THE SENIOR ADVISOR: 60 Minutes to Life with Sharon Fillyaw  

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60 Minutes …what is the significance of this particular number? 60 minutes is the target maximum intervention time that greatly increases heart attack survival rates and is gradually becoming the new standard of cardiac emergency care nationwide down from the 90 minute previous standard.
When one sustains a heart attack, blood flow is impeded to the heart in some way. Angioplasty or PCI (percutaneous coronary intervention) is one of the most common procedures in the U.S. to unblock an artery. Generally a wire mesh stent is also placed immediately after the blockage is opened that within a few days is covered by arterial scar tissue which “cements” it in place; some stents have a medication coating to inhibit too much scar tissue formation so as to not cause another stenosis (narrowing) of the artery .(Johns Hopkins Hlth Lbry, 2015) There are also oral drugs such as, aspirin or clopidogrel, intravenous blood thinning drugs such as heparin and blood clot dissolving agents thrombolytics which may be administered in addition to Angioplasty. (Circulation/2015)

When Emergency Medical Personnel arrive to administer care for a heart attack victim it is important for them to get a 12 lead ECG reading from their mobile unit and wirelessly transmit the information to the ER. The Attending ER Physician will then determine if the reading necessitates angioplasty (PCI) intervention, specifically if the ECG reading includes a “STEMI” (myocardial infarct with an elevated ST segment) which is a total blockage of one or more arteries. Why?? This heart attack is of the most serious nature. If the Cardiologist needs to be called in and/or the cardiac catheterization team mobilized, this can be achieved while the patient is en route, saving very valuable time. When the patient enters the ER, the cardiac team is ready to go in short order, threading the angioplasty catheter through the femoral artery up to the blockage, inflating the balloon, clearing the blockage and installing a stent to keep that area open thus restoring normal flow to the heart and brain. Studies have determined that when a patient enters the ER and the physician has to wait for test results, wait for the attending specialist to arrive, time is wasted increasing the probability of brain damage and/or death.

There is even a newer treatment whereas the cardiologist can insert a guide wire into the clot itself and flaring the wire open “capture” the clot and actually pull it out, all through the femoral artery in the thigh.

The time it takes for the patient to receive care is called the D2B time (Door to Balloon). The 90 minute rule used to be the gold standard, however hospitals are trying to get that time down closer to 60 minutes and earlier.

Symptoms of a heart attack can include:

Nausea

Shortness of breath

Sudden pain in the upper extremities

Heartburn

Clammy, cold sweat

Sudden extreme fatigue /collapse

Dr. Harlan M. Krumholtz, the Directorof the Yale-New Haven Hospital Center for Outcomes Research(CORE), (and also a New York Times contributing writer) is one of this nation’s premier researchers in this area. His research included studying analytics that suggest bringing down the catheterization time not only LOWER than 60 minutes but to strive for the lowest time possible. (Invasive Cardiology/2011) The tireless efforts and seminal work of Dr. Krumholz and his fellow colleagues have with no doubt saved countless lives, past and present, and set a new standard for American Cardiac Care. Thank you Dr. Krumholtz!

The American College of Cardiology has a D2B initiative (www.d2balliance.org) to support the importance of fast, and efficient angioplasty and you can also check the “D2B” time of your hospital through the Medicare Compare Website: http://www.medicare.gov/hospitalcompare

When a heart attack occurs time is of the essence. Unfortunately many patients who suffer a serious heart attack wait on an average of two hours before they go to the Emergency Room or call an ambulance (Web MD 2015). Sometimes false alarms do occur whereas the patient does not need an angioplasty and hospitals are attempting to minimize this false positive by having “borderline patients” evaluated quickly by a specialist in addition to the ER doctor before sending them to catheterization. However, hospitals would rather err on the side of caution.

Inquire as to which local ambulance services in your area have a wireless 12 lead ECG equipment and have an ambulance telephone number at the ready for any medical emergency.

Of course, what is just as essential as receiving timely angioplasty is aftercare. Quitting smoking and other lifestyle or dietary changes may be needed to help you stay on a healthy track; listening and complying with you doctor’s is imperative.  

Hopefully, you or a loved one will never need an angioplasty, but if you ever do, you now have some information to help you make better informed decisions!

 

Be sure to watch Sharon’s Full Body and Fitness Workout on MATV, Malden; CATV, Cambridge; BNN, Boston; BATV, Brookline; WMC, Wellesley and Revere TV, Revere and read about it on Thesomervillenewsweekly.com & BostonNewsGroup.com  

Remember to take care of yourself and…

Stay Healthy!!

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