During a heart attack, fast treatment is critical. Every second that the heart isn’t pumping, the heart muscles and other tissue throughout the body is deprived of life-giving oxygen. For the most serious heart attacks, ST element myocardial infarction (STEMI), the right diagnosis and rapid treatment are even more important.
In many cases, patients wait to arrive at the ER before getting a diagnosis from the medical team. However, in cases of STEMI, diagnosis must occur as soon as EMS staff arrives on the scene. That’s because not every hospital has the facilities and experts to properly treat STEMI, so EMT’s need to be sure that the patient is taken to a hospital that can offer what the patient needs.
The EMS staff conducts an echocardiogram (ECG) to determine the cause and severity of a heart attack. If they believe that a patient is suffering from STEMI, they immediately work to stabilize the patient and transfer the patient to the closest appropriate hospital.
A specialized team of cardiologists and nurses immediately meets the STEMI patient upon arrival at the hospital. Since STEMI is caused by a clot or blockage in the arteries of the heart, it’s necessary to remove that blockage as soon as possible. Cardiologists administer this treatment in a cardiac catheterization laboratory, where they can thread a catheter through the patient’s arteries and into the heart. Once the catheter is in place, the team may conduct one of these percutaneous coronary interventions (PCI):
- Balloon angioplasty: A balloon placed on the end of the catheter is quickly inflated, dislodging any blockage in the artery.
- Stenting: This procedure entails placing a mesh tube in the artery, holding it open after an angioplasty.
The team may also administer clot-busting medications, to thin the blood and dissolve any clots that may have contributed to the STEMI—or formed as blood pooled in the heart. Called thrombolysis, this procedure may also be done through the catheter, depending on the nature and position of any blood clots.
If PCI and thrombolysis are not completely effective at removing any blockage, or if blockage in other parts of the heart is also severe, the team may decide to do a coronary bypass artery graft. During this surgical procedure, a section of vein is removed (usually from the patient’s leg). A heart surgeon then attaches, or grafts, the vein to the heart. The vein serves as a “detour” around blocked arteries in the heart.
STEMI Treatment Guidelines
The American Heart Association and other professional medical organizations have laid out certain guidelines that apply to the quality and timeliness of STEMI care. Perhaps the most important is door-to-balloon (D2B) time. D2B time refers to the length of time it takes for a patient to receive PCI after entering the hospital. A hospital’s D2B time should be 90 minutes or less.
It’s important to remember that not every hospital will have a D2B time, because not every hospital is equipped to treat STEMI. If you’re looking for a hospital with advanced cardiovascular care, or simply have questions about your heart health, please contact us at HCA West Florida. Visit us online or call Consult-a-Nurse® at 1-877-442-2362 for answers to your questions and free physician referrals.