Lessons of Heart Disease, Learned and Ignored
by Gina Kolata
“Keith was hunched over and he didn’t put his seat belt on,” Mr. Friedman said. “I kept asking him, ‘Is it getting better or getting worse or staying the same?’ For the first 10 minutes he said, ‘It’s about the same.’ Then, when we were a block or so away, he said: ‘I’m not doing well. I think it’s getting worse.’ ”
When they arrived at the hospital’s emergency department, Mr. Friedman explained that his friend was having chest pains. Immediately, Mr. Orr was wheeled off for an electrocardiogram, showing his heart’s electrical signals. It was ominous, including one pattern called the tombstone T wave because patients who had it died in the days before there were aggressive treatments to open arteries.
The next thing Mr. Orr knew, he was being rushed to the cardiac catheterization laboratory for a procedure to open his artery.
“They said: ‘We’re going now. We’re going now,’ ” Mr. Orr recalled. “That really scared me. Someone kept yelling: ‘Do you have his labs? Do you have his labs?’ Someone else said, ‘We’ll transfer them later.’ ”
The electrocardiogram was at 3:45 p.m., roughly 30 minutes after his symptoms changed from intermittent to constant and 5 minutes after he got to the hospital.
At 3:52 p.m., Dr. Ashvin Pande, a cardiology fellow, was chatting in the hallway when he was called to the catheterization lab.
“Big M.I. coming in,” a nurse told Dr. Pande, using the abbreviation for myocardial infarction, or heart attack. At the time, the room was occupied — a patient was lying on the table for an elective procedure. He was quickly wheeled out and Mr. Orr was wheeled in. It was 3:56 p.m.
Within minutes, Dr. James M. Kirshenbaum, director of acute interventional cardiology, assisted by Dr. Pande, threaded a thin tube, like a long and narrow straw, from an artery in Mr. Orr’s groin to his heart. They injected a dye to make Mr. Orr’s arteries visible to an X-ray and they saw the problem — a huge clot in his heart’s left anterior descending artery, blocking blood flow to most of his heart.
The quickest option was to open that artery with a balloon and keep it open with a stent, a tiny mesh cage, if possible.
It worked — the balloon shattered the clot and pushed the debris against the artery wall and the stent held the artery open. Then a different problem arose. When the large clot was pushed aside, the debris was shoved against the opening of a small artery that branched from the larger one, much as a snowplow clearing a street can block a driveway.
“We made a calculated decision that it would be worth sacrificing the branch to secure the main vessel,” Dr. Pande said. But, fortunately, they were able to insert another balloon through the stent and into the small artery, opening it too.
At 4:43, the procedure was over and Mr. Orr was wheeled to the coronary intensive care unit. He had been awake but sedated and experienced what he said was the amazing feeling of having his artery opened. “As soon as the balloon goes in, all the pain disappears,” he said. “You know immediately.”
The cardiologists who saved his life walked out of the room, grinning and exhilarated.
“This adrenaline rush is why people like me go into cardiology,” Dr. Pande said.
The First Call: An Ambulance
Mr. Orr was incredibly lucky, said Dr. Elliott Antman, director of the coronary care unit at Brigham and Women’s Hospital. He ended up with little or no damage to his heart, even though he teetered between lifesaving decisions and critical miscalculations in his moments of crisis.
The first lifesaving decision was to go to a hospital soon after his chest pain began. But the miscalculation was to call his friend for a ride. He should have called an ambulance.
Had his friend gotten caught in traffic, Mr. Orr might have been dead or sustained serious injury to his heart. He might have had to go to a rehabilitation center and learn special tactics for conserving energy, like sliding a coffeepot along a counter instead of lifting it.
What few patients realize, Dr. Antman said, is that a serious heart attack is as much of an emergency as being shot.
“We deal with it as if it is a gunshot wound to the heart,” Dr. Antman said.
Cardiologists call it the golden hour, that window of time when they have a chance to save most of the heart muscle when an artery is blocked.