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November 29, 2012

Heart attack treatment: A cardiologist's retrospective

(Continued)

A significant advance in treatment was to give clot buster medications to dissolve the clot in the affected artery, in order to restore blood flow to that part of the heart. Our mantra was, and still is, “time is muscle,’’ meaning the sooner we get the artery open to restore blood flow to the heart muscle, the more heart muscle function we can save.

But we didn’t always know if the medication was effective. And even if treatment seemed successful, we still had the dilemma of deciding whether the patient should undergo a cardiac catheterization to assess the coronary arteries and evaluate if balloon angioplasty should be done.

Why not just get in there, see if the artery is clogged and fix it? Some pioneers in heart attack treatment were doing just that, and today that process, called acute intervention, is considered state-of-the art treatment for STEMI.

When a patient presents within a four to six hour window with signs and symptoms of a STEMI, our goal is to get that patient to the nearest Cardiac Catheterization Lab as soon as possible. Cardiac catheterization will determine the culprit artery so a stent can be inserted to open the artery and restore blood flow to the heart muscle.

We judge our success in several ways: Preserving the patient’s life, preserving heart muscle function, and preventing further heart attacks, to name a few. We also measure something called “door to balloon time.’’ This means how quickly we go from diagnosis of the heart attack (starting when the patient comes through the door) to when we treat the culprit artery (with a balloon/stent). We want this time to be 90 minutes or less because time is muscle.

I don’t know if my neighbor Mike G. would have survived if we were able to offer one of these advanced treatments, but he definitely would have had a better chance.

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