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Chest pain: Is it a heart attack?


The most important thing to remember about chest pain, particularly if it’s a heart attack, is that time is muscle. In other words, the longer you are deprived of blood flow to your heart, the more permanent the damage can be. William Ballard, M.D., an interventional cardiologist with the Piedmont Heart Institute, says pain associated with having a heart attack is a misnomer.

“It’s particularly more of a pressure sensation, it’s visceral,” he says. “You’re very aware of it being something bad in general. But it usually is associated with shortness of breath, a little nausea.”

If you experience any of these symptoms or if the pressure in your chest is increasing, take action.

“The first thing you should do besides alerting someone and calling 911 is to take an aspirin,” Dr. Ballard says. “That’s probably the most life-saving thing you can do, a simple aspirin.”

In the ambulance

When heart attack patients are transported by ambulance, paramedics will transmit a 12-lead EKG to Piedmont. The EKG will be read by a medical professional in the emergency department, and he or she immediately activates the heart team.

“If paramedics are convinced this is most likely heart disease, or it’s chest pressure they’re worried about, then they would often put in an IV at the scene, which is critical," explains Dr. Ballard. "Many people will die because their blood pressure drops alarmingly low.”

Dr. Ballard says if doctors can get the blocked artery open within 90 minutes, chances of a full recovery are very high.

If it takes longer than that, particularly more than a few hours, chances of a full recovery and recovery of the heart muscle are much lower.

In the hospital

“If the EKG shows a heart attack, then we would put the patient in the pathway of our STEMI (ST-Segment Elevation Myocardial Infarction) protocol, directly to the cath lab, quickly through the emergency department or bypassing it totally,” he says. 

Dr. Ballard says a distinguishing and exciting feature of the Piedmont Heart Institute is the ability to save patients who have a 90 to 95 percent likelihood of dying. Piedmont Atlanta, Piedmont Fayette, Piedmont Mountainside and Piedmont Newnan hospitals have earned chest pain accreditation.

“[Patients] might come in with no pulse, and we can cool them down to preserve their brain function, then we can resuscitate them further,” he says. “We can allow them and their heart to come back to life over a matter of weeks at times.”

By going to an accredited chest pain center, patients are assured the process is uniform, protocols are in place and care will be state-of-the-art.

The statistics

According to researchers at Yale University, five key factors indicate a hospital’s success in treating heart attack cases. Piedmont Atlanta follows all five strategies and has accreditations in both chest pain and heart failure. The strategies include:

  • Ensuring a cardiologist is in the emergency department 24 hours a day, seven days a week.
  • Monthly meetings between the hospital’s care team and paramedics to review heart attack cases.
  • Teamwork between doctors and nurses.
  • Creative problem solving among staff members.
  • Nurses with specialized duties.

Institutions that followed these five strategies doubled the 30-day patient survival rates compared with facilities that did not follow these guidelines. In fact, researchers found only 10 percent of the more than 500 hospitals they survey implemented even four of the five standards. Piedmont Atlanta meets these standards to ensure the best patient outcomes possible.

Dr. Ballard concludes, “The take-home message for patients experiencing chest pain is to tell someone else if anyone else is there, alert those people to any medical history you have, and contact someone - that someone should be via 911."

For more information about chest pain, visit Piedmont Heart Institute.

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