Sunday, June 10, 2007

Overcoming Barriers to Early Heart Attack Treatment

Image of a 12-lead EKG of an Acute Inferior Myocardial Infarction

One of the biggest factors influencing survival during a heart attack (also known as myocardial infarction) is the time it takes to open the occluded coronary artery. Cardiologists in Oregon have worked together to provide a plan that secures an earlier reperfusion time and published their remarkable observational results in the American Journal of Cardiology. Unfortunately, their approach has not been universally applied across the country. Municipalities should look carefully at these requirments for improved survival in heart attack victims as they plan upgrades to their Emergency Medical Services. These include the following:
  • Equip all ambulances with 12-lead EKG-capable defibrillator systems. These facilitate the early administration of life-saving medications in the field for patients suffering a heart attack. Use of 12-lead EKG, particularly a wireless system capable of transmitting the information to a hospital during transport, is also supported by the 2004 American College of Cardiology guidelines.
  • Development of policies that permit patients to be transported directly to a hospital capable of acute coronary intervention (not just the closest hospital). While understandable, this requirement might be difficult for more rural communities remote from hospitals equipped with an interventional cardiac catheterization laboratory.
Additionally, as an electrophysiologist, I would like to assure that the recordings of the heart rhythms obtained by these machines in the field are carefully archived to permit later review by specialists. These tracings can be invaluable for diagnosing the cause and best treatment options for the patient after their preliminary treatment in the Emergency Room and cath lab.


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