Cardiology
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Discover what happens when you arrive at a Mediclinic emergency centre with symptoms of a heart attack.
Early intervention is key
If you suffer a heart attack, the sooner you receive medical attention the better. “Early intervention may improve recovery time,” says Dr Ryan O’Meara, an emergency medicine physician and Head of the Emergency Centre at Mediclinic Milnerton.
As soon as you start experiencing symptoms of a myocardial infarction (heart attack), you should go to your closest emergency centre (EC), he advises. “We have systems in place that immediately activate the right teams as soon as we identify a patient needs a specific level of intervention and care.”
Research shows there is greater benefit when a heart attack patient receives intervention within four hours. “Each clinical scenario is managed according to the presenting signs and symptoms, which often indicate to us how severe the damage is,” says Dr O’Meara.
Common signs of a heart attack
- chest pain
- central crushing heaviness
- pain that may to the arms, jaw, neck
- sweating
- nausea
- shortness of breath.
What happens when you arrive at the Emergency Centre?
After triage – where chest pain is rated as “very urgent” (orange on the scale) – the nurse will check your vital signs and perform an electrocardiogram (ECG).
“The ECG records the electrical activity of your heart and helps to diagnose various heart conditions,” Dr O’Meara says. The doctor on duty, supported by the specialist who covers the unit, will interpret your ECG results together with your symptoms and risk factors.”
What tests will the EC doctors do?
“Depending on the clinical scenario, you'll probably have more than one ECG, because the ECG itself is just a snapshot in time,” Dr O’Meara explains. “A comparison of the two ECG results will show if any changes have occurred. It can also reveal signs that something serious is going on.”
If needed, the emergency centre doctor will order blood tests to check for cardiac enzymes, which are proteins released when the heart muscle is damaged. “We specifically look at Troponin and compare it to standard ranges to see if it’s higher than normal,” Dr O’Meara explains. Troponin is a protein found in the heart, and when the heart muscle is damaged, Troponins leak into the bloodstream.
In emergency centres, the doctor may also do a bedside echocardiogram to check your heart. “We look for signs of damage, called wall motion abnormalities,” he says. “If part of the heart hasn’t been getting enough blood, it won’t contract as well as it should.”
Combined with the blood tests, ECG results and risk scoring, doctors can be certain if you have or haven’t had a myocardial infarction. “It also helps us determine whether you must be admitted for further investigations and management,” Dr O’Meara says.
What is a cath lab?
Some hospitals have dedicated cardiac catheterisation laboratories, known as cath labs, where doctors perform minimally invasive procedures to diagnose and treat heart and blood vessel conditions.
“If a suspected heart attack patient arrives at a Mediclinic hospital a cardiologist is always available to provide that specialised support, even if this is an initial telephonic consultation for the EC team,” Dr O’Meara explains. “Our EC also has a specialist emergency medicine physician (unit head) who oversees and provides any additional critical care intervention needed before the patient leaves the emergency unit,” he says.
Doctors can also administer thrombolysis, a clot-busting medication to break down a clot provided certain criteria are met.
“Once in the cardiac catheterisation lab the cardiologist can do an angiogram and perform whatever further interventions are required,” Dr O’Meara says. “For example, they might use a balloon catheter to open an artery, where a stent (a small wire mesh tube) will be placed to keep the artery open.”
Am I more prone to have a heart attack?
Risk factors include:
- close family member has had a heart attack
- high blood pressure
- diabetes
- obesity
- smoking
- high cholesterol
- age
It's important to understand that once you've had a heart attack, your symptoms might be less severe if you experience another one, Dr O’Meara explains. For example, you might only notice that you’re struggling to breathe instead of feeling chest pain. Some people with diabetes also don’t get any chest pain at all during a heart attack. “Patient symptoms can vary a lot, which is why if anyone has vague-sounding symptoms of a heart attack, they should seek urgent medical attention.”