Timing is everything in heart attack care
By SHANNON FLANAGAN firstname.lastname@example.org
Area residents packed the McAlister Community Room Feb. 17 for Alliance Community Hospital's monthly Lecture Luncheon.
Lorrie Durkin, who became director of the Aultman Heart Center at Alliance Community Hospital in November, spoke about "Acute Coronary Syndrome, Early Heart Attack Care and Hands Only CPR" in honor of National Heart Month.
"This is obviously a very important topic seeing that heart disease is the leading cause of death," Durkin said. "This is bigger than cancer; it's bigger than diabetes; it's the leading cause of death among men and women. So there's a strong push to educate the community on heart disease and how to prevent it."
Durkin gave some alarming statistics including that every 1 1/2 minutes, someone dies from a heart attack. She said there are approximately 800,000 heart attacks in the U.S. each year, and a large percentage of people who have heart attacks never make it to the hospital.
She reviewed the work of the heart muscle and what happens with coronary artery disease when arteries become narrowed or blocked by plaque and fatty deposits that restrict blood flow to the heart. She explained that when the blood flow is blocked from reaching part of the heart, it can damages that part of the muscle, lessening the function of the heart.
Durkin said one of the confusing things for patients is knowing the difference between stable and unstable angina (chest pain) and when to get medical help. She said stable angina is something that a lot of people feel, and is typically a little twinge in the heart that is caused by the start of a blockage. It is recurring and comes and goes, lasting a few minutes at a time, and responds to rest. It becomes unstable angina when it doesn't go away with rest; it doesn't respond to medication that you may have been prescribed. "This is a medical emergency. When you're experiencing chest pain that does not go away when you rest -- it's persistent -- you need to seek help," she said.
Because tissue death in the heart can occur from a heart attack, Durkin said the goal of her and the staff at ACH is to get to the patients before heart attack occurs by educating them on the risk factors and warning signs.
She went over non-modifiable risk factors, such as family history and age, and modifiable risk factors -- things that can be changed to help prevent heart disease. She said lifestyle changes related to the modifiable risk factors include: stop smoking, eat a healthy diet, control cholesterol, control blood pressure, be physically active, take your medications as prescribed, aim for a healthy weight, manage diabetes, reduce stress and limit alcohol.
She also went over treatment which can include following doctors advice on management of heart disease, cardiac catheterization, angioplasty/stent placement, or coronary artery bypass graft surgery.
"With our two hospitals collaborating, we have put processes and protocols in place where if you come into the Alliance ED and you're having that heart pain and it's an emergency and we need to get those vessels open, we can get you to Aultman very smoothly where they have a cath lab and we can get you in there as quickly as we can where you bypass the ER," she explained. Durkin stressed the importance of calling for help from EMT rather than driving oneself or a loved one to the hospital because should the patient go into cardiac arrest, a family member driving the car can't do anything to help them.
Durkin said another confusion people often have is whether or not heart attack and cardiac arrest are the same thing. She explained these are two different things, the heart attack being caused by reduced blood flow to parts of the heart due to plaque buildup, while cardiac arrest is an interference with the electrical conduction in the heart causing a person's heart to stop beating and them to collapse. She said heart attack can lead to cardiac arrest.
"The goal with anybody that you observe going into cardiac arrest is to start early CPR because about four to five minutes without oxygenation can cause brain damage," she explained.
Durkin said if someone collapses and is non-responsive, the bystander should call 911 and start CPR immediately because "timing is everything."
"There's a lot of confusion and I think a lot of people out there that are nervous or scared and don't know what to do with CPR because it used to be that CPR was complicated and you don't want to cause any more damage to the patient," she said, adding that the American Heart Association has simplified it to doing only two things when someone goes into cardiac arrest: Call 911 and push hard and fast at the center of the chest.
She said you no longer need to worry about lifting the jaw or breathing for the person, and instead just get them down on the floor and push hard and fast on the center of the chest for as long as you can or until help arrives. "That can save somebody's life," she added. "Effective CPR after a cardiac arrest can double or triple a patient's chance of survival, so that's huge."
Durkin also stressed awareness and education about early heart attack care. "Every heart attack has a beginning. And I can't stress that enough," she said. "I hear so many times where a patient comes in and ultimately has to have open heart surgery and says, 'Well, about two weeks ago mowing the grass...,' or 'Well, it started about three weeks ago.' That's when we can really help you; when that first starts. If you wait two to three weeks, there's a lot of time where you're going to suffer heart damage."
She said it's important to know the warning signs, which are not always chest pain, especially in women. Besides chest pressure or discomfort, signs can include jaw pain, arm or back pain, anxiety, fatigue, nausea, shortness of breath, feeling of fullness and sweating. She added sometimes people have very few symptoms and don't know that's what is happening, so it's important to understand risk factors and to make sure you're watching your lifestyle habits to minimize your risks.