For a person who may be having a heart attack, getting him or her the care needed quickly means everything. That’s why to qualify as a STEMI-Receiving Center, Palmdale Regional Medical Center has to be able to go from “Time of First Medical Contact,” which is usually a 9-1-1 call, to “First Device,” or when the catheter is inserted into the clogged vessel to open it, in 90 minutes or less.
STEMI stands for ST-elevation myocardial infarction, the technical term for a heart attack.
Listen in as Ranjiv Choudhary, MD, discuses how Palmdale Regional Medical Center is STEMI certified by the American Heart Association, and is one of only 33 STEMI Receiving Centers in Los Angeles County.
Management of Acute Myocardial Infarction
Featured Speaker:
Learn more about Dr. Choudhary
Ranjiv Choudhary, MD
Dr. Ranjiv Choudhary specializes in Cardiology and is a member of the medical staff at Palmdale regional Medical Center.Learn more about Dr. Choudhary
Transcription:
Management of Acute Myocardial Infarction
Melanie Cole (Host): According to the world health organization, Acute myocardial infarction remains a leading cause of mortality worldwide. My guest today is Dr. Ranjiv Choudhary. He is a cardiologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Choudhary. Tell us, what is myocardial infarction? Is this the same as a heart attack?
Dr. Ranjiv Choudhary (Guest): Indeed, it is exactly the same as a heart attack.
Melanie: So, then people hear the term “heart attack” and they also hear “sudden cardiac arrest”. What is the difference between those two?
Dr. Choudhary: Usually, a heart attack is heralded by pressure or pain in the chest, sometimes, going in the jaw or the arm and that’s how patient presents to them. It’s either they come themselves or an ambulance is called and then the patients are brought in. That’s how a heart attack may present. The sudden cardiac arrest issue is when somebody suddenly passes out or loses consciousness. That is an electrical event where the heart becomes either very, very fast or stops. That’s a different issue altogether, although there is a close relationship between the two--one may cause the other.
Melanie: So, when you discuss a little bit about chest pain, pain in the jaw, tell us a little bit about more symptoms that might signal a heart attack and the difference between what a man might feel and what a woman might feel.
Dr. Choudhary: So, the classic textbook presentation is that somebody has heavy pressure in the chest, usually radiating to the left arm, sometimes into the neck, sometimes in the back. That is the typical presentation but not everybody presents like that. A few people have no chest pain and they just have shortness of breath or will feel bad, have nausea--those type of symptoms. They may not. They may be different and they usually or very often do not present in the manner that I’ve described. They may present with this unusual type of chest pain which is not the way I’ve described it; or with shortness of breath; or just not feel well. That is where the problem lies in picking up women who are actually having a heart attack.
Melanie: And, what are some different factors that may increase your risk for a heart attack?
Dr. Choudhary: So, the usual culprits are diabetes, high blood pressure, people that have high cholesterol, people that have a family history of early heart attack. There may be a genetic basis. People that are obese, sometimes people that have been working extremely hard in an unpleasant environment because it is very hot, things of that nature--those are the usual culprits.
Melanie: Are there some things with those symptoms that you described that could be confused? Sometimes people think if they got nausea, or chest pain, they feel anxiety, a sense of dread that it could be just a panic attack? Is that sometimes confused for people?
Dr. Choudhary: You’re exactly right. That happens a number of times. Our normal tendency is to deny that it might be something bad, so sometimes people will feel indigestion and think that it is indigestion. Very often, it might well be but sometimes, in association with that feeling, there’s a feeling of dread, not feeling good, shortness of breath, sweating, not a good color and those are not symptoms related to ulcers or stomach type of problems. They may be actually a reflection of underlying heart attack that has started.
Melanie: What can somebody do if they start to have those symptoms? Is there anything to do besides calling 911?
Dr. Choudhary: I think the best thing to do is to take aspirin quickly, if you have it available and call the paramedics because the sooner they come to the emergency room, the better it is. Even if it’s a false alarm and turns out not to be a heart attack, that’s not a problem. But, if it’s a heart attack, time is muscle and we’ve got to get it taken care of right away.
Melanie: So, what do you do? What can they expect if they call 911? What are those EMTs doing and then what happens when they get to the hospital?
Dr. Choudhary: So, the very first thing that happens when the EMTs arrive, they will do an EKG and they’ll take a look at that. If it looks to them that it is a heart attack, they will transmit the EKG to the emergency room so the emergency room physician is already prepared that there may be a patient coming in with a heart attack. Once he realizes that, he will activate the cardiac catheterization team and let one of us know that there is a patient coming in with a heart attack. As soon as the patient comes in, he is very quickly assessed and rushed to the cardiac catheterization laboratory so that we could take a look at the arteries. If there is a blockage, we can open the blockage, save the heart muscle quickly and make the patient well again.
Melanie: So, you mention that time is heart muscle. So, based on how quickly you can get to this patient, you can save some of that heart muscle. What happens after the fact, after you’ve done some of your treatment, then what’s life like for that patient?
Dr. Choudhary: If the patient comes in quickly and the diagnosis is made quickly and the patient is taken to the cardiac catheterization laboratory and we are able to successfully open the artery, then the muscle is saved. Often there is a little damage to the heart and once the patient will be able to leave the hospital, which is sooner rather than later, then they can, within a few weeks resume possibly a normal life and they’ll be good healthy people.
Melanie: So, do you recommend cardiac rehab after the fact?
Dr. Choudhary: We usually instruct patients on rehabilitation. There are not physical rehabilitation center anymore that do cardiac rehabilitation like there used to be. We usually tell the patients what they can and cannot do and how to increase their activity and get back to normality and often if the work is done quickly, there’s a little damage, there is not a great need for extensive cardiac rehabilitation.
Melanie: So, what lifestyle changes would you like to tell people about to either prevent acute myocardial infarction or, if they have suffered one, what you want them to change in their lives afterwards?
Dr. Choudhary: So, there are a few things in this regard. First of all, obesity is quite a problem in the United States so, obviously, control of weight and loss of weight is important if the person is heavy. Then, in concert with that, diet has to be implemented. Less food and better food--less in terms of fast food, fatty food, more healthier diet, vegetable based diet, salad, things of that nature. So, that’s the diet issue. And then, for daily activity, I’d recommended at least half an hour to 45 minutes of modest walking and exercise in the gym, if possible, once the patient has recovered from the heart attack. And, finally, take their medication on a proper, regular basis as prescribed to them. Do not smoke. Drink a little, not a lot, and follow-up with their physician on a regular basis. They would monitor their blood pressure, cholesterol, control of diabetes--those type of issues.
Melanie: In just the last few minutes, Dr. Choudhary, what should people who have suffered a myocardial infarction think about after their initial care? What would you like them to think about?
Dr. Choudhary: I’d like them to think about a few things. First of all, they’ve got to keep active and mustn’t focus on a day to day basis on the heart. They need to move on with their life but do the things that are recommended. Once that happens and they stay well, what happens to them with a heart attack recedes to the ground and the anxieties and stress would go away. And they can live a normal healthy life which is what we want them to be.
Melanie: And, why should they come to Palmdale Regional Medical Center for their care?
Dr. Choudhary: They should come to Palmdale Regional Medical Center because we have an excellent emergency room which recognizes heart attack quickly and activates the system so that we can take the patient to the cardiac catheterization laboratory. The laboratory has a very good staff, by compassionate people who there to serve the patients. They come quickly to help the patients and treat them with kindness, courtesy and respect. The same is true for the nursing staff. If they have a good experience, which patients do, then it’s a better thing for them than if it was not a good experience.
Melanie: Thank you so much, Dr. Choudhary. It’s really great and such important information. You’re listening to Palmdale Regional Radio. For more information, you can go to palmdaleregional.com. That’s palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Management of Acute Myocardial Infarction
Melanie Cole (Host): According to the world health organization, Acute myocardial infarction remains a leading cause of mortality worldwide. My guest today is Dr. Ranjiv Choudhary. He is a cardiologist and a member of the medical staff at Palmdale Regional Medical Center. Welcome to the show, Dr. Choudhary. Tell us, what is myocardial infarction? Is this the same as a heart attack?
Dr. Ranjiv Choudhary (Guest): Indeed, it is exactly the same as a heart attack.
Melanie: So, then people hear the term “heart attack” and they also hear “sudden cardiac arrest”. What is the difference between those two?
Dr. Choudhary: Usually, a heart attack is heralded by pressure or pain in the chest, sometimes, going in the jaw or the arm and that’s how patient presents to them. It’s either they come themselves or an ambulance is called and then the patients are brought in. That’s how a heart attack may present. The sudden cardiac arrest issue is when somebody suddenly passes out or loses consciousness. That is an electrical event where the heart becomes either very, very fast or stops. That’s a different issue altogether, although there is a close relationship between the two--one may cause the other.
Melanie: So, when you discuss a little bit about chest pain, pain in the jaw, tell us a little bit about more symptoms that might signal a heart attack and the difference between what a man might feel and what a woman might feel.
Dr. Choudhary: So, the classic textbook presentation is that somebody has heavy pressure in the chest, usually radiating to the left arm, sometimes into the neck, sometimes in the back. That is the typical presentation but not everybody presents like that. A few people have no chest pain and they just have shortness of breath or will feel bad, have nausea--those type of symptoms. They may not. They may be different and they usually or very often do not present in the manner that I’ve described. They may present with this unusual type of chest pain which is not the way I’ve described it; or with shortness of breath; or just not feel well. That is where the problem lies in picking up women who are actually having a heart attack.
Melanie: And, what are some different factors that may increase your risk for a heart attack?
Dr. Choudhary: So, the usual culprits are diabetes, high blood pressure, people that have high cholesterol, people that have a family history of early heart attack. There may be a genetic basis. People that are obese, sometimes people that have been working extremely hard in an unpleasant environment because it is very hot, things of that nature--those are the usual culprits.
Melanie: Are there some things with those symptoms that you described that could be confused? Sometimes people think if they got nausea, or chest pain, they feel anxiety, a sense of dread that it could be just a panic attack? Is that sometimes confused for people?
Dr. Choudhary: You’re exactly right. That happens a number of times. Our normal tendency is to deny that it might be something bad, so sometimes people will feel indigestion and think that it is indigestion. Very often, it might well be but sometimes, in association with that feeling, there’s a feeling of dread, not feeling good, shortness of breath, sweating, not a good color and those are not symptoms related to ulcers or stomach type of problems. They may be actually a reflection of underlying heart attack that has started.
Melanie: What can somebody do if they start to have those symptoms? Is there anything to do besides calling 911?
Dr. Choudhary: I think the best thing to do is to take aspirin quickly, if you have it available and call the paramedics because the sooner they come to the emergency room, the better it is. Even if it’s a false alarm and turns out not to be a heart attack, that’s not a problem. But, if it’s a heart attack, time is muscle and we’ve got to get it taken care of right away.
Melanie: So, what do you do? What can they expect if they call 911? What are those EMTs doing and then what happens when they get to the hospital?
Dr. Choudhary: So, the very first thing that happens when the EMTs arrive, they will do an EKG and they’ll take a look at that. If it looks to them that it is a heart attack, they will transmit the EKG to the emergency room so the emergency room physician is already prepared that there may be a patient coming in with a heart attack. Once he realizes that, he will activate the cardiac catheterization team and let one of us know that there is a patient coming in with a heart attack. As soon as the patient comes in, he is very quickly assessed and rushed to the cardiac catheterization laboratory so that we could take a look at the arteries. If there is a blockage, we can open the blockage, save the heart muscle quickly and make the patient well again.
Melanie: So, you mention that time is heart muscle. So, based on how quickly you can get to this patient, you can save some of that heart muscle. What happens after the fact, after you’ve done some of your treatment, then what’s life like for that patient?
Dr. Choudhary: If the patient comes in quickly and the diagnosis is made quickly and the patient is taken to the cardiac catheterization laboratory and we are able to successfully open the artery, then the muscle is saved. Often there is a little damage to the heart and once the patient will be able to leave the hospital, which is sooner rather than later, then they can, within a few weeks resume possibly a normal life and they’ll be good healthy people.
Melanie: So, do you recommend cardiac rehab after the fact?
Dr. Choudhary: We usually instruct patients on rehabilitation. There are not physical rehabilitation center anymore that do cardiac rehabilitation like there used to be. We usually tell the patients what they can and cannot do and how to increase their activity and get back to normality and often if the work is done quickly, there’s a little damage, there is not a great need for extensive cardiac rehabilitation.
Melanie: So, what lifestyle changes would you like to tell people about to either prevent acute myocardial infarction or, if they have suffered one, what you want them to change in their lives afterwards?
Dr. Choudhary: So, there are a few things in this regard. First of all, obesity is quite a problem in the United States so, obviously, control of weight and loss of weight is important if the person is heavy. Then, in concert with that, diet has to be implemented. Less food and better food--less in terms of fast food, fatty food, more healthier diet, vegetable based diet, salad, things of that nature. So, that’s the diet issue. And then, for daily activity, I’d recommended at least half an hour to 45 minutes of modest walking and exercise in the gym, if possible, once the patient has recovered from the heart attack. And, finally, take their medication on a proper, regular basis as prescribed to them. Do not smoke. Drink a little, not a lot, and follow-up with their physician on a regular basis. They would monitor their blood pressure, cholesterol, control of diabetes--those type of issues.
Melanie: In just the last few minutes, Dr. Choudhary, what should people who have suffered a myocardial infarction think about after their initial care? What would you like them to think about?
Dr. Choudhary: I’d like them to think about a few things. First of all, they’ve got to keep active and mustn’t focus on a day to day basis on the heart. They need to move on with their life but do the things that are recommended. Once that happens and they stay well, what happens to them with a heart attack recedes to the ground and the anxieties and stress would go away. And they can live a normal healthy life which is what we want them to be.
Melanie: And, why should they come to Palmdale Regional Medical Center for their care?
Dr. Choudhary: They should come to Palmdale Regional Medical Center because we have an excellent emergency room which recognizes heart attack quickly and activates the system so that we can take the patient to the cardiac catheterization laboratory. The laboratory has a very good staff, by compassionate people who there to serve the patients. They come quickly to help the patients and treat them with kindness, courtesy and respect. The same is true for the nursing staff. If they have a good experience, which patients do, then it’s a better thing for them than if it was not a good experience.
Melanie: Thank you so much, Dr. Choudhary. It’s really great and such important information. You’re listening to Palmdale Regional Radio. For more information, you can go to palmdaleregional.com. That’s palmdaleregional.com. Physicians are independent practitioners who are not employees or agents of Palmdale Regional Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.