• Q & A: A Possibly Lifesaving Guide to Heart Attacks

    July 14, 2015 MVP Blog comments

    Tremendous progress has been made in treating heart disease, but it is still the biggest killer of Americans, accounting for one in seven deaths. Here are answers to some common questions about the symptoms and treatment of heart attacks and narrowed aortic valves.

    How do you know if you are having a heart attack?

    Most people feel pain, pressure or squeezing in their chest. What doctors call the Hollywood heart attack — a person suddenly clutches his or her chest and falls to the ground — is unusual. In addition to or instead of chest pain, about a third of people have symptoms that include abdominal pain, heavy sweating, back pain, neck pain, nausea and vomiting. Many people mistakenly dismiss such symptoms, said Dr. Mary Norine Walsh, the vice president of the American College of Cardiology.

    How can you decide if symptoms other than chest pain are actually from a heart attack?

    If your symptoms come on suddenly, or if they worsen over a period of hours or days, you should assume they are caused by a heart attack and go to an emergency room.

    Do women have different symptoms than men?

    Probably not, but women are more likely to delay seeking help and doctors are more likely to dismiss their symptoms. That is especially true if the woman is younger, Dr. Walsh said. Women tend to on average have heart attacks about 10 years later than men, so doctors may dismiss worrisome symptoms in middle-aged women.

    What should you do if you are having heart attack symptoms?

    Call 911 for an ambulance to take you to the emergency room immediately. Do not try to drive yourself or have a friend or family member drive you. Paramedics can take an electrocardiogram on the way to the hospital that shows if you are having a heart attack and transmit it to the hospital. So as soon as you arrive, the medical staff is prepared and waiting. The paramedics can also administer oxygen and medications to ease your pain before you reach the hospital. And an ambulance is less likely to get stuck in traffic.

    How can you find out if your local hospital is able to treat heart attacks quickly?

    Time is of the essence when you are having a heart attack, and while most hospitals today are much quicker than they were a decade ago, some are faster than others. Often, paramedics know which hospital is best and will take you there. You don’t want to waste time fighting with paramedics when you are having a heart attack. “I have had patients drive three hours to come to my hospital when they were in the middle of a heart attack because they thought they needed to come to a big medical center,” Dr. Walsh sayid. “If paramedics say, ‘We’ll get you to this hospital,’ go,” she added.

    There is no national registry you can consult to find out how long it takes the hospitals in your area to open a blocked coronary artery with a balloon after your arrival at the emergency room. These statistics — known as door to balloon time — are generally measured by the hospital’s median time, which is the point at which half are opened faster, and half slower. If you want to know your hospital’s median door to balloon time, you will have to call each one and ask for it. If they do not provide it, you can ask if they take certain steps that speed treatment. Do paramedics transmit a patient’s electrocardiogram from the ambulance en route to the emergency room? Does the emergency room doctor read the EKG and send out a single call to summon the cardiology team? Are the team members on call required to be within 30 minutes of the hospital?

    What are the symptoms of a severely narrowed aortic valve?

    Cardiologists say there are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting. Such symptoms are often mistakenly attributed the normal process of slowing down that comes with old age. Six months ago, an 85-year-old woman might have been driving a car and doing her own grocery shopping, said Dr. Michael Mack of Baylor Health Care System. Now she is doing none of those things. Her children notice but say: “Well, she’s 85. What do you expect?” If a doctor is consulted, he or she may chalk it up to anemia or a thyroid problem. Many older adults with severe aortic valve disease are never diagnosed, said Dr. Howard Herrmann of the University of Pennsylvania.

    How can a doctor know if symptoms are caused by a narrowed aortic valve?

    The doctor can hear a heart murmur in the patient’s chest. An echocardiogram can reveal the narrowed artery and the extent of the damage.

    Should everyone with a severely narrowed artery have it replaced?

    Now that there is a procedure, transcatheter aortic valve replacement, or TAVR, that allows doctors to replace valves without doing open-heart surgery, high risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement. But, Dr. Herrmann cautioned, some patients are still too frail to benefit or have another disease like cancer or dementia that limits life expectancy.