HEART ATTACK
"DELIVERING THE GOODS"
The EHAC Message
The solution to solving heart attack deaths in the United States no longer
resides completely in medicine. The answer lies more in the delivery system.
It is here where together we, the public, can make a difference. In fact
it is only by employing the public can we ever think about taking the #1
killer of the adult population in the United States out of first place.
No one can remember it being out of first place. It takes the lives of more
Americans each year than the total number of soldiers killed in past wars
and it continues to do it yearly. What most Americans don't realize is that
this need not take place. The answer lies not within the hospital with better
drugs or more surgery, but in the public alert and response system."DELIVERING THE GOODS"
The EHAC Message
Now for the first time the public is being told (EHAC) message that it can play a major part in solving the heart attack problem. Studies have shown that damage control with heart attack is possible if patients can be treated with clot dissolvers within the first hour. The cause of a heart attack and the heart muscle damage that takes place results from a total blockage in one of the three blood (coronary) vessels supplying oxygen and nutrients to the heart muscle. The total blockage usually is the result of many years of cholesterol plaque build up, that then ruptures leading to clot formation and spasm of the vessel, totally blocking it and interfering with the blood supply.
Eighty-five percent of the damage takes place within the first two hours. Giving clot dissolvers early prevents damage from taking place. But the key here is that it has to be done within the first hour or so. Unfortunately in most instances this does not take place and most patients are left with heart damage and complications to deal with.
What does this information have to do with the public? Clot dissolvers (thrombolytic drugs) have brought forth the new service of Early Heart Attack Care, but so far this has not "delivered the goods". Only 20% of heart attack patients receive the drugs and only 10% of these patients receive it within the first hour resulting in only 2% of patients being treated well. The reason for this failure is that care is attempted when patients are crashing. Reducing time at this point under one hour becomes almost impossible.
It then begs the question "why do we start the meter of heart attack care when total blockage of the coronary vessel has taken place". This questioning opens our eyes and turns on our "brights" to clues and signals alerting us that heart attacks have beginnings. It is in these beginnings that we can search for the "Rosetta Stone of the heart attack hieroglyphic problem".
Do such early symptoms exist? The answer is YES, but they escape us because they don't literally stop us "dead in our tracks". Such symptoms start out as a mild chest pressure that comes and goes further deceiving our senses. Awareness here is not the total answer however. We have to change our behavior as well. Herein lies the problem. American adults are programmed from childhood up that it is important to be tough and not to cry "wolf" with every little symptom. What results here is a "cerebral bypass" in most victimes as activities of the day become more important than the mild symtpoms at hand. The mind has a tendency to play games. The key to overcoming this is in the bystanders who many times enable the heart attack process by going along with the patients interpretation of their symptoms, ie. indigestion, hiatal hernia, etc. It is here where the delivery system needs to be enhanced. It is here where together we can make a difference. What the heart attack solution needs is a good buddy system or a good samaritan system that stops this delaying process and allows us the time necessary to have the patient check out these early symptoms. It is here that vigilant intervention can amount to prevention of the heart attack. Thus death and heart muscle damage can be averted.
In preparation for this, many hospitals across the United States (approximately 1000) have developed Chest Pain Centers in their Emergency Departments to be user friendly when patients come in with mild symptoms. Once this linkage can be accomplished the patient after being checked out becomes more motivated to practice other risk factor reductions such as smoking cessation, reducing cholesterol, and keeping blood pressure in line. Disease prevention is an excellent motivator of health promotion.
Finally, "delivering the goods" is recognizing the goods. The heart is the center of our universe. Witness all of our expressions and metaphors of the heart that have to do with goodness.....heart felt thanks....heartening reaction, etc. Its purpose is to function as the most efficient pump known to mankind. It has tremendous reserved capacity. It pumps over 5 quarts a minute and can rise to the occasion to 40 quarts per minute if running straight up a mountain such as marathon runners do at the Red Rock in Central Australia. But mostly in everyday activities it functions on a curve delivering quietly what is sent back to it from the venous collecting system of the body.
If a heart was needed to be bought off a grocer's shelf it would cost in the neighborhood of $150,000 (heart transplant) but would not be available for several years because of the poor supply, and would be a used one at that. Ultimately the best form of prevention is to appreciate and act on what we have.
If so, the next time your expensive engine has a noise in it, act early to find out why and hope that you have someone in your midst who can encourage you to do so in acting the same. Together we can make a difference. Together we can reduce heart attack deaths from being the No. 1 health problem in the United States, and do it within our lifetime. To do so, we need the knowledge about the benefits of the best form of Early Heart Attack Care.....prodromal symptom recognition or EHAC.
Raymond D. Bahr, MD, FACP, FACC
Heart Centers of America
The Paul Dudley White Coronary Care System
St. Agnes Hospital
Baltimore, Maryland
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