Barbara Mitchell was dizzy and felt as though she was going to pass out. The St. Peters resident was visiting the Farmington area and speculated her blood sugar might be low. But eating candy didn't help. Soon she broke out in a cold sweat and felt pressure in her chest and between her shoulder blades.
When she arrived at Parkland Health Center's Emergency Department, her arms felt strange. She also felt nauseated and remembers thinking, "If only I could burp."
Emergency nurse Rachel Wren suspected that Mitchell was experiencing a heart attack and immediately performed an EKG. Wren was right.
New protocol set into action
Long-time Emergency Department nurse Kathy Ferguson suspected a type of heart attack known as s.t. elevation myocardial infarction (STEMI). Ferguson is specially trained in the new protocol for STEMI patients and, after consultation with the emergency department physician, activated the protocol. The protocol -- Heart LifeLine Alliance -- is in partnership with Missouri Baptist Medical Center St. Louis Air Evac.
Within minutes, Mitchell had received the pertinent medications which had been assembled in advance in a special kit. She was airlifted to Missouri Baptist. Meanwhile, with one phone call and one fax the special protocol was in high gear. The cardiac catheterization team was already assembling and preparing for her arrival in St. Louis.
Minutes matter
Within 16 minutes of landing at Missouri Baptist, Mitchell was in the cath lab with a balloon inserted in her clogged artery. "This is incredible time," says Nancy Nahlik, manager of regional development at Missouri Baptist.
The beauty of the Heart LifeLine Alliance protocol is that it saves precious minutes that can mean the difference between life and death for a STEMI patient. The local emergency physician has the power to set the protocol in action without consulting with a cardiologist -- which saves 20 to 60 minutes. Special medicines are assembled in advance in a kit -- saving 15 to 20 minutes. The patient is loaded into the helicopter with engines running and rotors spinning -- this saves 4 to 14 minutes.
How did this protocol come about?
"In the past we had an excellent ED to ED transfer system, but the team worked on how to make it better" says Patsy Coleman, manager, PHC Emergency Department. The result is designed to shave minutes off the total time from when the patient enters the Emergency Department to when the patient receives the cardiac catheter. When weather prohibits transfer by air, the patient is taken by ground in an ambulance. If the patient's heart attack does not qualify for this protocol, special "clot buster" medicines called thrombolytic therapy are given.
Getting the heart "breathing" again
"Like your brain, your heart needs oxygen. Every minute without it may result in irreversible damage or death. Thanks to the exemplary, proactive efforts of Missouri Baptist Medical Center, Air Evac and Parkland Health Center, we have a high-speed conduit leading from Parkland to some of the best heart facilities in the world. This precisely designed conduit dramatically shortens the time it takes to get the heart breathing again" says John Hunt, MD, medical director, PHC Emergency Department.
Barbara Mitchell was the first Parkland Health Center patient to utilize this special new protocol. Her recovery was quick -- she was released from the Hospital two days after her heart attack, and now feels great. A smoker for 42 years, she has quit and no longer desires to smoke. She feels better than she did before the procedure, and she is breathing better. This no doubt makes her two daughters and five grandchildren breathe a bit more easily too.
Mitchell, whose only prior hospitalization was to give birth, had no prior symptoms although her cholesterol was slightly high. Her advice to women is to educate themselves on the symptoms of a heart attack. "You may have all of the symptoms or none of the symptoms, but if in doubt, do something -- do not ignore it," says Mitchell.
Heart attack symptoms -- different for men and women
Heart attack symptoms can differ between males and females. "It is more common for women to have atypical symptoms," says Patsy Coleman, manager of the Emergency Department at Parkland Health Center.
Typical symptoms include:
- Uncomfortable chest pain
- Pressure or a squeezing sensation in the chest that lasts for more than a few minutes
- Pain that radiates to the shoulders, neck, jaw or arms
- Chest pain accompanied by dizziness, sweating, nausea or shortness of breath
"Women can have less typical symptoms such as those of Barbara Mitchell," says Coleman. In addition to the dizziness and the feeling of needing to burp but being unable to do so.
Atypical symptoms include:
- Pain or discomfort in the arms, back, neck, jaw or stomach
- Shortness of breath
- Breaking out in a cold sweat
- Nausea or light-headedness
Sometimes women experience no pain during a heart attack. If you think you may be having a heart attack, you should call 911 immediately.
