Heart Attack Victims Get Faster Treatment
The best response to a heart attack is swift action. A long wait for proper care can result in irreparable damage to the heart muscle.
Luckily, heart attack victims are now receiving quicker care. New technologies and protocols are being introduced to speed the delivery of treatment within the critical hours after an attack.
In June, the Chicago Fire Department equipped its ambulances with a sophisticated electrocardiogram (ECG) machine that identifies the severity of a heart attack while en route to the hospital, shaving precious minutes off the time spent in the emergency room confirming a diagnosis. Paramedics can phone ahead to alert the emergency room of the incoming patient's status.
Major local medical centers now have teams of professionals on call around the clock to handle heart attacks–a kind of pit crew. "We can mobilize the medical staff quickly," says Dr. Charles J. Davidson, interventional cardiologist and clinical chief of cardiology at Northwestern Memorial Hospital, Chicago.
Patients suffering a major attack are rushed to a catheterization lab where a balloon is used to reinflate the artery. A stent typically is placed in the artery during the procedure to keep blood flowing to the heart.
The goal is to open the closed artery within 90 minutes after a patient enters the hospital, according to the American Heart Association. Every minute counts. Heart muscle begins to die within 30 minutes of an attack, but doctors have another 60 to 90 minutes to prevent complete injury. "The more the damage, the higher the mortality and the higher the risk of complications like congestive heart failure," says Dr. Fred Leya, director of interventional cardiology at Loyola University Medical Center, Maywood.
Of course not all heart attacks victims arrive by ambulance. About half walk into the hospital, experts say, so medical centers are streamlining ER procedures for suspected heart attack cases.
Loyola introduced what's called pointof- care technology to speed diagnosis. Rather than send the patient to a lab, hospital staff bring testing equipment is brought to the bedside. A handheld i-STAT device, from Abbott Laboratories, analyzes the patient's blood; the test for the cardiac enzyme troponin, which is present after a heart attack, is crucial to the analysis. Results are available in 10 minutes, as opposed to the 35 to 40 minutes it takes for lab work. "We are saving 25 minutes," says Dr. Mark Cichon, professor and chair, department of emergency medicine at Loyola University Medical Center.
ECGs, ultrasounds and physical exams are also performed at the bedside. The point-of-care system was introduced after the hospital redesigned its emergency department based on business management systems designed to improve efficiency. As a result, the length of stay in the emergency room for patients with chest pains has been reduced by three hours, Dr. Cichon says. "We can see more people and intervene more quickly."
Results of fast action are encouraging. About 90 percent of those who get to a hospital quickly will survive a heart attack, Northwestern's Dr. Davidson says. "Treatment and outcomes have changed dramatically."
Heart attack deaths most often occur among people who don't make it to the hospital. Doctors stress it's important to recognize the early warning signs of an attack, such as chest or jaw pain, nausea and shortness of breath. Don't ignore the symptoms, hoping that they'll go away, doctors say. "We want to treat the victim right away, but if they're in denial and sit at home for a day, it won't matter," Dr. Davidson says. "Time is critical."