Not All Hospitals Equal for Treating Heart Attacks
Oct. 23, 2000 -- Anyone at risk for a heart attack -- and that includes just about all of us -- should talk with their doctor now about where to go if they ever feel those symptoms, heart experts say.
A heart attack happens when an artery in the heart develops a blockage. Fresh blood can't reach the heart muscle, and it starts to die. It's a pressing or squeezing sensation, like having a weight on your chest. Pain from a heart attack also can reveal itself in the neck, lower jaw, shoulder or arm, most often on the left side.
"We say time is muscle," Evangelos Giannitsis, MD, tells WebMD. The quicker someone gets treatment for a heart attack, the better the chance the heart muscle will be saved. Giannitsis is a medical doctor on the senior staff at the University of Lübeck in Germany, and an author of a recent study on the best way to treat patients with heart attacks, published in Circulation: Journal of the American Heart Association.
In the study, the researchers looked at ways to find out when someone arrives at the emergency room, whether they're really having a heart attack, and how bad it is. They found that patients with higher levels of a substance called cardiac troponin have a greater risk of dying from the heart attack and also benefit most from aggressive treatment, such as angioplasty.
Giannitsis and the Lübeck research team use angioplasty to help people who're having a heart attack. In this method, a tiny balloon-like device is used to open up the artery and restore blood flow to the heart muscle. "In the cath lab, we can reopen the vessel within five minutes," he says.
But heart catheterization is a sophisticated methodology, and many hospitals aren't set up to do angioplasty. Instead, they may use thrombolytics or "clot-buster" medications to dissolve the clot that's blocking blood flow to the heart. These medications may take an hour to work, Giannitsis says.
Both thrombolytics and angioplasty are much more effective than doing nothing. Both have saved many lives. If you think someone might be having a heart attack, get them to the hospital emergency room as quickly as possible.
But suppose there are two hospitals within a reasonable distance? "We are convinced that angioplasty is much more effective than thrombolytics," Giannitsis says. "If I could reach a hospital that offers angioplasty by driving an extra 10 or 15 minutes, I'd go there. However, if would take an extra hour, then it makes more sense to go to a closer hospital, even if it doesn't do angioplasty."
Stephen Siegel, MD, agrees. The hard questions, he says, arise in situations where it takes an extra 30 or 40 minutes to reach a hospital with a cath lab. "We don't know the exact point where the benefit cancels out." Siegel is a clinical assistant professor of medicine in the division of cardiology at the New York University School of Medicine in New York City.