Matter of the Heart: Early treatment vital to positive outcome

October 21, 2013 Updated: October 21, 2013 at 4:05 pm
photo - Phil Vigil (right) had a heart attack several weeks ago. He has started cardiac rehab with Memorial Hospital at the Printer's Parkway Medical Plaza. Cardiac-Rehabilitation Pulmonary Specialist Jason Al-Ghareeb shows how monitors are attached to Vigil to monitor him during his rehab sessions. Thursday, October 17, 2013.  (The Gazette/Jerilee Bennett)
Phil Vigil (right) had a heart attack several weeks ago. He has started cardiac rehab with Memorial Hospital at the Printer's Parkway Medical Plaza. Cardiac-Rehabilitation Pulmonary Specialist Jason Al-Ghareeb shows how monitors are attached to Vigil to monitor him during his rehab sessions. Thursday, October 17, 2013. (The Gazette/Jerilee Bennett) 

Philip Vigil had spent the morning loading large bins full of his daughter's belongings onto a rig for transport to her home overseas. He was on his way back inside his Fort Carson home when he spotted his neighbor struggling to hoist a heavy mechanic's tool box into the back of a truck.

Vigil helped out, then went inside to mop off the sweat and catch his breath.

"I figured I'd just overexerted myself. That's just a little too much for me at my age and size," Vigil said.

The 62-year-old retired career Army man felt a pop inside his chest. The muscles in his left elbow cramped; then, the muscles of his left hand. Suddenly overwhelmed by nausea, he fumbled for a seat and tried to calm himself. The panic, though, already had a grip. He felt his throat beginning to tighten.

The extreme physical exertion had caused one of Vigil's coronary arteries to become blocked. The muscles of his heart were now starving for oxygen and beginning to die.

Vigil was having a heart attack. The countdown between life and death had begun.

Door-to-balloon time

Each year, more than 5 million Americans visit hospitals with chest pain symptoms, and about 600,000 die from heart disease, the leading cause of death for both men and women in the U.S.

The faster a person recognizes the symptoms of a heart attack and seeks and receives help can greatly impact survival rates and quality of life after the event.

"There is no doubt the earlier you can open up the artery and the faster you reestablish blood flow, the better patients do," said Dr. Christian Simpfendorfer, an interventional cardiologist with Penrose-St. Francis Health Services. "The heart needs blood flow and oxygen to stay alive. Necrosis, tissue or cell death - that starts to happen in 15 to 20 minutes of an artery becoming blocked."

For the past decade, doctors and emergency medical professionals nationwide have focused on tightening "door-to-balloon" times, the period between a cardiac patient's arrival at the emergency room and the opening of the blocked artery, traditionally by stent using a balloon-tipped catheter.

The national door-to-balloon goal - 90 minutes - is now exceeded by most hospitals, including both Penrose-St. Francis and Memorial, whose numbers are in line with the current national average of about 60 minutes. Both Colorado Springs hospitals also stand out nationally for their cardiac care.

"We're fortunate that both hospitals provide outstanding post-resuscitation care," said Dr. David Ross, an emergency physician at Penrose-St. Francis and medical director for American Medical Response ambulance service, which contracts with the city and county for 911 services. "Once the heartbeat comes back in the field, the next few hours and days are critical as far as brain recovery. Both hospitals provide state of the art care."

Survival rates for patients suffering a cardiac arrest in El Paso County were between 11 and 12 percent from 2009-2011, and jumped to 15.2 percent in 2012, Ross said.

"That might not sound good, but it's actually quite good and better than the majority of the country," he said.

One reason for lower door-to-balloon times is mobile technology in ambulances, said Dr. David Rosenbaum, Vigil's physician and a cardiologist at Memorial.

"Paramedics can perform an EKG in the field and transfer that over a fax line to an emergency room, where the ER physician activates a call system that mobilizes the cath lab staff and the cardiologist on call," Rosenbaum said. "When we looked ... at how that changed door-to-balloon time, we went from being over 120 minutes to get an artery open to now we're down at about 63 minutes. We've cut the time about in half."

As fast as they can be

Even a decade ago, the system had no such time-saving shortcuts.

"In the old way of taking care of these folks who are suffering a heart attack, we basically waited for the patient to arrive at the hospital, then did an EKG, then the ER physician looked at the EKG, then called the cardiologist and then the cath lab," Rosenbaum said. "Now, we've taken layers of time out of the equation."

With speedy symptom recognition and medical intervention, even patients suffering severe heart attacks that require aggressive treatment can, after angioplasty, return to normal heart function long-term, Simpfendorfer said.

"There are times - through patient follow-up for those who had recognized their symptoms, called 911 and come in quickly - they can go from looking like someone at death's door to having virtually no evidence that anything had ever happened," he said. "That's dramatically different from how things used to be."

Continuing to shorten door-to-balloon times, if possible, won't necessarily improve outcomes among heart attack patients, though, studies have found.

"We're probably as fast on that side as we can be," Simpfendorfer said.

Reinforcing education

The room for improvement now lies at the front end, with the public.

According to the American Heart Association, most people suffering from "acute coronary events" delay their initial 911 call, perhaps because of uncertainty about their symptoms - especially if they don't mimic chest-clutching "Hollywood heart attack" stereotypes.

"On average, most patients wait about two hours before calling 911 and by then a lot of heart muscle is damaged," Simpfendorfer said. "About 40 percent of patients don't even seek medical attention during their cardiac event."

Mission: Lifeline, a program of the American Heart Association, advocates for improved cardiac systems of care, beginning with community education about the signs and symptoms of a heart attack..

"It's a routine thing for us to still see patients who think they're having an upset stomach or reflux," Simpfendorfer said, "and it's actually a heart attack. That's very upsetting."

That "cold sensation"

Vigil knew his body and his heart well enough to know what was happening that mid-September afternoon.

"My heart was going about a gazillion miles an hour. That's when I hit the panic button and said it's time to go," said Vigil, who has a history of heart problems, including an emergency quadruple bypass a decade ago.

"By now, I've had so much experience at cardio things that when the heart attack actually came, I recognized the symptoms."

Vigil managed to drive himself to the main Fort Carson gate, where MPs called an ambulance. Within minutes, he was in the ambulance and hooked up to an EKG machine, which confirmed the heart attack and alerted the cardiac and emergency teams at Memorial Hospital.

"When I got there, they were waiting for me and whisked me up to the cath lab," Vigil said. "Within 50 minutes, I'm done and in recovery. I had a local in my thigh. They didn't even knock me out."

In fact, Vigil remembers the sensation in his chest when the catheter - threaded up via the large, femoral artery in his leg - finally cleared the blockage.

"All of a sudden there was a cold sensation that ran down through my heart and it was very relaxing and soothing. I guess that meant the heart muscle was suddenly getting a new supply of blood," said Vigil, who began cardio rehab at Memorial last week. "Two hours later, I felt like nothing had ever happened."

Typical heart attack symptoms

- Chest discomfort or pain - Feels like a tight ache, pressure, fullness or squeezing in the center of the chest lasting more than a few minutes. Discomfort may come and go.

- Upper body pain - Pain may spread beyond the chest to shoulders, arms, back, neck, teeth or jaw. Upper body pain can occur with no chest discomfort.

- Stomach pain - Pain may extend downward into the abdominal area and may feel like heartburn.

- Shortness of breath - The need to pant for breath or take repeated deep breaths often occurs before chest discomfort develops and may occur without chest pain.

- Anxiety.

- Lightheadedness.

- Sweating.

- Nausea and vomiting.


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