Time heals all wounds? Not in a cardiac crisis, when waiting to feel better can mean the difference between life and death
Heart of the matter
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Hey there, time traveller!
This article was published 22/02/2016 (2533 days ago), so information in it may no longer be current.
Doug Little didn’t smoke. He rarely had more than a couple of drinks a week. And he was an avid runner.
“I considered myself fairly healthy,” says Little, 48, a professional photographer. “I was 25 to 30 pounds overweight, but I’d still run a number of half-marathons.” So when the father of two daughters woke up feeling nauseous after returning from vacation almost two years ago, he had no reason to suspect he was suffering a heart attack.
“We had lots of stuff to do because we had been away — groceries, laundry, taking the kids to their activities — so I brushed it off and got on with my day.”
As the morning progressed, Little felt increasingly worse. He was throwing up, had chills and cold sweats. He felt utterly exhausted. By late morning he could barely stay awake, and his wife drove him to Victoria General Hospital.
“I fell asleep twice in the front seat during that span,” he says about the less than two-minute drive from his home.
Even then, Little assumed he had “a really bad bug” or heatstroke from a sunburn on the last day of his vacation.
Instead, an electrocardiogram (ECG) revealed he was having a heart attack.
“I didn’t have the clutching of the chest and the shortness of breath, but it was probably the worst I’ve ever felt.”
Little’s experience illustrates the difficulty some people have recognizing symptoms of a heart attack, which can — and often does — delay getting help and lead to potentially deadly consequences.
Although great strides have been made raising awareness — including February’s Heart Month campaign — about “500 people die due to heart attack in Manitoba each year,” says Christine Houde of the Heart and Stroke Foundation of Manitoba.
It may seem like common sense to “call 911 or your local emergency number immediately,” she says. Yet many don’t, making public awareness an ongoing issue.
It’s a battle the Winnipeg Regional Health Authority has also been waging for almost a decade to boost the effectiveness of its Code STEMI (ST-elevation myocardial infarction) program to streamline care and improve outcomes for heart attacks.
Centralizing cardiac care at St. Boniface General Hospital, the program also enables first responders to test patients for a heart attack using an ECG on site and send results wirelessly to a cardiologist on call.
The overarching goal is to reduce the time it takes to receive care and, in turn, increase chances of survival.
And the program itself is largely successful, says Dr. Davinder Jassal, a cardiologist and medical director of the Winnipeg Health Region’s Coronary Care Unit at St. Boniface.
“Back in 2006, prior to starting the Code STEMI program, the risk of a patient dying from a heart attack was one in 10 in the WRHA,” he says. “By 2015, the rate has fallen to one in 30,” largely because patients receive care very quickly —within 30 to 45 minutes on average.
Before the program began, paramedics took patients to one of Winnipeg’s seven hospitals to undergo an ECG. If the results indicated a heart attack, patients received clot-busting medication and were taken to St. Boniface’s cardiac catheterization lab if needed. There, they would undergo an angioplasty; a procedure involving inserting a tiny tube with an inflatable a balloon on the end through an artery in the wrist, “snaking” it up into the coronary artery and inflating the balloon to open up the blockage.
“The whole process prior to Code STEMI could take two to three hours,” he says.
And that was problematic, he adds, because in the “heart plumbing” business, time is muscle.
“The problem arising from the ‘time-is-muscle’ phenomena is twofold,” Jassal says. “One, if you decide not to call 911 right away and have decreased blood flow to the heart, you’re also at increased risk of having what’s called cardiac arrest.”
While a heart attack generally results when an artery feeding the heart muscle is partially or completely blocked, cardiac arrest can occur when the heart’s electrical system short-circuits under the strain of reduced blood flow.
The heart stops beating, and the chance of being revived is low: about one in 10.
Fortunately, most heart attack patients don’t suffer cardiac arrest. But the time-is-muscle principle is still important to ensuring a good outcome, he says.
“That’s because the second issue is heart failure.”
If heart muscle is starved of oxygen long enough, the tissue dies and unlike other muscle tissue, it cannot regenerate. Consequently the heart’s capacity to pump blood may be permanently impaired.
“The normal pumping function of the heart is 60 per cent, so every time it squeezes, 60 per cent of the blood should flow to the rest of the body,” Jassal says.
Patients who suffer severe heart attacks can have their heart function reduced to 30 per cent or less. “Then they end up with heart failure,” he says.
The condition causes several negative side-effects: perpetual shortness of breath, swelling in the legs and difficulty performing the simplest of tasks like climbing up a flight of stairs.
And the long-term prognosis is a shortened lifespan, Jassal says.
That’s why Little considers himself so fortunate.
Despite the delay prior to undergoing angioplasty at St. Boniface to open up two coronary arteries, including one that was completely blocked, his heart sustained no meaningful damage.
He’s even training for the Manitoba Marathon in June. Realizing the outcome could have been much worse, Little is sharing his story so others recognize the symptoms — which do not always include chest pain — and seek help quickly.
“If you have a niggling thought it might be something more serious, get it looked at,” he says.
“Don’t neglect it — I’m a terrible example, because that’s what I did.”
Updated on Monday, February 22, 2016 11:29 AM CST: Photo added.