February 23, 2022
For most people, the hearts they think about during American Heart Month in February are the hearts that come with Valentine’s Day. For some others, the most important heart is the one that’s saved after a serious heart attack, thanks to the speed and experience of the people in the catheterization laboratory or “cath lab” at Good Samaritan Hospital.
Nearly 200 people come to the hospital’s emergency department every year with what the cardiology team calls a “STEMI” – an ST-elevation myocardial infarction, or extremely serious heart attack that poses the greatest risk to life. Major arteries supplying blood to the heart muscle have become blocked in a way that will rapidly lead to the heart being unable to function if the blockages aren’t removed.
“There’s a phrase when you’re treating a heart attack: Time is muscle,” said Julie Rush, a Registered Nurse and the Director of Cardiac Services at the hospital, who has specialized in cardiac care for a decade. “The longer that artery is blocked, the longer that heart is not receiving oxygenated blood, and it needs to be opened to preserve the heart muscles.”
That’s why care for most STEMI patients, who arrive by ambulance, starts even before they’re wheeled through the doors of the emergency department. Paramedics perform an EKG on the patient on the way to the hospital, to look for the abnormalities in the heart’s electrical signals that indicate a STEMI event. That information is transmitted to the hospital while the ambulance is still on the way, so that the cardiac care team can mobilize.
“When we get that call ahead, we activate what we call ‘Code Heart’,” said Dr. David Feldman, Emergency Department Director, who has been practicing emergency medicine for 22 years. “We work very closely with our EMS colleagues, to be an extension of the true hero work they do on the front lines, and we call an interventional cardiologist, the cath lab team that’s on call, to be ready when that patient comes in.”
“There are nurses, radiology technologists, physicians, all specially trained in cardiac care on the team,” Rush said, and everyone on call is never more than 30 minutes away from the hospital. They’re also an experienced group, some with 20 years’ experience, “so we have a really well-oiled machine.”
The “cath lab” is a feature at Good Samaritan Hospital because of its designation as a Heart Receiving Center. This specialized unit of the hospital not found in smaller facilities is where the real work is done.
There, the team performs a coronary angiogram to pinpoint the location of the blockage in the heart’s arteries. After that, the physicians and nurses will use catheters, stents and small, inflatable balloons to remove the blockage and hold the artery walls open to ensure blood keeps flowing to the heart. The goal in the U.S. is for every STEMI patient to go from entering the hospital to having the blockage corrected in the cath lab – what the team calls “door to balloon” time – in under 90 minutes.
In most cases, it’s a lot less.
“The majority of our cases are under that goal,” Dr. Feldman said. “Just this month, we have a patient that was in the cath lab in under 20 minutes.”
Once the blockage is cleared and the patient is stable, they’re usually transferred to the intensive care unit for observation. Some patients even go home the same day, while others with complications might remain in the ICU for a day or two.
Patients with serious heart attacks don’t always come in by ambulance, so the entire emergency department is on the lookout for patients who may be having a STEMI event.
“For any patient that walks into our emergency department complaining of chest pain or another symptom of a heart attack, our goal is to triage them and do an EKG in less than 10 minutes,” Dr. Feldman said. “Everyone on staff there is educated about that, and anyone is empowered to activate a Code Heart.
Regardless of how a heart attack patient arrives at Good Samaritan Hospital, the goal is the same: to provide the best heart care, do it fast, and with compassion for the patient.
“What makes us different, I think, is that we have the process down so well,” Rush said. “It’s about the collaboration among everyone, the departments and my team. Our staff is very caring, and they treat patients like their own family. We’re all in healthcare for a reason, and we all know what we’re here to do.”