop around the state.”

The AHA offers the following heart attack warning signs and tips:

Coronary heart disease is America’s No. 1 killer. That’s why it is so important to reduce your risk factors, know the warning signs, and know how to respond quickly and properly if warning signs occur.

Heart Attack Warning Signs

Some heart attacks are sudden and intense – the “movie heart attack,” where no one doubts what’s happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected aren’t sure what’s wrong and wait too long before getting help. Here are signs that can mean a heart attack is happening:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs may include breaking out in a cold sweat, nausea or lightheadedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea, vomiting, and back or jaw pain.
Learn the signs and even if you are not sure it’s a heart attack, have it checked out. Minutes matter. Fast action can save lives – maybe your own. Don’t wait more than five minutes to call 911.

Calling 911 is almost always the fastest way to get lifesaving treatment. Emergency medical services staff can begin treatment when they arrive – up to an hour sooner than if someone is taken to the hospital by car. EMS staff are also trained to revive someone whose heart has stopped. In addition, patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too.

If you can’t access the emergency medical services, have someone drive you to the hospital right away. If you are the one having symptoms, don’t drive yourself, unless you have absolutely no other option.

Spectrum Health is a not-for-profit health system in West Michigan that offers a full continuum of care through its seven hospitals, more than 140 service sites and 560,000-member health plan, Priority Health. Spectrum Health’s 14,000 employees, 1,500 medical staff members and 2,000 volunteers are committed to delivering the highest quality care to those in medical need. The organization provided $98.6 million in community benefit during its 2007 fiscal year. Spectrum Health has earned more than 50 national awards during the past 10 years.