Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: SUNDAY, February 27, 1994 TAG: 9402270027
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: LAURA WILLIAMSON STAFF WRITER
DATELINE: LENGTH: Long
Sara Anderson's chest felt heavy after a dinner of country-style steak and gravy.
Indigestion, she thought. She chewed an antacid tablet and stretched out in front of the television, ignoring a dull pain in the middle of her back.
When she stood up two hours later, the pain climbed to her neck. It shot into her jaw, then sliced into her ears. Her teeth ached.
"When it got to my neck, it was just like you cut my breath off," she said. "I told my husband, `I think something's wrong.' He said, `I think you're having a heart attack.' "
That was four years ago. Anderson, now 57, still suffers the consequences:
She can't climb stairs.
She carries nitroglycerin tablets with her at all times, ready to swallow one at the first sign of pain.
She worries about arteries that stubbornly remain blocked, despite a surgical procedure several years ago to clear them.
And she knows that if she had waited any longer to call for an ambulance that night, things could be much worse.
Sixty percent of the people who have heart attacks die before they get to a hospital, said Dr. Marta Sayers, Anderson's cardiologist at Community Hospital of the Roanoke Valley.
Why?
Because they wait too long to call for help.
A 1993 study by the National Registry of Myocardial Infarction shows people in Southwest Virginia who go to the hospital with chest pain wait, on average, more than 5 1/2 hours before seeking help. The national average is only 20 minutes less.
Yet 20 minutes is all it takes for damage to the heart muscle to begin, Sayers said.
"And the longer the pain goes on, the more damage you get."
Sayers and others at Community Hospital are trying to reduce the amount of heart damage to patients by encouraging them to come to the emergency room at the first sign of pain - even if they think it's only indigestion. They also are trying to reduce the amount of time it takes to treat patients who may have heart problems.
Beginning Tuesday, the hospital will put into place new protocols that will speed chest pain sufferers through the emergency department, Sayers said. The streamlined procedures call for testing, treating and releasing patients within an hour if the problem is not serious or heart-related.
If it is, patients will be admitted immediately into the hospital's coronary care unit.
Insurance companies typically cover the cost of emergency care, even if the problem turns out to be minor, those in the industry say. A trip to the emergency room at Community Hospital to treat chest pain would cost, at a minimum, $320 for preliminary treatment plus the physician's fee. Costs would be considerably higher if the patient was having a heart attack.
Community's "early response" program follows a national trend in hospitals to treat chest pain sufferers faster, said Wanda Ostrander, Community's nurse manager for cardiology.
Roanoke Memorial Hospital also plans to streamline its protocols for chest pain sufferers. Lewis-Gale Hospital in Salem already has, and the Salem VA Medical Center has reduced the amount of time it takes to administer anti-clotting drugs that help to restore the flow of blood to the heart.
The industry is responding to studies that show "clot busters," or thrombolytics, work best within the first four hours following a heart attack. After eight hours, Sayers said, they might not work at all.
Hence the theme for Community's new Chest Pain Center: "Time is muscle."
Health care professionals say it's not enough for the hospital to act quickly when chest pain sufferers enter the emergency room. The patients need to learn to identify symptoms quicker, and act on them.
Even when the signs are clear, Sayers said, people tend to ignore them.
Anderson, a communications supervisor at Community Hospital, had a family history of heart disease. Her father and a sister had heart attacks in their early 50s. Anderson smoked for 25 years, rarely exercised and ate poorly.
She typically didn't suffer from indigestion but didn't make the connection when pain struck her chest and back. And although she lived in Roanoke - within a few miles of three hospitals - she didn't think to go to one until the pain became acute.
"I don't think you really realize at the time what's happening to you," she said.
It's people like Anderson who Community Hospital wants to reach. Along with the new protocols, the hospital plans to start a community-wide educational and advertising program that will explain the signs and symptoms of heart attacks and encourage people to watch for them.
Hospital employees already have spoken to some church and civic groups, Ostrander said. They have prepared a one-hour slide presentation that they have shown to hospital staff and to rescue squads.
Sayers said people should watch for a feeling of "fullness" in the chest that feels like indigestion, particularly if they don't normally get indigestion. They also may feel pain in the arm, neck, head or shoulders. It can sometimes feel like a numbness or a deep ache.
That feeling comes from a lack of blood - and oxygen - going to the heart, she said. The oxygen loss causes the heart to "hurt," but that's not what the patient feels. The heart sends out pain signals through the nervous system, and these tell people they are having a heart attack.
People should be particularly alert to pain that follows stress or exertion, Sayers said. If it's not normal, they should call for an ambulance immediately.
Sayers warns that patients should not ask family members to drive them to the hospital or try to do it themselves, unless they live so far away from a rescue squad that calling one would take longer.
Rescue squads and ambulance personnel have the equipment and the expertise to correct irregular heart rhythms and save heart muscle, she said. That can save lives.
"There are people who've gotten out of their car and dropped dead in front of the hospital," Sayers said.
If patients do drive themselves to the hospital, she said, they should be sure to tell someone immediately that they are suffering from chest pain.
If they've waited too long, emergency room staff probably won't need the warning. They'll know, Sayers said, from the pale and sweaty look on the patient's face. "These are some of the worst-looking people you'll ever see."
by CNB