Anatomy of a 9-1-1 Call for Heart Attack Symptoms

Prompt Treatment Can Be a Lifesaver

You’re watching TV when you start feeling pressure in your chest. “It’s probably indigestion,” you think. A few moments pass, and you notice that you’re sweating and short of breath. You know these are signs of a heart attack, but you’re tempted to wait and see what happens. After all, you couldn’t be having a heart attack, could you?

The choice you make may determine whether you live or die. Whether you’ll lead a normal active life or face limitations because of a damaged heart. What’s the right choice?

“9-1-1. What is the nature of your emergency?” Calling 9-1-1 may be the most important call you make in your life. Here’s what happens: A 9-1-1 dispatcher sends the closest available emergency medical crew to your home or location, and the crew begins a race against the clock.

En route to the hospital
Within minutes, paramedics arrive at your location. They perform multiple tasks simultaneously while they place you on a gurney and transport you to the hospital.

The paramedics ask about your symptoms and begin assessing your condition. They perform a sophisticated 12-lead electrocardiogram (EKG) to look for heart attack signs, and start treating your condition as soon as possible.

Paramedics may administer oxygen, aspirin to help dissolve the blood clots that cause many heart attacks, and nitroglycerin to reduce pain and dilate your arteries. If your heart stops beating, they have defibrillators to help restart it.

“Time equals muscle,” says Michael Heffner, the emergency medical services coordinator for the city of Salem, explaining how prompt treatment means less damage to a patient’s heart. “Providing patients with therapies before they reach the hospital helps improve their chances of survival.”

At the emergency room
Your paramedics call the hospital to alert the cardiac staff that they are transporting a patient who may be experiencing a heart attack. Upon arrival, the hospital’s emergency room (ER) staff is ready for you. Everyone works quickly and efficiently within the next 90 minutes.

The paramedics give your ER physician a verbal report of their observations and test results while your doctor conducts a more in-depth evaluation. He or she reviews your EKG taken in the field and asks about your symptoms and medical history.

It’s not always easy to determine whether a patient is experiencing a heart attack or displaying similar symptoms because of another problem. So the ER staff may perform blood tests, additional EKGs and monitor you continuously until they can confirm or rule out a heart attack.

“ER physicians now take a more active role in assessing heart attack patients,” says Rob Kelly, M.D., an emergency physician at Salem Hospital. “When our evaluations indicate that a patient is having a heart attack, we initiate a Cardiac Alert, which means a cardiologist and a team from the cath lab are called to the ER immediately. We also may give patients additional treatments, including intravenous nitroglycerin, beta-blockers and aspirin, depending on their symptoms and what therapies they received in the field.”

In the cardiac-catheterization lab
“There has been a major shift in the way we treat heart attack patients,” says Raghu Kamineni, M.D., the medical director of acute myocardial infarction (heart attack) and the cardiac-catheterization lab (cath lab) at Salem Hospital.

“In the not-so-distant past, the primary treatment was medications that helped dissolve blood clots,” says Dr. Kamineni. “But we now know that patients have much better outcomes when we can open their blocked vessels quickly. So our focus is to have patients on the cath-lab table within 45 minutes of their arrival at the hospital and to open any blocked arteries within 90 minutes.”

The cath lab is similar to an operating room and contains an extensive amount of very specialized equipment, used exclusively in diagnosing and treating heart problems. (Salem Hospital has the only cardiac-cath lab in Marion and Polk counties.)

When you arrive at the cath lab, your cardiologist performs a coronary angiogram. The cardiologist makes a small opening in your groin, inserts a thin catheter into the opening and uses imaging technology to advance it to your heart.

Your doctor can view any blockages or narrowed areas that are restricting blood flow to your heart. He or she can then use a balloon catheter to create an opening in the vessel and deploy a tiny mesh tube, called a stent, to keep the vessel open.

“The sooner we can restore blood flow to patients’ hearts, the better their long-term outlooks,” says Robert Estrada, R.N., the cardiovascular services manager at Salem Hospital. “When we open vessels quickly, we can help prevent or minimize permanent damage to the heart.”

The importance of prompt response
You called 9-1-1 immediately. After you recover from your heart attack, you’re able to spend time with your family, take your grandkids to the park and continue to do the things you enjoy.

“Many people who get to the hospital fast leave with a heart that functions normally,” says William Shely, M.D., a cardiothoracic surgeon with Northwest Surgical Associates, a division of the Oregon Clinic. Dr. Shely performs heart surgery at Salem Hospital.

People who delay seeking treatment may not be as fortunate. One study found that heart attack patients had a 16 percent greater risk for impaired heart function for every hour they delayed going to the hospital.

“Those who wait often have serious long-term problems,” Dr. Shely says. “If people are concerned that their symptoms could be a heart attack, they should act as if their life depended on getting prompt treatment—because it does.”