Yesterday’s LA Times health section had an important article about what to do in the event of a heart attack. In the last decade our understanding and treatment of heart attacks has improved dramatically. The best treatment for a heart attack is immediate angioplasty, a procedure that inserts a tiny balloon in the closed artery, opens it and leaves a metal stent to keep the vessel open. Studies have shown that this immediate intervention saves lives compared to the previous standard of care. Studies also show that the time between onset of symptoms and the angioplasty is critical to a good outcome.
This is when a wrong decision can cost a life. Many medical centers can not maintain the staff and facilities required to provide emergency angioplasties 24/7 to any heart attack patient in the emergency department. Those medical centers give the next best therapy — intravenous clot-dissolving medicine. So if you decide to have a relative drive you to a nearby ER when you think you’re having a heart attack you are risking two very dangerous hurdles. First, you’ll be triaged with all the other patients who come into the ER. Ideally, the triage nurse should give heart attack patients immediate priority, but human systems don’t always work ideally. Second, you may find yourself at a hospital without facilities for immediate angioplasty.
So always call 911 if you think you’re having a heart attack. Paramedics have EKGs that can help them determine the likelihood of a heart attack, and they automatically take potential heart attack patients to medical centers that treat heart attacks with immediate angioplasty (like UCLA and Cedars-Sinai). And when the paramedics bring you to the ER, you won’t wait with everyone else in the waiting room.
How do you know if you’re having a heart attack? This WebMD article has a good review of the typical symptoms, the most common one being a squeezing or pressure in the center of the chest that lasts longer than a few minutes.
Another problem that deserves emergency department attention is transient ischemic attacks (TIAs) or mini-strokes, about which I wrote two years ago.