Getting Aggressive With Impending Heart Attacks
June 20, 2001 -- Having chest pain? Don't ignore this important warning sign. A new approach to therapy employing new blood-thinning drugs combined with sophisticated artery-unblocking techniques can prevent a heart attack and greatly improve your chances of avoiding disability or death.
When blocked blood vessels starve the heart, a person experiences a symptom called angina. This usually feels like a dull pain, squeezing or heaviness in the chest -- often described as a clenched fist -- with discomfort usually spreading to the neck, left shoulder, and left arm (and, rarely, to the right side or back). Sometimes, people also experience intense sweating, shortness of breath, or nausea. When it happens during rest or mild exertion, doctors call it unstable angina. It warns that a heart attack, where damage occurs to the heart muscle, may be on the way.
For years, doctors were unsure of how to treat unstable angina. But now that has changed.
Using the same technology currently used to treat heart attacks, doctors are opening and repairing blocked heart arteries with tools that can reach the heart through tubes (catheters) that enter the body through an artery in the arm or leg. The procedure -- catheterization -- is spectacularly successful, preventing heart attack damage from occurring, but it has to be performed quickly. And, that isn't possible in most hospitals where the equipment and experts aren't always available when needed.
At last, doctors have a way to buy time until aggressive treatment can be provided. New drugs have become available that prevent dangerous blood clots from causing further heart damage. And now a major study of 2,220 U.S. patients - highlighted in the prestigious New England Journal of Medicine -- shows that these drugs let doctors save lives when combined with early, aggressive catheterization.
"Now we think 85% of these [unstable angina] patients should be undergoing catheterization," study author Christopher P. Cannon, MD, tells WebMD. "If a patient comes in with worsening chest pain or a small heart attack, he should ask his doctor when he is going to be sent to the catheterization lab. If the answer is tomorrow, good. If the doctor says to wait and see, it is probably fair to ask, 'Well, didn't the vice president (Dick Cheney) go right on to catheterization [when he had chest pain]?'"
Cannon, a cardiologist at Boston's Brigham and Women's Hospital, led a multicenter trial that compared the use of the new clot-prevention drug aggrastat and routine catheterization within 4-48 hours to a more conservative approach that called for the use of the clot-preventing drug alone unless there was urgent need for catheterization. After six months, the patients at highest risk of having a severe heart attack were significantly less likely to die or have that heart attack if they got the more aggressive treatment.