Real World Health Care Blog

Tag Archives: heart health

Don’t Judge a Book By Its Cover

Editor’s Note: February is American Heart Month, sponsored by the American Heart Association. While some may think heart problems are primarily a concern of the middle-aged and older, one out of every 100 kids has a heart condition. Simon’s Fund was established in 2005 in memory of Simon, son of Phyllis and Darren Sudman. The organization provides free heart screenings to children in the Greater Philadelphia area. It also sponsors medical research projects, hosts awareness events, works with major medical institutions and promotes legislation. We’ve invited Simon’s dad to share his thoughts in this week’s blog post.

Last year, many parents in the Greater Philadelphia area learned what I learned ten years ago – sudden cardiac arrest (SCA) isn’t just an adult thing. It takes the lives of thousands of children every year.

Simon Sudman

Simon Sudman

Two students, an eighth grader from Mount Laurel, N.J., and a first grader from Philadelphia, collapsed and died from cardiac arrest.

In 2005, my son, Simon died suddenly. He was a baby so most people told me it was SIDS. Our pediatrician, however, was a bit wiser. She said, “Get your hearts checked because babies don’t just die.” Following her advice, we got tested. My wife, Phyllis, was diagnosed with a heart condition called Long QT Syndrome. It’s an arrhythmia that is linked to 15 percent of all SIDS deaths.

My heart breaks for these two families. The obvious reason is that there is a gaping void in their life now. It may narrow over time, but it will always be there. There is nothing more painful or unjust than losing a child. We all know that life is unfair, but it’s not supposed to be this unfair.

The less obvious reason is that I’ve dedicated the last decade to raising awareness about sudden cardiac arrest in children so that other parents wouldn’t have to take this path. I wanted them to be smarter so they could do a better job of protecting their children. Apparently, I failed. I let these families down.

Now, they’re walking in my shoes wondering how, in the 21st century, their child can die from a detectable and treatable heart condition. Think about that. It’s not a rare disease. We don’t need billions of dollars to find a cure. We have the technology. We have the treatments. We just need to look. We need to be a little curious, like my pediatrician was 10 years ago.

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The Journal of American Board of Family Medicine published a study in 2012 showing that 72 percent of all students that died from SCA reported having symptoms from the underlying heart conditions. I’ve met students who reported symptoms like a racing heart or fainting. They were later diagnosed with heart conditions. Prior to their diagnosis, their symptoms were dismissed as drinking too much soda and being dehydrated, respectively. The signs were there. We almost let those kids down. We need to be a little more curious…a little wiser.

SCA happens when the heart stops beating, suddenly and unexpectedly. It is not a heart attack. That’s what happens when blood can’t get to the heart. The conditions that cause SCA in children come in two varieties: structural and electrical.

Here are the warning signs: 1) fainting or seizures during or immediately after exercise, 2) unexplained shortness of breath, 3) dizziness during exercise, 4) extreme fatigue, and 5) a racing heart. Also, parents should be aware if a family member has died suddenly and unexpectedly before the age of 50.

So what’s next? The experts will debate the merits of making heart screenings a standard of care, while we continue to provide free eye and ear exams to students in schools. The lawmakers will debate the merits of placing AED devices in schools, even though each is already equipped with life-saving measures like fire alarms, sprinkler systems and security systems. However, starting tomorrow, we, the parents, can be more diligent and less dismissive about the warning signs of the underlying conditions.

My seemingly healthy baby, who was average height and weight and scored an 8 and 9 on his Apgar tests (used to quickly and summarily assess the health of newborn children immediately after birth), had an undetected heart condition. These two boys, energetic and vibrant students, described as “one of the kids everybody knew,” and “shy, funny and loveable,” had undetected heart conditions. The answers may be right in front of us. We just need to look.

As children, we learn not to judge a book by its cover. Remember, we need to look at what’s on the inside. It’s time to realize this saying applies to our children’s hearts too.

Do you agree that heart screenings should be standard for children? Let us know your thoughts in the comments section.

It’s Not Over Yet: Addressing Part Two of the Door-to-Balloon Time Initiative’s Success

ReillyJohn

John P. Reilly, M.D., FSCAI

From the very first sign of a heart attack, the clock starts ticking in the race to save a patient’s heart muscle and even his or her life.

Thanks to technology and finely tuned systems of heart attack care that are now available in communities throughout the United States, we are getting faster all the time.

But sometimes we still lose the race.

During a heart attack, the heart is deprived of oxygen. The longer the heart goes with too little oxygen, the more muscle is lost, often irreversibly. This is what doctors mean when we say, “Time is muscle.” How quickly a patient receives treatment once heart attack symptoms appear often determines if he or she will make a full recovery, suffer heart muscle damage, or die.

Door to Balloon Signaled Success, or Did It?

This is why, a decade ago, healthcare professionals across the country set out to reduce the time it takes to treat heart attack patients once they arrive at the hospital. Since stopping a heart attack often involves balloon angioplasty to reopen the blocked artery, the effort was called the Door-to-Balloon (D2B) Initiative. This effort has prevented or limited heart damage for countless patients.

The D2B initiative involved making the healthcare system more efficient, more responsive and more effective, starting from the moment a heart attack patient comes to the attention of an emergency medical responder (EMR) answering a 9-1-1 call or presenting in the emergency department.  When D2B began, it often took more than two hours from the time a heart attack patient arrived at the hospital until he or she received life-saving treatment to reopen a blocked artery.

Now, 90 percent of patients who enter hospital doors receive treatment in less than 90 minutes and many are treated within 60, 30, even 15 minutes. [1]

D2B is one of healthcare’s greatest success stories. But, according to a new study [2], reducing D2B times has not been enough to significantly reduce mortality rates among heart attack patients.

What Happens Before the Hospital Door?

There are two sides to the time equation. Unfortunately, the part of the equation that has not improved enough is how long it takes patients to get to the hospital once heart attack symptoms start. Most patients wait two or more hours after heart attack symptoms appear to seek medical help. [3] Many patients are taking too long to call 9-1-1, placing themselves at risk of suffering irreversible heart damage or death.

We must do for Symptom-to-Door (S2D) Time what we have done so successfully for D2B. Revamping a system of care outside the hospital, however, is much different and perhaps more difficult than revamping a system of care within the hospital.

There have been myriad heart attack awareness programs, including online public education programs like SecondsCount.org, for which I am an editor, aimed at helping people understand the risks of heart attack, how to recognize the symptoms and why responding promptly is essential.

We have made progress. An increasing number of people know that chest pain, shortness of breath, nausea, fatigue, dizziness, and pain in the jaw, back or arm are often the first signs of heart attack. While I see more people who identified their symptoms early on, there are also many who remain unaware, are in denial or are just confused. Every day, I see patients who thought their symptoms “weren’t that bad” or explain them away as indigestion or a virus. I also see the toll that lost time takes in hearts damaged and lives lost.

Only 60 percent of patients contact emergency medical responders when experiencing symptoms. About 40 percent arrive at our hospitals on their own. [4] That’s dangerous, whether the patient is driving him- or herself. Or, even if a friend or relative is driving, it still represents a lost opportunity for treatment to begin in the ambulance, or to alert the doctors in the emergency room that a heart attack patient is on the way in.

Let’s Save More Hearts and Lives

To get started, here are a few thoughts on how we might reduce S2D:

  • We need a concerted national effort to reduce S2D time that establishes consistent messages rather than myriad programs offering incomplete or inconsistent information.
  • We must improve regional and statewide systems of care to coordinate heart attack care to ensure everyone gets the most expeditious care.
  • We need to better inform the people who are most at risk for heart attack or other heart issues about what symptoms to look for and what to do if they develop.
  • And, of course, we must continue our educational efforts, helping everyone to understand that if they are concerned they may be having a heart attack, then they should call 9-1-1 without delay and without concern about looking foolish if their symptoms turn out to be something other than a heart attack.  The alternative – sitting at home while having a heart attack, with heart muscle dying as the minutes tick by – would be far worse.

We’ve had remarkable success in reducing D2B times. But it’s not enough. To save hearts and lives, we must take on the other side of the heart attack challenge.

We’ve done it once. We can do it again.

1. Bates ER, Jacobs AK. Time to Treatment in Patients with STEMI. N Engl J Med 2013;369:889-892.
2. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013;369:901-9.
3.  Life After a Heart Attack. National Heart, Lung, and Blood Institute.
4.  http://nypress.com/forty-percent-do-not-call-911-survival-rates-show-every-minute-matters/, http://www.nejm.org/doi/full/10.1056/NEJMp1308772