Rushing to Save Heart Attack Patients

In our story “Rushing to Save Heart Attack Patients,” we meet Clayton resident Arlene Skuba, who survived a heart attack at 72, after doctors at the John Muir Medical Center in Concord rapidly unclogged her arteries.

Just 30 years ago, doctors could only watch patients as they suffered their heart attacks. As many as 20 percent of them ended up dying. Now, by rushing patients to the operating table and opening their blocked arteries while their heart attacks are underway, they’re able to save all but 5 percent of those who make it to the hospital.

This success is the result of a national campaign by the American Heart Association, the American College of Cardiology and other groups to reduce the time it takes for the hospital to move a heart attack patient from the hospital door to the operating table. Among healthcare personnel, this is known as “door-to-balloon” time. The balloon refers to the stents cardiologists inflate inside heart attack patients’ coronary arteries to remove the clots blocking blood flow to their heart and causing their heart muscle to die.

“Time is muscle,” said Dr. Agustin Argenal, former chief of John Muir’s catheterization lab, where heart attack patients are treated. “The longer that an artery is blocked, and thereby heart muscle is deprived of oxygen and blood flow, the more muscle is damaged and actually dies.”

At John Muir Medical Center in Concord, door-to-balloon time is usually under an hour, compared to the campaign’s national target of 90 minutes, said nurse Pam Lavering, coordinator for the hospital’s chest pain centers in Concord and Walnut Creek. In 2007, the hospital’s Concord campus averaged 94-minute door-to-balloon times. In the first quarter of 2012, the average was 48 minutes, said Lavering.

Dr. Argenal helped reduce John Muir’s door-to-balloon times by having paramedics diagnose heart attacks in the field, instead of waiting until patients arrived in the emergency room.

“Historically, the emergency room would evaluate the patient,” said Argenal. “If they were having a heart attack, a cardiologist would be called. A lot of time was wasted.”

Today, paramedics call the emergency room to let them know that they’re bringing in a heart attack patient; the emergency room calls the cardiologist and the rest of the team, and the patient is taken directly into the catheterization lab as soon as they arrive at the hospital. That way, a doctor can start removing the blockage in the patient’s arteries as soon as possible, said Dr. Argenal.

The last remaining challenge to getting patients onto the operating table as soon as possible is getting them to recognize that they’re having a heart attack and calling 911, he said. He offered some tips to help the public recognize heart attack symptoms.

7 Things You Might Not Know About Heart Attack Symptoms:

1. The most common symptoms are quite varied.

The most common symptoms of a heart attack are chest tightness associated with breathlessness and perspiration; arm discomfort – classically the left arm, but it can be in both arms, and heaviness, numbness or tightness in the arms. Neck discomfort, jaw discomfort and even upper back discomfort can be symptoms too.

2. People having a heart attack often don’t realize they’re having one.

“That’s a really major issue,” said Dr. Argenal. “So if patients could possibly recognize the symptoms, although they may not seem to be cardiac, and call 911, I think more lives would be saved.”

3. People often confuse their heart attacks with indigestion, muscle skeleton pain and sore muscles.

4. Even if you're in doubt, the best thing to do is to call 911.

“The key thing is to get to a place where the physicians can get blood tests and do an EKG,” said Dr. Argenal. “Those kinds of things really help us differentiate between something that may be innocent, and something that may be life-threatening.”

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An EKG or electrocardiogram is a test by which doctors can determine the electrical output of the heart. Beating heart cells have unique electrical properties that make them similar to brain cells. These properties help them beat in unison to pump blood throughout the body. An EKG can detect areas in the heart that are being injured during a heart attack, which makes it a good diagnostic tool.

Ambulances are equipped with devices to perform electrocardiograms, which is why it's key to call 911 if you suspect you're having a heart attack. Driving yourself to the hospital can waste precious time and lead to more heart damage, or death.

5. Doctors sometimes confuse patients’ symptoms with gall bladder disease, stomach upsets or gastritis.

6. Even cardiologists can get confused by their own heart attack symptoms.

“I started with thumb tingling in both hands, and that led to numbness in my arms, and ultimately, after quite some time, discomfort in the chest,” said Dr. Argenal. “But I’m a cardiologist, and I was faked out. So it is difficult for patients.”

7. Women's symptoms can look different than men's.

Women are somewhat more likely than men to experience symptoms like shortness of breath, nausea or vomiting, and back or jaw pain, according to the American Heart Association.