Health Matters Blog

BMH Says in Treating a Heart Attack – Time Matters

by Christopher Schmidt, MD, and  John Starkey, RN.

When President Dwight Eisenhower had a heart attack in 1955, doctors had limited tools for dealing with it. Eisenhower survived with treatment that consisted mainly of morphine to kill the pain and bed rest that continued for nearly a month before he was able to sit in a chair for a few hours each day.

Thirty years ago, if you were having a heart attack you were put on pain medication and sent to the ICU to treat the pain and monitor the heart.

In the mid-1980s, clot-dissolving medicines officially called thrombolytics (but commonly known as ‘clot busters’), starting with Streptokinase, became the best treatment. These medicines were developed after it was discovered that most heart attacks were due to a clot forming acutely in a narrowed artery that was feeding the heart muscle. However, besides causing some bleeding side effects, Streptokinase produced allergic reactions.

Within a short period, safer and more specific thrombolytics were introduced. Once administered, the patient was monitored in the ICU, and then transferred to Dartmouth-Hitchcock Medical Center for a cardiac catheterization. This procedure would assess the amount of damage to the heart muscle.

Then it was discovered that immediate catheterization to open up a narrow artery was the best treatment after a heart attack. So, for the past several years, Brattleboro Memorial Hospital has been following new Evidence Based Practice by providing rapid thrombolytic therapy, then expediting a patient’s transfer from the BMH ED to Dartmouth for an immediate cardiac catheterization which opens up the narrowed artery in the heart. Dartmouth sends BMH direct feedback on each case to ensure a quality review on our end, knowing as we do that “Time is Muscle”.

Today, doctors know more about heart disease and have sophisticated technology and established procedures. A patient surviving a heart attack similar to that suffered by Eisenhower can expect to be up and around within a few days. Even so, a heart attack is still a serious event and the number one cause of death for both men and women in all parts of the world.

The heart is a muscle. A heart attack occurs when blood and oxygen flow to part of the heart becomes interrupted because of a blockage in one of the coronary arteries. Lack of oxygen is responsible for the chest pain or pressure, shortness of breath, nausea, palpitations, sweating, and other symptoms.

When Americans recognize these symptoms, most know they should dial 911 right away. “Time is muscle,” doctors say, and the goal of treatment is to get blood flowing quickly, preferably within 90 minutes. Even if you think it might not really be a heart attack, if there is any question at all, the emergency department staff implores you not to waste time being in denial…just get to the hospital as quickly and safely as you can, and if it turns out to be a heart attack you will give them a chance to treat you. Should it end up being something else, they’ll treat you as needed. A number of years ago, BMH ran an ad with Dick Lane (former head of the Austine School), and the headline was “Don’t die of embarrassment”. The gist was that, even if it ends up being indigestion, it’s better to be safe than sorry.

At Brattleboro Memorial Hospital, emergency room physicians and nurses agree that “time is muscle.” BMH Emergency Department physician Christopher Schmidt, MD, says, “The quicker we can stop the spread of damage throughout the heart muscle, the better the outcome for our patient.” ED Nurse manager, John Starkey, RN, adds, “When blood flow can be restored promptly, the patient is less likely to suffer permanent damage to the heart.”

BMH closely monitors several point key times for each patient arriving at the Emergency Department with heart attack symptoms, looking at each step to find areas for improvement.

So, if you’re experiencing symptoms of a heart attack, don’t consider driving to the hospital yourself; it’s dangerous. And don’t have someone else take you unless there’s no other option; you’ll get treated more quickly and efficiently if you dial 911. Remember what the doctors say: “time is muscle.”

How do I know if I’m having a heart attack?

The pain of a heart attack can feel like bad heartburn. You may also be having a heart attack if you:

  • Feel a pressure or crushing pain in your chest, sometimes with sweating, dizziness, nausea or vomiting
  • Feel pain that extends from your chest into the jaw, left arm or left shoulder
  • Feel tightness in your chest
  • Have shortness of breath for more than a couple of seconds
  • Feel weak, lightheaded or faint
  • Have sudden overwhelming fatigue
  • Don’t ignore the pain or discomfort. If you think you are having heart problems or a heart attack, get help immediately. The sooner you get treatment, the greater the chance that the doctors can prevent further damage to the heart muscle.

Better Yet, Prevent a Possible Heart Attack. Read On…

The best way of treating a heart attack, of course, is prevention. On the day of his attack, Eisenhower ate what many today might refer to as a heart attack on a plate: sausage, bacon, mush, and hot cakes for breakfast; a hamburger for lunch; and roast lamb for dinner. He had previously smoked four packs of cigarettes a day.

At that time there was little knowledge about the role of diet, exercise, and smoking. A heart attack was commonly accepted as a sign of an aging, dying heart.

By contrast, most Americans today know what constitutes a heart-healthy lifestyle and have medications available that can reduce their risk by lowering cholesterol and blood pressure.

If you’re taking aspirin to help prevent a heart attack, be aware that taking the painkiller ibuprofen (Advil, Motrin, others) at the same time may increase the risk of gastrointestinal problems and may interfere with the heart benefits of aspirin. If you need to take a pain-relieving medication for certain conditions, such as arthritis, discuss with your doctor which is best for you.

Lifestyle changes

In addition to medications, the same lifestyle changes that can help you recover from a heart attack can also help prevent future heart attacks. These include:

  • Not smoking
  • Controlling certain conditions, such as high blood pressure, high cholesterol and diabetes
  • Staying physically active
  • Maintaining a healthy weight
  • Eating healthy foods – cut the fat and the salt
  • Reducing and managing stress

Heart attacks nevertheless occur at a rate of 1.2 million a year, and they occur both to those diagnosed with cardiovascular disease and those who have no idea they are at risk. Symptoms may come on gradually, and studies show that patients wait an average of three hours before calling for medical help–a serious mistake. As many as half of heart attack fatalities occur in the first hour.

So remember the advice at the beginning of this article…get help quickly if there is any possibility that you’re having a heart attack. As the emergency staff at Brattleboro Memorial Hospital says, “Time is muscle…if you’re having a heart attack, time matters!”

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This article was written by Brattleboro Memorial Hospital staff, in particular BMH ED Medical Director Christopher Schmidt, MD, and BMH ED Nurse Manager John Starkey, RN.