The Emporia Gazette

February 14, 2012

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Call an Ambulance

Most people who think they may be having a heart attack come to the hospital the wrong way — in a private vehicle or on foot.

“We encourage people to call 911,” said Randolph Whitely, emergency room doctor. “It is important that people get treatment as soon as possible.”

The Emporia-Lyon County ambulance service has trained personnel who can start the vital oxygen and IV medications, dispense aspirin, and do an electrocardiogram on-board, he said.

All of those emergency services otherwise would have to wait until the patient reaches the emergency room, and that delays the start of treatment.

• • •

A Glossary

Heart Attack: Reduction in blood flow to — not through — the heart; the blood flow is to the heart’s vessels, which provide the heart muscle with oxygen and nutrients.

Myocardial Infarction (MI): The medical term for heart attack. If the heart does not receive adequate blood flow, its muscle will begin to die.

Artherosclerosis: Fatty deposits on inner vessel walls, which build up and eventually block vessels, causing a heart attack.

Electrocardiogram (EKG): Tracing of heart’s rhythm for viewing. Heart damage can lead to abnormal electrical activity.

Thrombolytic Medication (”clot buster”): “Clot busters” dissolve clots that can be blocking blood flow and damaging the heart.

Ventricular Fibrillation: A severely abnormal heart rhythm that, unless treated immediately, causes death.

Sudden Cardiac Death: Most cardiac arrests occur when heart goes into ventricular fibrillation; must be treated immediately.

• • • 

Treatment

Oxygen, an EKG, an aspirin if medical personnel approve it, and intervaneous fluids are just the beginning of treatment for a patient who exhibits signs of a heart attack.

The priority is diagnosis and treatment; however, patient comfort also is important. The patient may receive a painkiller, such as morphine, to relieve intense pain.

X-rays are taken to get a look at the heart and lungs, nitroglycerin may be administered under the tongue, a pulse oximeter will be snapped onto the thumb to measure oxygen levels, blood will be drawn to measure cardiac enzymes.

A rise in the enzyme troponin reflects a problem. That recently-found “biomarker” is found only in cardiac muscle. When it is present, it indicates that a heart injury has taken place. However, lack of a high troponin level does not mean that the patient is not having a heart attack.

“We want to admit them,” Whiteley said. “That triponin level will go up in the next 12 hours.”

The triponin level almost always is checked at three, six, and 12 hours after the patient comes into the hospital.

• • •

The Telltale EKG

Doctors look for tell-tale signs of heart attacks when they read EKGs.

Whitely said they watch for ST segment changes in contiguous EKG readings.

“ST elevation — more than one in two leads or more — means they’re actually having a heart attack,” Dr. Whitely said.

The elevations, at least 1 millimeter high, that are visible on an EKG readout are caused “tombstoning.”

That can make the patient eligible for thrombolytic medication, which is a “clot buster” to dissolve blood clots that can stop the heart from beating.

“That depends on how much suspicion we have that they actually are having a heart attack,” Whitely said.

Not every heart-attack victim will receive a clot buster.

Newman personnel consult with a cardiologist to see whether the drug should be administered. Many cardiologists want a patient transferred directly to the doctor’s location to do a cathaterization of the heart. Clot busters can cause bleeding that could complicate the cathaterization and the treatment.

• • •

Important questions

While medical personnel work on the patient, they ask questions to better define the situation and the treatment.

“Chest pain is common,” said Nancy LeClear, director of marketing and education; “myocardial infarction is not.”

Whiteley asks a laundry list of questions of patients who are able to respond:

• Have your lungs been hurting? How long?

• Where is the pain? Chest? Left shoulder? Neck? Jaw? Between shoulder blades? Arms? Stomach?

• What kind of pain are you having — pressure? sharp and stabbing? dull ache? heaviness?

• How long have you had the pain?

• Does pain increase with exercise?

• Nauseated?

• Light-headed?

• Short of breath?

• Cold sweats?

• Lightheaded?

• Fatigue?

• Pain high in the stomach?

• Describe the worst pain you’ve had since this began on a scale of 1 to 10.

• What number is the pain now?

“If they describe it as someone sitting on their chest, that’s not a good thing,” Whitely said.

Other observations may be made and questions asked to eliminate non-heart causes:

F Recent medications taken

F Presence of sore throat

F Cough

F Dark stools

Chest pain isn’t exclusive to heart attack; chest pain can be a symptom of other conditions, such as stomach or esophogeal problems.