• Treatments for heart attack still evolving

  • February is heart disease awareness month, and even though I believe we are making progress, it is clear there is still a lot of work to do when it comes to Americans’ heart health.

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  • February is heart disease awareness month, and even though I believe we are making progress, it is clear there is still a lot of work to do when it comes to Americans’ heart health.
    The good news, according to the American Heart Association, is that from 1999 to 2009, the cardiovascular disease death rate declined by 33 percent. But heart disease remains the number one killer of men and women in the U.S. – causing an average of one death every 40 seconds.
    In last week’s column, we looked at cardiac catheterization and how cardiologists use it to find and open blockages in the arteries.
    Catheterization has historically been done through the femoral artery in the groin. However, since the first article on catheterization was published in 1988, there has been a steady increase in the number of cardiologists who have been performing the procedure through the radial artery in the wrist. As previously mentioned the transradial approach provides patients a more comfortable procedure with less bleeding risk and fewer complications than femoral artery procedures.
    St. Mary’s was the first hospital in the region to embrace radial catheterization over five years ago. The reasons for starting a transradial program revolved around studies that showed that bleeding following angioplasty procedures was a predictor of worse outcomes. In an effort to decrease the bleeding risk, we saw that transradial catheterization would make a difference in bleeding immediately. This bleeding risk is also an important predictor in the outcome in treating acute heart attack. An acute heart attack is often caused by blockage, or clot that forms in the artery. It is necessary to use blood thinners to help dissolve the clot in this treatment.
    By performing catheterization through the radial, we decrease the risk of bleeding significantly. St. Mary’s performs about half of the cardiac catheterization procedures through the radial artery as compared with only about 15 percent of patients at hospitals nationally. St. Mary’s also does nearly half of the procedures for acute heart attack radially, compared with only about 6 percent nationally.
    When a patient comes to a hospital having a heart attack, time is an important factor, because time is muscle. A study released a couple of months ago in the Journal of the American College of Cardiology, found heart attack patients who had transradial catheterization had fewer episodes of bleeding and a lower risk of in-hospital mortality than patients where femoral access was used.
    Even though the study showed a slightly longer “door-to-balloon” time (the time it takes to get the artery open from when the patient comes to the ER) researchers said the reduced risk of major bleeding offset the longer time. They also thought the reduced stress on the body may be a factor in the improved outcome.
    It’s very important to know heart attack symptoms so you can take action to help get treatment as soon as possible. Remember, the major warning signs of a heart attack:
    Page 2 of 2 - -- Chest pain or discomfort
    -- Abnormal discomfort in the arms, back, neck, jaw or upper abdomen, especially with exertion.
    -- Shortness of breath with less exertion than usual
    -- Nausea, lightheadedness, or cold sweats
    -- Unexplained fatigue.
    Not all people have the same symptoms and symptoms can be subtle. If you suspect it could be experiencing a heart attack, please don’t delay, don’t try to drive yourself or someone else to a hospital – call 911 immediately.
    Daniel Dunker, MD, FACC, practices at Carondelet Heart Institute at St. Mary’s Medical Center.

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