Mar 25, 2011

A shorter 'door to balloon' time reduces heart damage

When the words "Code STEMI" echo through the halls at Baxter Regional Medical Center, a team of health care professionals springs into action with a single goal in mind -- saving the life of a patient who is about to come through the doors of the Cline Emergency Center.

The national benchmark is to have the patient to the cath lab for treatment in less than 90 minutes after he enters the hospital. The median "door to balloon" time at BRMC is 58 minutes, and patients have reached the cath lab in under 15 minutes. STEMI stands for ST elevation myocardial infarction -- a type of heart attack. Heart attacks are the leading cause of death for both men and women. BRMC Emergency Department Director Kelly Dicks says the classic heart attack symptoms are chest pain, shortness of breath, pain in the left arm, pain extending up the neck and a heavy feeling in the chest.

"But women and diabetics often don't experience those symptoms," Dicks said. "They may just feel discomfort or feel like they have indigestion." She says often they will have shortness of breath and sweating, but they don't always have those symptoms. A feeling of discomfort in the chest that does not go away should be checked, she adds, and prompt treatment is key.

Dicks also recommends chewing a regular aspirin or four baby aspirin.

"What's happening is the blood vessels to your heart which are feeding the muscle aren't getting enough blood flow," Dicks says. "So it's actually causing part of your heart muscle to die because there's a clot or a spasm that's preventing the muscle from getting the blood supply it needs."

Ready for arrival

She described what happens to the patient once the 9-1-1 call is made. When the ambulance crew arrives, they will take vital signs and put the patient on oxygen. Once they get into the ambulance, they will use an EKG to determine the heart rhythm. BRMC ambulances have the equipment to do an EKG and send the results ahead to the Cline Emergency Center.

If the emergency department physician determines this is a STEMI event, the code will be called. This code sets off several sequences of events. One of BRMC's three cardiologists -- Dr. Michael Camp, Dr. Otis Warr or Dr. Erick Araneda -- will head to the cath lab to prepare for an angioplasty if one is indicated. Angioplasty is the insertion of a balloon into the blood vessel using a tiny guide wire known as a catheter. The balloon is inflated to clear the blockage.

The Code STEMI also will summon the cath lab team to assist the cardiologist.

Meanwhile, another group of health care professionals is preparing to receive the patient at the Cline Emergency Center. Dicks says patients may be surprised to suddenly find themselves the center of a hub of activity.

One team member will be talking to the patient -- asking questions and getting consent. Others will be starting IVs. Someone else will be preparing the patient for insertion of the catheter through an artery in the groin. Another person will be marking their pulses on their feet where the cath lab team can read them.

"I've had students watch this and say it looks like a well-oiled machine," Dicks says. She says the team is constantly looking at ways to improve the time it takes to get patients to the cath lab. But why is the "door to balloon" time so important?

"The less time it takes us to get that clot or plaque opened in the cath lab, the less damage there is to the heart," Dicks says.

If the cath procedure can't clear the blockage, bypass surgery may be necessary. If so, BRMC has a nationally recognized heart surgeon, Dr. Louis Elkins, on staff.

Dicks said although an active lifestyle can help reduce the risk of heart attack, even people who are physically fit can fall victim. "And you can't always go by age. We've had heart attack victims in their mid-20s before," Dicks says. "We've had people in their 30s who have had to have bypass surgery."

She stressed that in the event of a heart attack, time is crucial. "Any time you have chest pain, shortness of breath, sweating or chest discomfort that doesn't go away," she says, "it's an emergency."

Sharon Miller is the coordinator of BRMC's Schliemann Center for Women's Health Education and a former award-winning reporter for The Bulletin.

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