August 5, 2008

Heart Attack, Cardiac Arrest Differ in Important Ways

By Tracy Wheeler, The Akron Beacon Journal, Ohio

Aug. 5--Before March 5, Akron Police Officer Michael Vavro had never used an automated external defibrillator (AED) in a real-life situation. And he hasn't used one since.

That one time was enough, though.

"He saved my life," said Patricia Monstrom. "He really did."

"No," Vavro said, sheepishly. "The machine worked."

The 70-year-old Akron woman was shopping at the Giant Eagle on Waterloo Road in Akron, when she started feeling dizzy and sat down in the aisle.

"I asked her if she needed help, and she said, 'No, no, I feel OK. I just need to call my daughter,' " Vavro said. "Next thing you know, out she goes."

Vavro called for an AED -- a computerized device that assesses whether a shock is needed to return a heartbeat to normal -- and, fortunately, the store had one. Monstrom is now alive and feeling "fine."

Usually, a story like this is used as an anecdote about why AEDs are so important. And that's part of this story, too. But Summa Health System wants to use Monstrom's situation as an educational tool, first for its nurses, then the general public.

Most people, even nurses, would hear Monstrom's story and assume she had a heart attack, said Dr. Michael Pelini, Summa's medical director of heart rhythm services. She didn't. Instead, she suffered a sudden cardiac arrest.

And comparing a cardiac arrest to a heart attack is like comparing a blown fuse box to a clogged drain pipe.

Both can lead to catastrophic effects, but through totally different means.

Summa Health System wants to make sure everyone knows the difference between the two cardiac events. The message will be delivered first to Summa's own nurses during a "grand rounds" educational forum later this week, with plans to get the word out to the general public by the fall.

"People think cardiac arrest and heart attack are the same thing," said Pelini, "but they're not."

To put it in basic terms, a heart attack is a plumbing problem, which occurs when a blood clot blocks the flow of blood to the heart, said Kaye Reiter, director of Summa's catheterization, electro-physiology and endovascular labs. Sudden cardiac arrest is an electrical problem, in which the heart begins beating too rapidly until it stops beating altogether.

In more than 90 percent of cardiac arrest cases, the patient dies, making it the leading cause of death in the U.S., killing more than 325,000 people each year.

Knowing the difference between a heart attack and a cardiac arrest is not important during initial emergency treatment, Pelini said. Both problems require CPR or an AED, along with a quick trip to the emergency room, to save the victim.

The difference, though, matters in the follow-up care.

For a heart attack patient, it's important to know your blood pressure and cholesterol levels. That's important for cardiac arrest patients, too, but so is another little-known number called ejection fraction, Reiter said.

Measured during an electrocardiogram using ultrasound, a person's ejection fraction measures how effectively your heart is pumping blood. Even though it's not always associated with symptoms, a low reading (35 or below) puts a patient at greater risk for heart disease.

"If they're heart patients," Reiter said, "we want them to know their ejection fraction."

Patients with low ejection fractions will be put on medications to keep their hearts on pace, while other testing is done to find the cause of the problem. If medications aren't effective, an implanted defibrillator will be surgically placed near the heart to deliver a shock if it begins to beat too rapidly again.

"I always tell patients it's like having a paramedic with you all the time," Pelini said.

Patients should talk to their doctor about ejection fraction or other heart tests if they: (1) have a family history of early heart disease; (2) faint without explanation; (3) or have chest pain, shortness of breath or fainting during exertion.

Pelini said Summa's cardiac arrest campaign wants to hit on three key points:

--Basic prevention is key. Eat right, exercise, and pay attention to your cholesterol and blood pressure.

--Quick use of AEDs in public are critical. In fact, he said, Akron's survival rate among cardiac arrest patients is higher than the national average -- 12 percent vs. 8 percent -- because of the focus on placing AEDs throughout the community. When a cardiac arrest patient is treated within 60 to 90 seconds, the survival rate is about 98 percent. If treatment waits for nine minutes, the chance of survival is essentially zero.

--It's important that medical professionals -- whether they are nurses or doctors who don't specialize in cardiac care -- know the difference between heart attacks and cardiac arrests.

"We don't want the patient to walk in and say, 'What's my [ejection fraction]?' and the doctor says, 'What?' " Reiter said.

More than four months since her incident, Monstrom said, "I feel fine. I really do."

She spent 20 days in the hospital and now has an implanted defibrillator. She just wishes it had never come to that.

"I didn't take care of myself the way I should," she said. "I thought I had high blood pressure but I didn't take care of it. I hadn't gone to the doctor in a long time."

Tracy Wheeler can be reached at 330-996-3721 or [email protected]


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