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Timothy J. Boyek, MD, FACC, FSCAI, Cardiologist
The Chester County Hospital and Health System
Published: May 24, 2010
The weather has been perfect for outdoor gardening. You planted some new shrubs, but were short of breath. During the weeding you felt a nagging chest "feeling" that seemed to go away as you kept working. The next morning you awoke with the same sensation, but it didn't go away. Now what? See your family doctor? Call 911? Won't that be embarrassing if it's just indigestion?
What could be happening in this person's heart? The heart muscle needs blood to keep pumping. The blood comes from arteries, each one like a pipe or garden hose. Cholesterol deposits (plaque) can build up inside those pipes (think of a garden hose with a clump of debris blocking the flow), but usually it's walled off by a thin layer of tissue that's like an interior skin. Plaque can weaken that skin; if it rips open exposing the cholesterol to the blood within the pipe, in the next few seconds the body will see this "rip" as a cut and respond as it would to any cut -- by sealing it off with blood elements called "platelets" and other clotting material. This accomplishes the task but in the process may eventually block the artery shut. The heart muscle downstream that depends on the blood from that artery is then starved of oxygen and can eventually die unless blood flow is re-established quickly. That's a heart attack.
Current American Heart Association "Mission Lifeline" guidelines require Interventional Cardiologists to re-establish artery flow mechanically by removing the clot and delivering a balloon or stent to open the clogged pipe (this process is called "PCI" for percutaneous coronary intervention or "Angioplasty"). We call the time it takes to do this the "Door to Balloon" (D2B) time. Regardless of time of the day, weekend or holiday, this procedure has to happen in less than 90 minutes in 75% of all heart attack patients, an accepted national standard for measuring the quality of a hospital's heart attack treatment program. The fastest D2B times correlate with better results. Imagine developing a life-threatening heart attack and having it successfully treated within 15-30 minutes after you call for help. It won't happen that quickly if you choose to drive yourself to the hospital, which 50% of heart attack victims attempt to do.
Calling 911 is therefore critical. "Time is Muscle" means trying to re-open the closed artery as quickly as possible to preserve as much heart muscle as possible. In Chester County, most if not all Paramedics have the expertise to rapidly diagnose an evolving heart attack. They obtain a Field Electrocardiogram and fax it via cell phone to the hospital where an Emergency Room Physician reviews it. Assuming the hospital is a "PCI Capable Center," this doctor can then activate the Angioplasty Service such that a specialized rapid response team will be waiting and ready when the patient arrives by ambulance. Usually, within minutes, a stainless steel stent will have "squeezed" the artery open.
Bottom line: If you are having chest pain, don't hesitate or be embarrassed to call 911. Let the Paramedics evaluate you at your own home to start your care immediately. They are the best equipped to assess whether they need to quickly activate the hospital's PCI Center so that the clogged artery is opened sooner, thus saving your life.
This article was published as part of the Daily Local News Medical Column series which appears every Monday. It has been reprinted by permission of the Daily Local News.
Last Updated: 5/24/2010