STORY BYSavoring a fine November day from his motorcycle, Carl Chargois had a hankering for some pecans. He pulled over at a farmer's market.
"I took about six steps off my bike and suddenly felt weak and light-headed. I went back and sat down on my bike. I started sweating and felt this pressure on my chest," he recalls.
Perched unsteadily on his beloved motorcycle, the 69-year-old Chargois was having a heart attack.
It's a scenario that plays out suddenly more than a million times a year in the United States - life-threatening blockage of arteries that supply blood to the heart. But what happened next to Chargois is rare: swift evaluation and initial treatment in the field by trained paramedics working under the remote supervision of a cardiologist.
Heart attack victims often wait
for up to an hour to call for help,
losing precious time.
Symptoms vary and include:
Chest pain: Most involve
discomfort in the center of the
chest that lasts for minutes or
fades and then returns. It can
feel like pressure, squeezing
or even resemble heartburn.
Upper body discomfort: This
can include pain or numbness
in one or both arms, the back,
neck, jaw, or stomach.
Shortness of breath: In some
cases this precedes the chest
discomfort.
Cold sweat,
nausea or light-headedness.
Chargois received a clot-busting drug that attacked his heart attack while he was still in the ambulance. It's all part of an innovative clinical trial to treat heart attack with the same urgent, systematic approach that works so well for auto accident victims and other trauma patients.
"Our system of care is very arbitrary, there is no uniform approach to treating heart attacks," says study principal investigator Richard Smalling, M.D., Ph.D., head of the division of cardiology at The University of Texas Medical School at Houston and director of Interventional Cardiology at Memorial Hermann Hospital.
A seriously injured trauma patient is transported swiftly to a Level 1 Trauma Center with expertise and equipment geared for optimal care. Heart attack victims are often taken to the nearest hospital, where type and quality of care varies.
"Half a million people die every year in this country of acute heart attack. Our goal is to define the optimal mode of treatment for heart attack patients," Smalling says. "Trauma care has its 'Golden Hour,' that first hour after injury where treatment is optimal. Heart attack victims are the same. Yet the average time from the first pain to that call to 911 is 60 minutes. We can't wait for patients to get to the hospital."
Smalling, the Houston Fire Department Emergency Medical Service and Memorial Hermann Hospital, have launched a two-part study. In the first part, paramedics perform an electrocardiogram (EKG) and transmit the results to an emergency physician at the hospital. If the physician diagnoses a heart attack and approves treatment, the clot-breaking drug Retavase is administered with the patient's consent.
The next step occurs at the hospital. Patients are randomly assigned to two types of care: One group receives a second dose of clot-busting drugs and then is admitted to a cardiovascular intensive care unit, which Smalling says is how most heart attack patients are treated if taken to the closest hospital. The second group will go directly to the cardiac catheterization laboratory where they will receive an emergency angiogram of the heart's arteries and balloon angioplasty or stent placement to open the blocked arteries.
The study will evaluate the mortality and incidence of second heart attacks among patients who receive the two courses of treatment. Patients randomized to the cardiovascular intensive care unit can be "crossed over" to the cardiac catheterization lab if the clot-busting drugs fail to work initially.
The six-month mortality in heart attack patients across the country, when treated with either standard hospital clot-busting therapy or coronary angioplasty alone, ranges between 6 and 10 percent. Smalling and colleagues believe a coordinated, aggressive strategy for treating heart attack patients that combines early administration of a clot-buster with transportation to hospitals for immediate angiography and catheter-based treatment, will lower the six-month mortality to 2 to 4 percent.
The clinical trial in Houston, Miami, Fort Lauderdale, Fla., and Lubbock, Texas, is expected to lead to a large-scale clinical trial involving 20 institutions nationally. All of the cardiac centers in the study have advanced capabilities for treating heart attacks, a high volume of major heart attack patients, and heart attack clinical trial experience.
Investigators expect the pilot study to stimulate discussion of certifying Level 1 Cardiovascular Centers that would be similar to the present certification of Level 1 Trauma Centers, which provide swift, advanced care to trauma victims. "If this works here, we can set a new standard for heart attack care," Smalling says.
So far, 21 people have been treated in the trial. The time from onset of chest pain to initial heart attack treatment has been reduced by 40 minutes and the time for transport of the patient to the catheterization lab has been reduced by almost 2 hours with the coordinated approach.
In Chargois' case, market employees noticed his plight and called Houston EMS. Among the responders was paramedic Bonnie Richter, the leader in EMS 's training of paramedics for the program. "Bonnie was extremely professional and really took charge," Chargois says.
It all went well enough that Chargois was back on his bike - against doctor's orders - a week later. He relented and backed off his rides for a while. In the meantime, he's grateful that his heart attack didn't strike while he was still riding, and for the quick treatment he received. "I'm extremely appreciative of how this went for me."
UPDATED: 2-15-2005
Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
©2000-2006 Office of Institutional Advancement, UT-Houston
Dr. Richard Smalling is a professor in the Division of Cardiology at the UT Medical School.
See Dr. Smalling also at:
Food Irradiation
and Safety
On August 22, 2008, the Food and Drug Administration (FDA) published a final rule that allows the use of irradiation to make fresh iceberg lettuce and fresh spinach safer and last longer without spoiling.
Irradiating fresh iceberg lettuce and spinach will help protect consumers from disease-causing bacteria such as Salmonella and Escherichia coli O157:H7 (E. coli). Illnesses from these bacteria range from uncomfortable symptoms to life-threatening health problems.
The foods affected by the final rule are
Irradiation (also sometimes termed "ionizing radiation") is a process of treating products with a measured dose of radiation. Food irradiation is not new. FDA has conducted irradiation safety evaluations for more than 40 years and has determined the process to be safe for use on a variety of foods.
After studying the safety of irradiating fresh iceberg lettuce and fresh spinach, FDA has determined that these greens, when irradiated under the conditions specified in the final rule, retain their nutrient value and are safe to eat.
FDA considers irradiation a complement to, not a replacement for, proper food-handling by producers, processors, and consumers. Irradiation is just another tool to reduce the levels of disease-causing microorganisms on fresh iceberg lettuce and fresh pinach.
Irradiation does not take the place of washing. FDA continues to recommend that consumers wash fresh and bagged produce before eating unless the packaging specifically states that the product has been pre-washed.
For more information, go to: http://www.fda.gov)
