Peter Franklin, a radiologist from Boston, was vacationing with his wife Kathleen in Marathon when he felt his first chest pains. Alarmed, the couple went to the closest hospital for a checkup and from there to Mount Sinai Heart Institute.
But that ambulance trip to Miami Beach was only the beginning of his roller-coaster journey to health.
While in the cardiac catheterization lab, Franklin, 63, went into severe cardiac arrest and was without oxygen for almost 15 minutes. He was lucky, though. The quick action by the cardiologists at Mount Sinai saved his life.
“If I had not been in this hospital with these doctors, I would not be having this conversation right now,” said Franklin, from his hospital bed weeks later. “Essentially I should have died right there on the table.”
Added Kathleen: “He’s completely and miraculously intact, but it was a real wake-up call.”
Franklin’s story of cheating death is a perfect example of how far medical treatment of heart attacks has come. Ultimately, however, it is also the story of how seeking help quickly can make all the difference.
“Minutes count,” said Dr. Nirat Beohar, director of the Mount Sinai cardiac catheterization lab and one of two doctors who, along with five nurses and five technicians, worked on Franklin. “We see enough of these that we are very attuned to what we must do.”
Franklin went into cardiac arrest on the table, just as Beohar had noticed that Franklin’s left anterior descending coronary artery was completely blocked. Immediately, the medical team dilated his artery and placed a stent to preserve it. With an AngioJet, a high-powered vacuum, they sucked up the clot. They also used a pump to help stabilize blood flow to the heart.
Once Franklin was stabilized, the team froze the patient to 34 degrees Fahrenheit for 24 hours to preserve brain function and stop the body’s normal inflammatory response. Later, Franklin was slowly “warmed.” Eventually he was able to respond to commands and after six days moved to a regular room.
“If all these pieces hadn’t come together in quick succession,” Beohar said, “he might not have been telling this story.”
Dr. Yvonne Johnson, emergency director of the Heart Attack Unit at South Miami Hospital and co-medical director of the hospital’s Emergency Center, says South Floridians are fortunate when it comes to treatment for heart attacks. Ten Miami-Dade hospitals and six fire-rescue departments are part of a STEMI network that, since 2007, has committed to getting heart attack victims to a cardiac cat lab in 90 minutes. Broward has a similar network.
Such speedy response time, as exemplified in Franklin’s case, can make the difference between life and death, recovery or irreparable loss of heart muscle.
“As an E.R. physician, what I’ve seen in the past 20 years is amazing,” Johnson said. “What we are able to do, the kind of care we can give, makes all the difference.”
New guidelines for treating STEMIs — the acronym for ST Segment Elevation Myocardial Infarction, or the most severe type of heart attack — were updated in December by the American Heart Association and the American College of Cardiology. The guidelines, last published in 2009, detail the best treatment plan that doctors should follow.
Among the highlights:
• The time between first medical contact to when a doctor uses angioplasty to open a blocked artery should be 90 minutes or less. This means that the cardiac team that will work on a patient should be alerted as soon as the patient is checked by an emergency medical service.
“It’s critical for the hospital to be ready as soon as that patient arrives,” said Dr. Mauro Moscucci, chief of the cardiovascular division at the University of Miami Miller School of Medicine. “You need to activate a very complex system and the best way to do this is contact the hospital on the way there.”
In Franklin’s case, the team was already at the cat lab.
• To speed diagnosis, emergency medical technicians should perform electrocardiograms in the field. Johnson of South Miami Hospital says many EKGs are done in the patient’s house or on the emergency truck. “We can then start preparing for the patient before the patient even arrives,” she said.
• Therapeutic hypothermia — lowering the body temperature to protect the brain from damage — is recommended if a patient goes into cardiac arrest.
Years ago, UM’s Moscucci added, there was no standard practice in treating heart attack patients. That has evolved steadily so that there has been a 50 percent reduction in heart attack deaths in the past five decades.
This is important because STEMIs affect about 25 to 40 percent of the 683,000 people who are diagnosed with obstructed coronary arteries every year.
Moscucci said evolution of treatment includes the introduction of the ICU, or Intensive Care Unit, concept and the use of aspirin therapy and clot-busting medications. In the past two decades angioplasty, the mechanical opening of a blocked artery, has also contributed to improved heart attack survival.
“There has been tremendous progress,” Moscucci said. “It’s one of the real successes in modern medicine.”
In addition to the national guidelines, local hospitals have their own time goals to treat patients. For example, in Franklin’s case the complex procedure to revive him took only 35 minutes. “We had to work like clockwork,” Beohar said, adding that Mount Sinai Heart Institute has the best heart attack survival rate in Florida.
Hospitals also measure the efficacy of their heart attack treatment by how quickly a patient makes it from hospital door to angioplasty, when the artery is opened, ideally within 60 minutes.
Cardiologists, however, point out that guidelines are useless if the patient doesn’t dial 911 as soon as they recognize the onset of heart trouble.
“A very important component is patient education, knowing the common symptoms but also the symptoms that aren’t typical,” Moscucci said.
Johnson said she urges people not to second guess themselves. Too many attribute heart attack symptoms to indigestion or muscle spasms.
“It’s OK to be wrong,” she said. “The only downside of being wrong is really not so bad.”