Sep 24, 2018

The Golden Hour – Part II – Heart Attack (STEMI) Care

As I mentioned in part I of this three part series, Dr. Cowley recognized that the sooner trauma patients reached life-saving care – particularly if they arrived within 60 minutes of being injured – the better their chance of survival. This holds true with many other illnesses and maladies. This article will briefly discuss signs and symptoms of a heart attack and the need to seek stabilizing treatment.

A heart attack occurs when a narrowing in the arteries and/or a sudden blockage from a blood clot cuts off vital nutrients and oxygen supply to the heart muscle. The “Golden Hour” is a critical time because the heart muscle starts to die within 80-90 minutes after it stops getting blood, and within 6 hours, almost all affected parts of the heart could be irreversibly damaged. So, the faster normal blood flow is re-established, lesser damage to the heart would occur.

Many times, a person may not realize that he or she is having a heart attack, and quite a few who harbor doubts to that affect, spend a considerable length of time in self-denial. By and large, the warning signs are:

  • Chest discomfort
  • Radiating pain or discomfort in the arm, neck or jaw
  • Shortness of breath
  • Nausea or lightheadedness

If you have one or more of these symptoms, you need to call emergency services of a nearby hospital, or get somebody to drive you to the hospital. DO NOT venture to drive yourself to the hospital. Always seek help.

What can we do in the “Golden Hour” for a heart attack patient? To reduce the damage to the heart, it is important to get to the hospital as soon as possible. Other than the consequences of a damaged heart muscle, the most common killer in the early period following a heart attack is an abnormal heart rhythm called ventricular tachycardia where the heart muscle is pumping at a very fast rate, however, no effective pumping of blood takes place. The other condition is called ventricular fibrillation where the heart muscle is literally in the chest quivering like a bowl of jelly with no pumping action at all.

This is why we must ensure that once that person reaches a medical facility, they are immediately put on an ECG monitor to assess the heart rhythm, so they can be provided prompt treatment in case of any abnormalities.

Upon reaching the hospital, the primary goal of treatment would be to dissolve the obstructing clot, and restore blood supply to the affected part of the heart. This is done most commonly, by clot-busting drugs. But of late, the preferred modality is mechanical dissolution of the clot by a procedure called primary angioplasty.

Angioplasty must be performed in a facility where there is a cardiac catheterization laboratory and invasive cardiologists are employed. Our local hospital has the expertise and staff trained in recognizing and treating a heart attack with clot busting drugs. Once again, restoring blood flow to the heart muscle within the golden hour and providing the necessary stabilizing treatment to get you to the cardiologist and the cardiac catheterization lab is paramount.