Heart-Attack-Blues
Call 911 if you want to live
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Wrong Time, Wrong Place




Wrong time, Wrong place,  Right system




Image source: Clotbuster Archives.



 

A 63-year-old woman named Denise worked  as the manager of a concession stand at Dodger stadium. Because there was home game that night, she was due at the ball park at 6:45 p.m. 

Denise took medication for her high blood pressure, but she didnt take the pill her doctor prescribed for high cholesterol because it made her legs weak. She said she had quit tobacco three years ago after 25 years of smoking a pack a day, but she sneaked in three to five cigarettes a day, thinking no one would know.

Everybody did.



5:00 p.m.

Denise was just getting ready to go to work when she began to notice moderate back pain that radiated to her left shoulder. It was more annoying than painful. Her breathing was normal, but she felt some irregularity of her heartbeat and slight nausea. She had never felt this way ever before. She decided the sensation was just one of those things that happen when youre 63 and ignored it.


6:10 p.m.

Denise left her house at the usual time, headed for the ball park. On the road, she began to feel much worse. The back pain was more severe and now she felt like she needed to vomit.


6:25 p.m.

She drove for 15 more minutes on her usual route. When she saw the local community hospital, she decided it might be good idea to get the back pain checked out. She went to the emergency room entrance, walked up to the reception window, and described her symptoms to the triage person. Because Denise didnt seem to be in immediate danger or severe pain, she was given a packet of forms to fill out and told to take a seat - they were quite busy and she would be seen as soon as they could. twerthwere quite busy and she would be seen as soon as they could.

While searching for a chair in the crowded waiting room, Denise suddenly collapsed and fell to the floor. That got her immediate attentionshe was promptly brought to the treatment area of the ER.




 




 6:41 p.m
.

An EKG was quickly performed. This showed tombstones in leads II, III, and AVF. In other words, Denise was having an acute ST elevation myocardial infarction (STEMI).



6:45 p.m.

The ER physician recognized the EKG findings and knew something needed to be done right away. The community hospital was too small to have a cardiac catheterization laboratory, which meant Denise couldnt get a coronary angiogram to see where the blockage was in her heart artery, and she couldnt get angioplasty to open the blockage. The ER doctor had to decide whether to give Denise a clot-busting medication or to arrange her transfer to a STEMI receiving center (SRC). Luckily, a program had recently been developed in the LA area to handle this sort of cardiac emergency. The program allowed the ER at the community hospital to call 911 and have the local EMS providers respond immediately to transfer the patient to the SRC for emergency intervention.

The community hospital doctor called his counterpart in the emergency room at the SRC and presented the case. They agreed that the patient was a good candidate for transfer and possible intervention.

A code STEMI was called at the SRC to activate the cath lab and bring in the interventional cardiologist on call.



7:21 p.m.

Denise arrived at the SRC. The interventional cardiologist met her at the ambulance bay. He briefly explained what needed to be done and she agreed to proceed. The paramedics then transported her straight to the cath lab.


7:41 p.m.

Denise had emergency angioplasty to open her totally blocked right coronary artery.  A stent was then placed to keep the artery open. Blood flow was quickly restored, with complete relief of her pain and near normalization of her ECG.







The Results


First medical contact to open artery: 76 minutes.

First EKG to open artery: 60 minutes.


An echocardiogram performed the following day showed that Denise
s heart strength was completely preserved. She had sustained minimal damage to her heart muscle. She was discharged home on day two and returned to work in time for the next home stand. She finally quit smoking for good.




Image source: Clotbuster Archives.