Physicians from outlying community hospitals that lack sophisticated equipment can now provide top-notch care to heart attack victims.
Clot-dissolving drugs and other medicines can immediately benefit these patients, Dr. Eric J. Topol told more than 120 medical professionals from Utah, Idaho, Wyoming and Nevada.Topol, director of the cardiac catheterization laboratory and associate professor of internal medicine at the University of Michigan Medical Center, was featured speaker Friday at an educational seminar at the Doubletree Inn.
The seminar, "Administration of Thrombolytic Agents," was sponsored by LDS Hospital and the Intermountain Cardiac Emergency Network.
The network was formed July 1, 1988, to link community hospitals with three cardiac care centers - LDS Hospital, McKay-Dee Hospital Center and Utah Valley Regional Medical Center. Today, 25 hospitals in Utah, Idaho and Wyoming participate in the network. Their joint goal is to reduce the number of deaths from heart attacks in the Intermountain West.
Using thrombolytic agents, Topol said, is a key way to reduce heart attack deaths.
Most heart attacks, he said, are caused by a blood clot in a narrowed coronary artery. These arteries have been progressively restricted by cholesterol build-up. The cholesterol plaque on the artery wall becomes the site for formation of a blood clot.
The clot lodges in the narrowed artery and cuts off the heart's supply of blood and oxygen. If blood flow is not restored, the muscle is starved of oxygen and gradually dies.
The average victim usually waits three hours before seeking help. After four hours, most of the heart muscle damage is irreversible; after six hours, salvage of damaged tissue is unlikely.
Yet, according to Topol, the clot can be melted and the heart saved if the thrombolytic agents are administered immediately. The earlier it's done, the better the outcome.
In fact, if treatment begins early enough, a heart attack can sometimes be aborted entirely.
"This therapy is ideal because it is a very rapid-fire technique to get the artery open," Topol said. "All it requires is to get an intravenous line in. It has a big impact on patient's chances for survival and his heart function in the long term."
This is good news for Americans. Heart attacks are the nation's biggest killer, accounting for 540,000 deaths annually.
Forty years ago, medical personnel took a passive approach to heart attacks. Patients were treated for pain and given plenty of bed rest. It took literally months for them to heal - if they did.
Coronary care units emerged in many hospitals 20 years ago, and physicians began treating arrhythmias or fluctuations in the rhythm or strength of heartbeats. Today, physicians recognize that thrombosis (the presence of blood clots in the arteries) causes most heart attacks and that a patient's prognosis is directly related to the amount of heart muscle that is in jeopardy.
Specialists acknowledge that there's a critical two-to-six-hour "window of opportunity" for intervening in a heart attack and that heart attack victims don't benefit from immediately receiving balloon angioplasty, an expensive procedure that opens up clogged arteries in their hearts.
Drugs and new technology make immediate intervention possible.
Yet, two relatively new drugs - tissue plasminogen activator, or TPA, and streptokinase - released for use in November, are still not commonly used in many of Utah's smaller hospitals.
"Even though there may be 1 million heart attacks in the country, we know that only 150,000 or so were treated with thrombolytic agents last year," said Dr. Jeffrey L. Anderson, chief of cardiology at LDS Hospital.
Friday's educational conference was designed to teach medical specialists "on the firing line" how to administer the drugs, and then refer selected patients to the larger hospitals for further treatment if necessary.