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I had the opportunity to attend the 7th Annual Cardiology Update Course put on by Trillium Health Centre (an Ontario hospital) for primary care doctors in their community. It was an excellent opportunity to get acquainted with new programs, technology and advances in our community. In our modern health care system trying to keep up with what is new and what no longer exists is a continuous struggle. I applaud the efforts of Trillium Hospital to address this matter in an organized and centralized fashion.
One of the most exciting new developments in our community is with regards to heart disease and acute events. Dr. Bob Singh, Dr. Vlad Sluzar and other cardiologists at Trillium Hospital outlined new programs and treatments for cardiac patients, particularly for people suffering a STEMI. This is medical jargon for an ST Elevation Myocardial Infarction or your common type of heart attack. The key is to recognize a heart attack. Intense chest pain often radiating to the left arm, sweating, weakness and shortness of breath are key indicators. Heart attacks can be lethal because they involve blockages from small clots breaking off the accumulated garbage on our arterial walls and then occluding the blood flow to the heart muscle itself. Without life sustaining oxygen in the blood flow, the heart muscle will die off in sections. This means that every minute counts for survival and recovery.
Up to now, the standard of care for a heart attack victim was to immediately take aspirin which still has value, followed by immediate transport to hospital. In hospital, the current dictum is to administer a clot busting drug, known as TNK (Tenecteplase). This may be followed by a time consuming transfer to a cardiac center where a “rescue PCI” (percutaneous coronary intervention) may be performed. This is a procedure where a balloon catheter would be passed through the groin artery up to the blocked part of the heart artery and a small stent is used to expand the blockage. It is left in place forming a type of tunnel that allows normal blood to flow. This used to be called angioplasty. This is only possible if you happen to have a highly specialized cardiac catheterization facility staffed around the clock available in your back yard.
There is only a handful of such facilities in the entire country and Trillium has one. The cardiologists in our region are pioneering an amazing concept. Central to the idea is to have someone who is sitting in their living room and develops chest pain, diagnosed quickly and transported directly to the cardiac center. It flies against the traditional dictum where ambulances take people to the closest hospital, unless ordered otherwise by a physician. Instead, advance care personnel diagnose a heart attack in the field by performing an EKG. Urgent and immediate transport takes place to the cardiac center. This not only bypasses the local hospitals, but also bypasses the emergency departments themselves. At the Trillium catheter lab, a PPCI (Primary PCI) takes place by passing the catheter to the heart and inserting a stent. The initial results have been positive if not amazing, even in people who suffered a complete cardiac arrest. The stable and comfortable patient is then transferred back to their local hospital. It is hoped that this type of rapid response will be expanded to the Peel region very soon.
The stumbling block which needs to be addressed is the initial diagnosis which requires an EKG. Most offices and clinics in Ontario do not have this technology, because OHIP does not fund technology for primary care offices. It also underscores the need for all of us to have basic training in CPR. I urge people to become familiar with automatic defibrillators. These machines are popping up around arenas and public gathering places. They are capable of saving a heart victim and are simpler to use than operating a toaster oven. Become familiar with the symptoms of a heart attack, take a baby aspirin if available and seek medical assistance. Do not hesitate to call 911. Above all, do not wait to see if the aspirin helps! Every minute that you wait results in more damage to your heart muscle. Time is muscle.
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