By Michaela Gibson Morris/NEMS Daily Journal
Mississippians have been adding insult to injury.
Nevermind that the state leads the nation in cardiovascular disease risk factors like obesity, high blood pressure and diabetes. Mississippians are waiting too long to get help when heart attacks strike.
“People often have symptoms for two hours before they start calling for help,” said Tupelo cardiologist Dr. Barry Bertolet, a member of the Mississippi Health Alliance, which has worked with the Mississippi Department of Health to set up a statewide protocol to get people prompt treatment for heart attacks.
When a heart attack strikes, patients need to be at the hospital – ideally in the cath lab – within 90 minutes to two hours for the best outcomes.
“If time is muscle and someone stays at home two hours, we’re almost out of the window,” Bertolet said.
The prescription for the delay is for people to dial 911, not drive, when they have symptoms typical of a heart attack:
• Indigestion feeling that doesn’t go away
• Chest discomfort that can radiate to either shoulder or arm, neck and/or jaw or back
• Shortness of breath
• Cold sweats
• Feeling like someone is standing on your chest
• Chest pain that disappears and returns
• May not be any “pain” at all.
• Unusual fatigue
If the symptoms don’t resolve in 10 to 20 minutes, there’s a good chance it’s a heart attack, Bertolet said. But people often wait, wanting to make sure it’s a heart attack to avoid bothering anyone.
“If it’s not a heart attack, there’s still a medical condition that needs attention,” Bertolet said. “Some of them are equally life threatening or serious,” such as a severe ulcer or pulmonary embolism – a blood clot to the lungs.
Chain of events
A heart attack occurs when one or more of the tiny coronary arteries that deliver oxygen and nutrients to the heart is blocked. Generally, the definitive treatment is for cardiologists to thread a tiny wire through an artery in the leg or arm, use a tiny balloon to open the blockage and place a stent – usually a tiny mesh tube – to keep the artery open long term.
“If we get the artery opened up, it stops the heart attack,” Bertolet said. “There’s less risk of death and disability.”
When people who suspect a heart attack call 911, they set a chain of events in motion that will help them get to the cath lab as quickly as possible.
In North Mississippi, all ambulances have the capability of performing an EKG – a key diagnostic test – and send it in to cardiologists.
“We can diagnose a heart attack at someone’s house,” Bertolet said. “As the ambulance is in route, they can begin medications.”
With new protocols in place around the state, the ambulance will then take the patient having a heart attack directly to a hospital that has a cath lab and cardiologists available. In Northeast Mississippi, that means heading to Baptist Memorial Hospital-North Mississippi in Oxford, Magnolia Regional Health Center in Corinth, North Mississippi Medical Center-Tupelo.
From the EKG, the cardiologists have a good idea where to start looking for the blocked coronary artery and can prep the cath lab before the ambulance even arrives at the hospital.
“You can bypass the ER, going directly to the cath lab for definitive therapy that can stop the heart attack,” Bertolet said.
The new protocols are making a difference across the state, Bertolet said.
“We’ve been cutting off 30 minutes on average,” in the time it takes to get people to the cath lab, Bertolet said. “The faster we’re able to do this, the better the outcome is likely to be.”
The difference in the outcomes can be heart-breaking. Recently, Bertolet had a patient in his 40s who had chest pain on and off for several weeks and then continuous chest pain for three days before coming in to the hospital.
“By the time he came in, he had completed the heart attack,” Bertolet said, and the heart muscle had died. He went into heart failure, and his heart couldn’t hold a steady beat. The patient died after a few days in the hospital.
“We weren’t able to reverse the damage,” Bertolet said.
For patients who get to the hospital promptly, Bertolet and his colleagues are able to stop the heart attack quickly. Many of those patients are showing no sign of damage to the heart muscle after treatment.
“People who present early are clearly having the best outcomes,” Bertolet said.
Although they still have follow-up visits with cardiologists and need to work to manage their individual risk factors like smoking, cholesterol, high blood pressure and diabetes, many are going home after one night in the hospital and are able to go back to work in a few days.
Generally, if there is no muscle damage, cardiologists are only waiting for the incision for the catheter to heal adequately, Bertolet said.
“The down time is almost nothing,” Bertolet said. “It’s a lot different than the old days.”
List of heart health events in February in today’s NEMS Daily Journal newspaper.