You're never to old for the "big one"

This past weekend I took care of a 47 year male in the early stages of a large heart attack. On the outside he appeared to be a healthy and fit guy. However, on the inside, he had a huge clot in his proximal left anterior descending artery -- a lesion we call the "widow maker." Think Tim Russert.

Heart attackes (myocardial infarctions/MI's) come in many different flavors. The ones that we all worry about are the acute ST elevation MI's (think Sanford and Son). This is when a cholesterol plaque ruptures and in the process of thrying to heal the crack in the innner lining of the wall of the artery -- a large clot froms. This clot can end up filling up the enite inside (lumen) of the artery and choke the heart muscle (myocardium). If not treated quickly, permanent damage will occur. Watch the animation below to see this process in action:

My job is to quickly and safely get in that artery and open it up with a balloon and a stent. Watch the animation below to view a stent being deployed.

How could this have been prevented?

My patient did have a family history of heart disease and high cholesterol.

In my patients, I help assess their risk of "cardiovascular events" with the following:

• cholesterol levels
• highly sensitive CRP (marker of inflammation)
• stress test
• carotid ultrasound
• review of risk factors: smoking history, blood pressure, diabetes
• family history
• physical activity levels
• eating habits

Please consult with your doctor to evaluate your risk of heart disease.

Pre-Hospital care of the patient with an acute heart attack

Once a heart attack starts, the clock starts ticking on the viability of the heart muscle. If the blocked artery is not opened quickly, the heart muscle will be permanently damaged. Therefore, we try to have the artery opened in less than 90 minutes after the patient first arrives at the hospital. We call this the Door-to-Balloon time (D2B time).

One way to get the process rolling faster, is to have the emergency medical team alert the hospital that a patient is having a heart attack even before he/she arrives at the hospital. This gives the hospital time to mobilize the doctors/nurses/techs that will be taking of the patient, prior to hospital arrival.

A recent study in the April 2009 edition of the Journal of the American College of Cardiology: CardioVascular Interventions showed that in 10 regional communities that utilized the strategy of prehospital alert of a heart attack, 86% of patients were successfully treated in less than 90 minutes. This is well above the benchmark of 75% set by the American College of Cardiology.

At Stamford Hospital, we initiated this strategy over 2 years ago. We too have witnessed a dramatic decrease in our D2B times. With this, we are saving a lot of heart muscle and improving patient outcomes.

With the success of the program at Stamford Hospital, I have been helping develop similar programs for the Bridgeport and Norwalk communities at St Vincents Medical Center and at Norwalk Hospital's new program.



Ted

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