And if I die before I wake…

Tuesday, September 28, 2010

News headlines haven’t caught up to reality when it comes to news about heart attacks. The astonishment shown in the press about how quickly a patient can get in and out of the hospital was evident again with the coverage of Michigan State football coach, Mark Dantonio and his heart problems. After coaching against Notre Dame, Mr. Dantonio developed squeezing chest pain, went to the ER and the wheels of modern medicine went into motion.

The heart is a muscle like any other in the body. It needs oxygen delivered by red blood cells to function. If the blood vessels to the heart muscle narrow and can’t deliver enough oxygen, the muscle starts to hurt, no different than legs that hurt when running or arms that ache with lifting. The difference is that you can rest your arms and legs, but the heat can’t stop and take a breather. Should a coronary (heart) artery become completely obstructed by cholesterol that ruptures and the formation of a blood clot, the part of the heart muscle that it supplies starts to die. That’s called a heart attack or myocardial infarction. Not al chest pain is due to muscle death, sometimes the pain or angina is due to decreased blood supply. It becomes a warning sign that a heart attack may be happening in the near future and that pain should not be ignored

The initial responsibility in treating a heart attack lay with the patient. Nothing can be done unless the patient accesses medical care and even with all the public education messages and advertising, people still stay at home, pretending the chest pain is indigestion and hoping that it will go away. The first step of treatment starts with showing up in the ER or preferably calling 911. Most hospitals have protocols in place to deal with chest pain patients. EKGs get done within a few minutes. If it shows a heart attack, the clock starts running to get the blocked blood vessel open. Time equals heart muscle. The longer the artery stays blocked, the more muscle that dies and the weaker the heart becomes. If the EKG is normal, then the doctor needs to decide whether the chest pain was angina or whether it was coming from another organ in the body. If the thought it is angina, a cascade of events will take place over the next few hours to decide if a heart catheterization is necessary to potentially open a narrowed artery and prevent a future heart attack.

A generation ago, there was little available to intervene and stop a heart attack from happening. The patient was made pain free and it was accepted that heart muscle was going to die. Less muscle meant less pumping potential and patients became cardiac cripples, developing chest pain and shortness of breath with minimal activity and living shorter, less satisfying lives.

Major leaps in medication and technology allowed blood clots to be dissolved, blood vessels to be opened with balloons and kept open with metal cages called stents. Intervening immediately re-established blood supply to areas of the hear starving for blood and oxygen and literally stopped and reversed the heart attack from happening. If heart muscle damage is prevented with timely and aggressive care, there is little need to stay in the hospital and people can gradually get back to their regular lives as soon as possible.
In a patient who presents to a larger hospital, if the EKG show a heart attack, the blood vessel can be opened within minutes and if nothing more needs to be done, discharge home happens in a day or two. For the patient whose EKG is normal, it may take an extra day to decide the necessity and type of heart imaging. A spectrum of imaging options exists and can be tailored to the individual patient’s situation. From a treadmill stress test to echocardiography (ultrasound), CT or MRI to heart catheterization, finding the least invasive test that gives the most information remains the goal.

The key to heart care though remains with the patient. Mike Dantonio made the right call when he woke up with chest pain. Instead of rolling over, he got the medical care he needed and ended up back at work instead of becoming another statistic of a patient who died in their sleep.

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