 | Joseph P. Galichia, MD is the founder and Medical Director of the Galichia Medical Group, PA. He is an internationally recognized pioneer in the field of interventional cardiology. In the 70's, Dr. Galichia studied in Zurich, Switzerland with the inventors of the balloon angioplasty technique for treating heart disease. As a result of his experience, he was able to bring this historic technique back to the United States where he was one of the first physicians to perform coronary angioplasty here. A noted medical spokesman, he appears on a weekly Newstalk segment on KWCH Channel 12 and has a weekly syndicated radio talk show on KNSS 1330 AM every Saturday live from 11:00 am to noon. Dr. Galichia may be contacted by sending an e-mail to service@galichia.com |
Health & Medicine
2009-08-01 12:16:00
Time is muscle
Answer: We have a saying in cardiology that “time is muscle”. By that, we mean that the sooner we are able to intervene and open up a blocked artery causing a heart attack, the less damage will be done to the heart. In fact, it has been shown in some studies that if we can re-establish blood flow within the first 30 minutes that there is virtually no heart damage in most patients. This certainly has been my own personal experience. There are many logistical reasons however why patients will delay getting to the emergency room. Most of the time, they are simply trying to figure out what is going on themselves and delay calling 911.
There are many people in this country who live far away from tertiary care centers where emergency treatment for heart attack is not available. We know from today’s studies that if we have a chance to open the artery within 4-6 hours that we can minimize heart damage and that we also have less likelihood of heart failure in the future. It has also been found that every moment that ticks off the clock following the onset of the heart attack there is more heart damage and more likelihood that the patient will simply die of a heart arrhythmia or pump failure. Getting to the hospital immediately is critical and opening up the artery is critical.
Addressing your question regarding what can be done, there are several approaches. There are certainly medical treatments such as clot-busting drugs which we can give intravenously and they tend to dissolve clots in arteries and restore blood flow at least momentarily. This is a strategy we often employ in people from rural areas knowing that it may take several hours for them to get to a heart catheterization laboratory where a balloon or a stent procedure could be done. More and more however, we are inclined to take the patient immediately to the heart catheterization laboratory, give a blood thinner, and immediately open up the artery and address the area of narrowing with a balloon with a stent procedure. In this week’s New England Journal of Medicine there’s a great study comparing bare metal stents to stents that have medication on them, otherwise known as medicated stents. It has been shown that in heart attack patients fewer of them have to return for recurrence if we use a medicated stent, however, it has also been shown that the immediate survival is excellent in this group of patients and that the long-term survival is quite good no matter which type of stent we use.
Currently, we are using medicated stents in virtually every patient with a heart attack.
The key in this entire situation is to get emergency medical care as soon as possible, to get to the hospital as soon as possible and to get the blood flow restored in the blocked artery as soon as possible to limit the heart attack size. In our community, this almost always means a direct admission to the heart catheterization laboratory with an immediate intervention to open up the blocked artery. We first started doing balloon dilatation of these vessels in the early 1980s and were able to document a tremendous decrease in the risk of dying from a heart attack while in the hospital. Advances have been enormous since then and we are overall quite pleased with our current results. My own personal goal is to have the patient in the catheterization laboratory within thirty minutes to one hour to one hour following the onset of the heart attack and to have a happy, comfortable and minimally injured patient shortly thereafter.
