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Melanie Cole (Host): For someone suffering from a heart attack, prompt treatment is critical. Every minute of delay can result in additional damage to the heart. When it comes to heart attack treatment, every minute counts.

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole and joining me today is Dr. James Lee. He's the Medical Director of Henry Mayo's Roberta G. Veloz Cardiac Cath Lab. He's an Assistant Clinical Professor of the Department of Medicine at UCLA and the Associate Regional Director of Interventional Cardiology at UCLA Health.

Dr. Lee, it's a pleasure to have you join us again today. So, I'd like to just sort of set the stage because we talk about stroke a lot, but this is really heart attack. And tell us about heart disease and the risk factors for cardiovascular disease and possible heart attack.

James Lee, MD (Guest): Yeah, heart disease over the past more than three decades has been the number one cause of death in the United States and even nationally and globally. And it's so prevalent in the United States that statistics usually estimate that every 60 seconds someone's actually having a heart attack. In Santa Clarita, the area that I work in, the prevalence of heart disease is also very high. It's sometimes estimated when we view numbers of being two to three times higher than the national average.

So, despite all the technology and all the media access and information at our fingertips, there still is such a lack of an awareness of what causes a heart attack, what the mechanism is, what the treatment measures are, and for patients, the most important thing, the symptoms that present when one is having a heart attack.

Host: So for stroke, Dr. Lee, we have that acronym FAST and BFAST. But the acute signs that someone's having a heart attack, you know, we've seen in the movie the clutching of your chest and the arm, but is there an acronym for heart attack and the difference between between a man and a woman, those symptoms are different as well, yes?

Dr. Lee: Yes. So, the most important we usually don't have, I have an exact acronym, but you know, the symptoms most common that everyone is aware of is that there's going to be chest pain associated with the heart attack. And usually those symptoms occur in the middle of the chest sometimes towards the left of the chest. And they could radiate up to the neck or jaw, or even to the inner aspect of the left arm. And sometimes can be associated with shortness of breath. These profuse sweating and patients can also feel very dizzy or feel their heart racing at the time. Unfortunately, in women, sometimes the presentation can be quite different.

And also in diabetic patients and sometimes the symptoms may not be typical. And thus, it's very hard sometimes to diagnose whether someone's having a heart attack. Sometimes there may be no chest pain. There may only be a profound sense of fatigue. There may be some shortness of breath. The symptoms may be specifically localized to the neck or the jaw, even the upper back or shoulders.

And so sometimes women may not present as quickly for treatment for heart attacks. And another thing that you had asked about is the risk factors of heart disease. And so in the United States, the top three risk factors for heart disease are high blood pressure, high cholesterol and cigarette use. But on top of that, risk factors, such as diabetes, family history, genetics, lack of exercise, and also increased weight, all also contribute to prevalence of heart disease.

Host: This is really vital information we're giving here today, Dr. Lee. Tell us why a fast door to PCI time is important for these heart attack patients and how Henry Mayo Newhall Hospital has achieved such a low average door to PCI time. What is that?

Dr. Lee: So, the first thing to understand, to acknowledge why that's so important is first understanding what happens in a heart attack. So, when one has a heart attack, there's a sudden blockage of blood flow to your heart. The heart muscle then is deprived of nutrients and oxygen is required for function resulting in a sudden onset of the symptoms that I had just mentioned.

And when those symptoms are occurring, this is indicative of the lack of blood flow to the heart muscle tissue. And a heart attack can result in permanent damage to the heart muscle as the heart muscle tissue dies off from the acute compromise of blood supply. And diving deeper into what's happening in the arteries of the heart, which are a network of blood vessels that supply the heart muscle, they require a continuous supply of nutrients and oxygen to actually function. Over time, the arteries become damaged due to the buildup of cholesterol and fatty deposits called plaque along the inner walls, which we usually refer to as atherosclerosis. In some situations, this plaque suddenly ruptures forming a clot in the artery restricting blood flow.

And this is the mechanism of what happens in a heart attack. The greatest benefit occurs when the patient presents to the hospital within three hours of the onset of the heart attack, but usually only one in five patients present to the hospital within this timeframe. Once the time exceeds 12 hours from when the heart attack started, the overall benefit of treatment can start to significantly decline.

Current national guidelines require that hospital systems treating heart attacks, ensure that patients are treated within 90 minutes or less from the time of medical contact to minimize risk for the patient. These days, most hospitals have targeted times of 60 minutes to further optimize patient outcomes.

Henry Mayo's Hospital has started their heart attack program back in 2013. And during the pandemic last year, Henry Mayo Hospital achieved average treatment times for 2020 during the pandemic of 45 minutes, compared to the national target of 60 minutes. The more time that passes, a patient's tends to have both immediate and long-term survival are affected. And this is why this is such an important metric.

Host: Well, tell us how you achieved such low average door to PCI time. And Henry Mayo Newhall Hospital is also a designated Los Angeles County STEMI receiving center. What is a designated STEMI receiving center? So, tell us how you achieved that low time and what really, what kind of center is this.

Dr. Lee: So, there's a rigorous list of requirements that must be submitted for a hospital to be designated as STEMI receiving center. And it also involves complicated coordination from the paramedics, the emergency room department and the cardiac catheterization lab staff. And there are a lot of nursing and ancillary staff that are involved in this process. It's a very streamlined communication process. So, the reason why it's so important when patients are having a heart attack to call 911, instead of trying to drive themselves or have a family member drive them to the hospital, is as soon as 911 is contacted and the paramedics arrive, something called an ECG is performed.

It's called an electrocardiogram. It's a tool used to diagnose a heart attack. And when a certain pattern is noticed on that test, then immediately the hospital is notified during transport to help initiate a very rapid process to have the team members come into the hospital, as well as prepare the emergency room for the arrival of that patient.

And as soon as that patient comes to the door, they bypass all other areas of the hospital, immediately get triaged in the emergency room and get transported straight up to the cardiac catheterization laboratory. So, it's a very complicated process that requires a lot of work in optimization. So, at Henry Mayo Hospital, since 2013, there's been constant drills, constant monitoring of metrics of how long it takes for a patient right when they hit the emergency room door, how many minutes it takes for the patient to be transported up to the cardiac catheterization lab? How long does it take for the paramedics to notify the emergency room and communicate effectively the information regarding the patients. So, this process has been fine tuned over many years to help achieve this metric.

Host: Very well done and well said, Dr. Lee. So, now tell us just briefly about some of the treatments. You you've talked about the, ECG and getting up to the cath lab, but tell us about a cardiac procedure whereby balloon angioplasty, stent, suction devices are used. Tell people a little bit about how this works up in the cath lab.

Dr. Lee: So, as soon as a heart patient comes to the hospital, the first thing that happens is on top of the ECG that was mentioned, they also get blood tests and there are special blood tests that are called cardiac biomarkers that help measure heart muscle damage. Those are drawn to also aid with treatment and the patient will receive medications, blood thinners in the form of aspirin and IV blood thinners. And once they are transported up to the cardiac catheterization laboratory, they undergo a procedure as you mentioned. The first step is called a coronary angiogram. And what that involves is taking a picture of the arteries using x-ray technology.

And we go in either through the wrist or the groin, and we use plastic tubes that are hollow over a wire to go all the way up to where the arteries are coming off the main blood vessel of the body called the aorta, right where it connects to the heart. And we're able to map out all the arteries of the heart and in the setting of a heart attack, the arteries are usually clogged. And usually there's a single artery causing the heart attack. And when we identify that occluded blood vessel, then we pass a wire through that artery. And then we use a balloon to dislodge the blood clot, and expand the blockage. And then we place something called a coronary stent, which is a metallic sort of coil that acts as a scaffold to keep the blockage open and that permanently heals into the body. And by doing this procedure, we're able to relieve the obstruction of blood flow to the heart muscle tissue. And the patient is able to recover from the heart attack as time goes on.

Host: What an amazing educator you are, Dr. Lee. You explain things so very well. And it's so understandable. This is such an important topic. So, you know, thank you for your really great explanations here. Before we wrap up, one of the things that a lot of people and especially women, you know, we're the caregivers of the world. And we don't always put our own masks on, as it were before we take care of our loved ones and many conditions can mimic heart attack symptoms, panic attacks, stress, we're all so anxious right now. Heartburn. I want you to give us your best advice about how we can know the difference between those, how we can possibly even know that we have heart disease that could predispose us to a heart attack. Kind of wrap that up for us with what you want us to know about those things that can mimic a heart attack. And when you feel it's really important that we call 911.

Dr. Lee: I think the most importanp point when you mentioned that is that, as I mentioned before, having risk factors for heart disease, is one first thing to recognize when considering your personal risk for heart disease. And it's also important, if you have a physician to always discuss your personal risk for having a heart attack so that you realize if any symptoms were to develop, where do I fall in that spectrum?

Because if a patient who's only in their twenties is worried about a symptom versus someone who's more in their fifties or sixties, there's a totally different level of risk. But the most important thing to remember is that patients should always err on the side of safety, we do not usually want patients to try to figure out on their own if they are having a heart attack.

So, when in this type of situation, since the treatment times are so critical in ensuring the proper outcome, it is always better to err on the side of safety. And if you are concerned that you may be having symptoms that are similar to a heart attack, as I had mentioned, then it's best to come to the hospital and let the medical healthcare personnel help guide you and figure out if you are truly having a heart attack. We are always prepared. We have had multiple situations when there have been false alarms, but that's what we're there for. And so we help guide patients through the process, figure out through testing and evaluation, whether patients really are truly having a heart attack.

Host: It's so reassuring to know that you are there and what a great message to say that's what you're there for. And sometimes it might be a false alarm, but better safe than sorry. Thank you so much, Dr. Lee, you are just such a great guest. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital.

Please visit our website at henrymayo.com for more information, and to get connected with one of our providers. And please listeners share this show with your friends and family, on your social channels. We're learning from the experts at Henry Mayo Newhall Hospital together. And Dr. Lee gave us so much important information today. So, be sure and share it so that we can all learn and stay safe. I'm Melanie Cole. Thanks so much for listening.