Saving time on heart attack victims


Shands at AGH physician/cardiologist Mike Dillon demonstrates Wednesday how Alachua County ambulances are now equipped to send electrocardiograms from the field to a cardiologist before heart attack patients arrive at the hospital.

Doug Finger/The Gainesville Sun
Published: Thursday, January 17, 2008 at 6:01 a.m.
Last Modified: Wednesday, January 16, 2008 at 11:58 p.m.

"Time is muscle." That's the cardiologist's mantra.

During an acute myocardial infarction - a heart attack - heart muscle begins to die off within 30 minutes after an artery is totally blocked, cutting off the vital flow of oxygen and nutrients to the heart.

The more time it takes for a patient to receive treatment, the more heart muscle is lost. That translates into a loss in quality of life, and sometimes into loss of life itself.

Shands AGH is one of a handful of hospitals across the country taking part in a Duke University heart study in which cardiologists are attempting to reach heart attack victims with artery-opening treatments more quickly.

Beginning this month, cardiologists with Shands AGH HeartCare Center have teamed with paramedics on four Alachua County ambulances and one from Bradford County to cut the "door-to-balloon" time that passes from the moment the emergency vehicle pulls up to AGH's emergency department to the first inflation of an angioplasty balloon in the patient's blocked artery.

The goal is to preserve more healthy heart tissue and ultimately save lives. Results at Shands AGH and seven other hospitals, including South Miami Heart Center in Florida, will be tracked for two years.

Dr. Michael Dillon of Cardiology Associates of Gainesville is one of the specialists participating in the study. Dillon said that Shands at AGH has tracked the time to treatment for heart patients for a number of years. With the new approach, they think they can do better.

"The goal (of the study) is 90 minutes (from door to balloon), and on average, we were at 105 minutes. That is not as close as we'd like to be," Dillon said Wednesday.

Right now, Dillon explained the delay comes when the EMT picks up a patient and brings him or her to the emergency room, which may take 20 to 30 minutes. Then they have to be seen by an ER doctor, and then that doctor calls in a cardiologist.

"Now if the ambulance paramedic identifies a heart case, they can do an EKG, send it to us, and roll right into the cath lab," Dillon said. "We've identified the parts that slow the system down, and I believe we can knock that time in half."

Here's how it works.

Inside the hospital-bound ambulance transporting a patient, a paramedic attaches six electrical leads to the left chest, two to the wrists and two to the ankles. They can read the action of the patient's heart in a 12-lead electrocardiogram, or EKG. That EKG is electronically transmitted from the ambulance unit to the waiting cardiologist through two linked PDAs, a type of handheld computer.

The manufacturer, Welch-Allyn, has provided five defibrillators with PDA transmitters and two PDA receivers for the Gainesville study.

If one of the seven participating cardiologists has questions, he can call the ambulance and talk to the paramedic directly. Meanwhile, the cardiac catheterization team is mobilized and the patient is brought directly to the HeartCare Center, bypassing a stop in the emergency department.

Time is of the essence, Dillon said.

A third of patients with blocked arteries die within 24 hours of their first symptoms, and most patients do not seek medical attention for more than two hours. Opening up the blocked artery quickly saves muscle and lives and decreases the chances of the patient developing other complications.

The American College of Cardiology and the American Heart Association recommends that patients have their arteries opened within 90 minutes of arriving at the hospital. The team in the pilot program of this study at NorthEast Medical Center in Concord, N.C., reduced that time to an average of 50 minutes.

Dillon hopes for similar results at Shands AGH.

The cardiologist emphasizes that a key to success lies in the hands of the patient.

"Activating the 911 call is the first step, and it is crucial. Getting them into the cath lab in 90 minutes doesn't mean much if they have waited four hours before heading to the hospital," Dillon said. "Coming in is exactly the right thing to do."

Diane Chun can be reached at 352-374-5041 or chund@gvillesun.com

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