Act fast on chest pain to preserve heart

[WAS967 97]

From http://www.msnbc.msn.com/id/5214850/

Act fast on chest pain to preserve heart

Quick treatment needed for common, severe attack

June 15, 2004 Reuters

WASHINGTON - Aggressive new guidelines published Monday call for quick

treatment of a common form of heart attack marked by chest pain and

shortness of breath.

The American Heart Association and American College of Cardiology issued the

joint guidelines for treating ST elevation myocardial infarction or STEMI, a

severe heart attack in which an artery is completely blocked.

While heart attack patients may be unsure about their symptoms and wait to

call an ambulance, every minute counts in this form of heart attack, said

Dr. Elliott Antman of Harvard Medical School and Brigham and Women's

Hospital in Boston, who helped write the new guidelines.

"It is not unusual for patients to wait two hours or longer before seeking

treatment, when they should get help as quickly as possible to minimize

damage to their hearts," Antman said in a statement.

The Heart Association said an estimated 500,000 Americans have a STEMI every

year.

"Treating this type of heart attack requires fast action, because if blood

flow is not restored to the heart within 20 minutes, permanent damage will

occur," Antman said.

"Speedy treatment not only means the difference between life and death, but

also between disability and a return to an active lifestyle after a heart

attack."

Antman said earlier guidelines were not always helpful to doctors trying to

make fast decisions about treatment.

Cardiovascular disease poses major risk to women

One crucial decision is whether to open the blocked artery with a

clot-busting drug or by using tiny flexible tubes called stents that prop

open blocked arteries.

Aspirin, beta-blockers

The new guidelines, published in the journal Circulation and the Journal of

the American College of Cardiology, distill this decision to four issues:

How much time has passed since the onset of symptoms?

How great is the risk of death?

How great is the risk of bleeding in the brain if clot-busting drugs are

used?

How long will it take to get the patient into a cardiac catheterization lab

for stenting?

The guidelines also recommend that patients take aspirin and drugs called

beta-blockers after a heart attack.

"We also strongly endorse the use of angiotensin-converting enzyme (ACE)

inhibitors for all patients to improve heart function," Antman said.

And all patients with low-density lipoprotein cholesterol or LDL of 100 or

more should get cholesterol-lowering statin drugs, the guidelines say.

This article falls in the area of "well, duh!" for most of us. But interesting none the less.

[x635 4,066]

Unfortunetly, no matter how much public education there is, denial and macho-ism will still alway be prevalent, leading to more muscle loss, especially in firefighters.

[WAS967 97]

It is scary the statistics. Pull out the latest issue of the local fire newspaper and take a look at the firefighters who were lost in the line of duty in the past several months. It is staggering how many are not from injury, but from sudden cardiac arrest.

[Guest alsfirefighter]

MI is the top killer of all firefighters every year w/exception of 2001. I've always been critical of the fact that we pay close attention to catastrophic loss of firefighters and make sweeping changes in tactics and safety, but very little comes into fitness and other factors to lower heart attack deaths. For one, look at the average age of the victims.

Two, there is one action that may make a difference, REHAB, it also can reduce injuries and maybe other deaths being fatigued minds don't respond as quickly.

On a EMS note, we may see sweeping changes that may impact EMS on an entire level within the next several years. There is writing on the wall that soon all MI patients will be transported to a hospital which catherization is available 24 hours a day. That will certainly put a drain on resources in several areas if more localized hospitals don't step to the plate.

[WAS967 97]

The good news is that several hospitals in our area have applied for the ability to do catherterizations. II know Northern Westchester is one, and I think White Plains was the other. So it will make things a little easier. But yes, in a lot of cases it will involve longer transports as it does in the cases of trauma. In the end it all comes down to what is good for the patient. If a patient in need of a cath doesn't get one because they have to wait at an incapable hospital for three days while a bed frees up at the med, there is no benefit to going to the hospital without the cath. The problem we have right now is that the medical center is overloaded with patients, does not have enough beds, and simply does not have the time in the day to schedule all the caths that are needed by people out there. I hope the state sees this and grants NWHC and WPHC the ability to perform this much needed procedure. (There is of course much more to the issue, but I'll spare you the gory details.)

[x635 4,066]

Keep in mind, these hospitals that are applying to do caths (I've only heard Sound Shore in NY, and Greenwich,Stamford and Danbury in CT personally) are only going to be able to do diagnostic caths, not interventional caths.

Diagnostic caths are for patients with low index of suspicion, and can be treated with pharmaceuticals, such as Plavix. If the patient needs a stent, then they will need an interventional cath, which needs to be done at a facility that has the capability of open heart surgery, such as the Medical Center.

There will be some benefits to these hospitals being able to do caths, but it does have some risks. These hospitals applying will probaly be leading to more "stat-cath" jobs.

As far as ALSFirefighters comment, in MA, we transported to the hospital that had the MOST appropriate care available for the patient, IMO, the way it should be here too.

(I.E. trauma patient to trauma center, MI patient to cardiac center....peds to peds....stroke to stroke, etc..except in arrest and closest facility cases) Hypothetically, if you have an suspected MI patient in Yonkers, on CPA by Best Buy.........you could take the patient to Lawrence or WMC.......chances are the pt would go to Lawrence, but why would you take the pt to Lawrence when he would probaly end up at the MC anyways? Why not save time and just go there first?

[WAS967 97]

The simple reason at it stands right now: Protocol. There is nothing that says we should go to the med for a patient in MI and no local. If you take the extra 10 to 15 minutes to go to WMC from lower CPA, and the patient codes, there could be potential for a huge liability. I personally would like to see patients go to a center equipped for cardiac care. But personally, right now the medical center is so swamped, I don't see them being capable of handling the extra load. If I had a heart attack right now, I'd demand to go to the city or Jersey. I hope things improve in the future (and I'm sure it will eventually) but right now the medical center is just in a state of chaos. I went to the medical center with a head injury patient and had to wait about 10 minutes before anyone really paid any attention to us. It was just too damn busy and the nurses are overworked as it is. Anyone who said that the 160 nurses cut doesn't affect patient care is full of you know what.