It’s the chest discomfort that has an unusual,
uncomfortable characteristic, it is generally fairly severe. It comes on in a crescendo
manner it may radiate to the jaw, teeth and to the shoulder but generally people can’t
put their finger right on it. It is more of a widespread discomfort. It is often accompanied by shortness of breath,
sweating and an overall feeling of doom on the part of the patient. The patient clearly
does not feel good at all. They generally know they’re in trouble. If they already have nitroglycerin, we generally
recommend they take the nitroglycerin. If they have a regular aspirin available, we
ask them to take it, chew it in fact if they can and wash it down with a glass of water.
If they are really uncomfortable they probably need to have someone drive them to the emergency
room. Family history has a huge role. Primarily
in terms of which risk factors someone has and how the person responds to those risk
factors. Hypertension, for instance, tends to run in
families. The severity of it not necessarily but there is a tendency. The second risk factor
is high cholesterol, in which particular type of high cholesterol. There is an abnormal
lipid profile that is characterized by a high LDL or bad cholesterol and then there is a
profile that is characterized by low good cholesterol. Both of those are risk factors
for the occurrence of coronary artery disease, Atherosclerosise, the development of vascular
disease and so forth, even stroke. The American Heart Association has been able
to clearly document there is an improvement in survival and an improvement in treatment.
We have set goals in terms of the speed of treatment and we have refined them to a shorter
and shorter time period as time goes on. We have a program here that is directed by one
of my partners in the catheterization laboratory in concert with the emergency department.
We have a specific series of steps that occur very promptly when somebody shows up with
clearly a heart attack. That ultimately culminates with the patient going to the catheterization
laboratory, hopefully, within an hour to 90 minutes and having that artery opened. Somewhere around 30 percent of myocardial
infarctions present as sudden death. In the vicinity of the center, let’s say someone
here in Omaha, who has a heart attack; there are a lot of places with emergency care for
that. If they survive to the emergency facility the mortality rate is actually quite small.
It is that initial group that has the cardiac arrest where the numbers are not good at all. In people with any risk in their family, they
ought to at least get a blood test, check their blood pressure and perhaps do that on
a yearly basis or maybe every other year if it’s lower risk. Certainly diabetics and
younger people already diagnosed with hypertension, they should definitely be under the care of