NATURE'S BYPASSES

WHAT TO EXPECT IN THE EMERGENCY ROOM

The treatment of a heart attack has changed dramatically in the past 20 years.  Heart attack patients are no longer admitted to the hospital to be observed and kept at bedrest for two weeks.  Emergency rooms (ER) are now designed to place heart attack patients on a fast-tract to immediate, interventional, treatment.

A heart attack is caused a thrombotic (a blood clot) obstruction of one of the coronary arteries.  The chest pain associated with this obstruction is due to injury or damage to the heart muscle supplied by that artery.  The heart attack may be large or small, but all heart attacks are serious and are treated similarly.  There are no “mild” heart attacks.  Injured heart muscle can recover, but dead heart muscle cannot.  The aim is to reduce heart muscle damage by restoring blood flow in the affected artery.  Blood flow is restored by opening the artery and getting rid of the blood clot (thrombus) with a tiny balloon catheter in a Catheterization Laboratory (Cath Lab).  The longer the artery is obstructed the greater will be the heart muscle damage so we want to go to the cath lab as quickly as possible.  The aim, in ideal circumstances, is to open the artery within 90 minutes of the onset of the chest pain. 

Once the cardiologist arrives in the ER and the diagnosis is established, the ER becomes a flurry of activity.  Laboratory work, x-rays, ECG, I-V fluids, and oxygen must be obtained and started.  The procedure must be fully explained to the patient and the family to get the necessary permits signed.  This is a difficult time for the patient and family because there is some risk in the cath lab.   There is also risk in not doing anything.  My advice is to sign the permits and get to the cath lab as quickly as possible.  This approach to the heart attack patient has been approved by the hospital and the medical staff and the results are closely monitored.  The goal here is to stop further cardiac muscle injury.  This is modern day cardiology .  See blogs 12 and 13. 

Summary:  If you suspect a heart attack, call 911 and get to the hospital as quickly as possible.  I will devote a later blog to help you recognize the type of chest pain associated with a heart attack to assist you in deciding whether or not to call 911.