by Kitty Wheeler
Coastal Journal contributor
BRUNSWICK — Protocol changes for heart attacks are under way at the emergency room at Mid Coast Hospital. Dr. Paul Burns and Dr. Ben Lowenstein, two of the five cardiologists at the hospital, note that the community hospital is responding to Maine Medical Center’s changing protocol. Mid Coast Hospital works closely with Maine Medical Center on cardiac concerns, and it wants to be on the same page with the tertiary center.
Dr. Burns received his medical degree from Boston University as well as his residency training. He then had a three-year cardiology fellowship at Rhode Island Hospital, one of Brown University’s medical school training hospitals. He hails from New York State, and arrived at Mid Coast Hospital in 1998.
Dr. Lowenstein, originally from New York City, attended University of Vermont’s medical school. He received his residency training at Maine Medical Center and then had a fellowship in cardiology there. First practicing in York, Maine, and Portsmouth, New Hampshire, he came to Mid Coast Hospital last year.
When a patient has chest pains at home, whether they be pain in the left arm, a feeling of pressure on the chest, sweating and major discomfort, he or she should come to the emergency room at the nearest hospital immediately. An ambulance is the best means of transportation, because the EMT can provide necessary assistance to the patient. A family member, however, can drive the patient to the hospital.
The emergency room doctors are well versed in caring for at-risk heart patients in conjunction with one of the five cardiologists who are always on call and available. Acute coronary syndrome (ACS) is a broad term that describes insufficient blood reaching the heart. The heart attack can either be a total occlusion, where some arteries are completely blocked, or due to an incomplete occlusion that only has partial blockage in one or more arteries. An electrocardiogram (EKG) is administered as soon as the patient enters the hospital; this test is a critical tool in making the diagnosis of heart attack and directing the type of care that is required. If there is any elevated activity noted, quick action is taken.
Whenever troubling readings appear on the EKG, typically, a clot busting medication or thrombolytic agent is administered in order to restore blood flow to the heart as soon as possible. The patient, as part of the protocol set up with Maine Medical Center, is then transferred to Portland, so that if need be, they can be brought to the catherization laboratory and have the artery opened.
The process of catherization involves injecting contrast dye into the arteries of the heart in order to determine whether a significant blockage exists. If so, angioplasty and stenting may be required. Stents are spring-like devices, attached to an inflatable balloon. The balloon is inflated, expanding the stent against the blood vessel wall. It works as a scaffolding to hold the artery open. The balloon is then removed, leaving the stent permanently in place.
If stents are not able to provide a clear passage for blood to travel to the heart, bypass surgery may be needed. There is a remote possibility that damage may occur when a stent is inserted; ideally, back-up cardiovascular surgery should be available. The majority of patients who have an occluded vessel are placed in this protocol and go directly to MMC. Completed occluded vessels still only account for a small fraction of the patients seen with Acute Coronary Syndrome at Mid Coast Hospital.
Most patients who arrive at the emergency room with chest discomfort, however, do not have a completely occluded coronary artery responsible for their symptoms. The EKG is a vital tool in sorting this out, and EKG results can be faxed to one of the on-call cardiologists although the emergency room doctors are well trained at reading the tracings. If thrombolytic therapy or acute catherization is not required, the patient may be transferred to a medical bed or placed in the Cardiac Care unit.
To stabilize a patient, the doctors use medical therapy to prevent or reduce heart damage. This consists of blood pressure and cholesterol control, the use of aspirin and other blood thinning medications when appropriate, and close monitoring of the heart rhythm and vital signs. In addition to medication, other tests including heart catherization at Mid Coast Hospital may be utilized to determine whether a patient would benefit from a stent placement or bypass surgery.
Once the patient has responded to treatment, the doctor, nurses and other clinicians will begin the discussion and education about the importance of healthy living and cardiac risk factor reduction. Cessation of smoking, controlling one’s weight, and the need to exercise regularly are stressed. If a patient has experienced a mild heart attack, these healthy reminders can well eliminate further problems. Mid Coast Hospital has an excellent outpatient Cardiac Rehab to help the recovery process.
For acute cases of heart attacks, this protocol of treating heart attacks and transferring the patients if necessary has saved lives. This strategy has been studied in trials, and from this gleaned information, these protocols have been put into place to affect positive results. Representatives from the Maine Health hospital meet on a regular basis to continue improvements.
The critical factor to make heart attack care a success is educating the public. If a patient has 10 to 15 minutes of chest discomfort, he should get to the hospital quickly. Time is of the essence in treating heart attacks, particularly if one’s arteries have been completely blocked. A clot-busting agent must be given as soon as possible, and the patient needs to be transferred to Maine Medical Center for further necessary treatment.
Burns and Lowenstein are pleased with Mid Coast Hospital’s heart attack protocol. Burns said, “We are able to save lives if a patient arrives quickly at our hospital. We can triage him immediately to Maine Medical Center for a rapid medical response there after we have given him [appropriate drug therapies].”
Don’t wait to feel better at home if an elephant is sitting on your chest. Mid Coast Hospital is ready to help you, but you must get there first.