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'Door-to-Balloon' Care Critical for Saving Heart Attack Victims' Lives

When crushing heart pain threatens lives, patients have a need for speed, in the form of fast "door-to-balloon" care.

All-around bon vivant Larry Amestoy of Deer Valley quit smoking January 2 at 2:15 p.m. That was the instant his pulse rate erupted and he "felt weak as a kitten."

Door to Balloon Cardiac Care
Larry Amestoy with beloved fiancée Dana — and beloved Porsche.

"I was landscaping," Larry recalls, "and suddenly couldn't lift my arms. I went to the bathroom for an aspirin. I couldn't remember if you were supposed to swallow or chew the asprin, so I broke it in half, swallowed the first one and chewed the rest."

He tried to ignore overwhelming weakness, chest tightness and an icy sweat that unexpectedly broke out. But it got worse. Larry thought he was dying. He called 9-1-1.

His fiancée, Dana, got home just before the paramedics arrived. By this time, Larry — normally a healthy, ruddy blond — was "ash-grey and his skin was freezing," according to Dana. "They asked me if he was always that color," she says.

The ambulance raced Larry to John C. Lincoln Deer Valley Hospital.

Door-to-Balloon Time

At the hospital, Larry was immediately given an EKG, which revealed that Larry was having a heart attack and located the blocked blood vessels. He was then rushed to the hospital's Cath Lab, where cardiologist Robert Bear, DO, and his team performed a balloon angioplasty to restore arterial blood flow to Larry's heart.

Remarkably, the time that elapsed between Larry's arrival in the ER and restoration of blood flow to his heart was 51 minutes — less than two-thirds of the 90-minute national standard. While it's one of the hospital's best times, it is not uncommon at Deer Valley Hospital, where in January 2007 the mean "door-to-balloon time" was 63.75 minutes.

Door-to-balloon time, or "D2B," is the catchphrase of a new campaign launched by the American College of Cardiology (ACC) and the American Heart Association (AHA), in conjunction with hospitals across the nation, to combat heart disease — America's number-one killer.

D2B refers to the interval between a patient's arrival time at the hospital and the instant a blocked coronary artery is opened with an angioplasty balloon.

Coordination and Speed Are Vital

Because heart muscle dies when it's deprived of blood for an extended period of time, one of the primary goals in treating heart attacks is speed. "If you wait around to see if heart attack symptoms will go away, the delay can kill you, or at best cause irreversible damage," says cardiologist Dr. Robert Bear.

The faster that blood supply can be restored after a heart attack has blocked blood flow to the cardiac muscle, the better the chances of recovery, Dr. Bear says. Chances for complete recovery are significantly enhanced if blow flow can be restored in less than a couple of hours.

For this reason, the ACC and AHA have established 90 minutes as the national standard for door-to-balloon time. Larry's experience is testimony to the effectiveness of the ACC/AHA recommendation and the way it has been implemented at John C. Lincoln Deer Valley Hospital.

"The real key to this is coordination between pre-hospital paramedics, hospital staff and the cardiologist," says John C. Lincoln Health Network President and CEO Dan Coleman.

The Best Hospital Experience

Larry's fiancée Dana describes the treatment as "the best hospital experience either of us has ever had." She was impressed by the caring attitude of John C. Lincoln staff.

"The nurses, the doctor and the technicians were all so kind and so good about telling us exactly what they were going to do," Dana adds.

Larry is alive and healthy today because of the coordinated, expedited care he received. The outcome affirmed his attitude toward life.

"Dana was terrified, but I wasn't," he remembers. "As the paramedics were loading me into the ambulance, I just told her to take care of my Porsche."

Heart Attack Warning Signs

It's not only elderly men who suffer from heart disease and stroke. Heart disease is also the number-one killer of women; stroke is the number-three cause of death.

Nearly 5.2 million Americans are living with heart disease, and almost 550,000 new cases are diagnosed each year. Important warning signs you should never ignore include:

  • Chest Discomfort: Uncomfortable pressure, squeezing, fullness or pain that lasts longer than a couple of minutes, or goes away and returns.
  • Other Upper-Body Discomfort: Pain in one or both arms, the back, neck, jaw or stomach.
  • Shortness of Breath: With or without chest discomfort.
  • Other Signs: Sudden cold sweat, nausea or lightheadedness.

Deer Valley Hospital Meets, Exceeds Heart Care Standard

The national standard for door-to-balloon time is 90 minutes. Yet, in March, April and May 2007, John C. Lincoln Deer Valley Hospital performed every percutaneous coronary intervention (PCI, formerly referred to as "angioplasty") on an average of just over 60 minutes.

The reason? The high level of teamwork and coordination involving all who combat heart disease — physicians, nurses, technicians and support staff in the pre-hospital services department, the emergency department and Cardiac Cath Lab. These professionals have closely collaborated on ways to shave minutes off steps in the door-to-balloon process.

New 12-lead EKGs in many ambulances also have helped, enabling EMTs to send results for review in the ED prior to patients' arrival. With these EKGs, the Cath Lab team can be summoned in advance, as well.

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