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North Hills Monthly

In a Heartbeat: Teaming Up to Save a Heart Attack Patient’s Life

Oct 31, 2019 01:32PM ● By North Hills Monthly magazine

Mike Zdinak, patient, and Christopher Wentz, MD, UPMC Heart and Vascular Institute

High school teacher Mike Zdinak, 40, thought he was having indigestion or fighting off the flu when he stopped to pick up his daughter’s eyeglasses at Family Eye Care in McIntyre Square. But moments later, he fell to the floor. As the staff called 911, bystanders and a responding police officer worked frantically to keep him alive with CPR and shocks from an automated external defibrillator.

Within minutes, a local Emergency Medical Service (EMS) team arrived. An electrocardiogram (EKG) performed on site confirmed that Mike was suffering a massive heart attack as the cause of the sudden cardiac arrest. Paramedics continued administering lifesaving shocks and fluids as they whisked him by ambulance to UPMC Passavant.

Because they had already been alerted by the EMS, UPMC Passavant’s Emergency Department and cardiac catheterization team were waiting to begin treatment. After stabilizing him in the ED, Mike was moved to the cath lab where interventional cardiologist Christopher Wentz, MD, performed a lifesaving emergency angioplasty. 

Mike’s “door-to-balloon” — the time between his arrival at the hospital to when a balloon was inflated in his blocked artery to restore blood flow to his heart — was just 65 minutes. He had survived blockages to two main arteries, including his left anterior descending artery, known as “the widowmaker” because blockages there are often fatal.

MINUTES MATTER

A STEMI (ST-segment elevation myocardial infarction) is a serious heart attack in which a coronary artery is completely blocked, preventing blood from flowing to a large area of the heart. Heart muscle will die if blood flow is not restored quickly. 

“When you’re having a heart attack, time is muscle. Quick intervention increases your chance of survival and minimizes damage to the heart,” says Dr. Wentz.

In Mike’s case, the STEMI led to sudden cardiac arrest, which means his heart stopped beating. Without the heart pumping blood, the brain and other organs are starved of oxygen. Immediate treatment is needed to prevent brain damage and death.

“He actually dropped dead,” says Dr. Wentz. “But Mike is alive today because everyone acted quickly and a system was in place to promptly provide the specialized care he needed.”

DOOR-TO-BALLOON TIME

National guidelines call for hospitals to perform an angioplasty within 90 minutes — starting from the moment a patient enters the hospital until the balloon is inflated and blood flow is restored. At UPMC Passavant, the hospital averages an impressive “door-to-balloon” time of just 68 minutes, says Saleem Ahmed, MD, an interventional cardiologist and director of the Cardiac Catheterization Lab.

“Time is critical. The faster we restore blood flow through the arteries, the less damage there is to the heart,” says Dr. Ahmed.

At UPMC Passavant, a team of interventional cardiologists, nurses, and technologists is on call 24/7 to treat emergency heart conditions. Team members, who are required to live near the hospital, must be at the state-of-the-art cath lab within 30 minutes. There, doctors diagnose and treat heart problems using specialized imaging equipment to visualize the heart’s arteries and chambers.

A TEAM EFFORT

How fast heart attack patients receive medical intervention is key to their survival and quality of life. That’s why EMS responders play such a vital role in this lifesaving effort, says Dr. Ahmed. Not only can they start treatment when they arrive on the scene, they also can use an EKG in the field to quickly diagnose a STEMI and activate the cath lab — up to a half hour sooner than if someone arrives at the hospital by car. 

This “field-to-balloon” time — or “first medical contact” to balloon time — also has a 90-minute goal to reopen an artery. At UPMC Passavant, the average field-to-balloon time is 88 minutes.

“It takes a coordinated effort by EMS, nurses, technicians, and doctors to get a patient into the lab as quickly as possible,” says Dr. Ahmed. “Our goal is to open that blocked artery as fast as we can.”

EMS workers are specially trained to revive someone like Mike, whose heart has stopped beating, he notes. In addition, those patients with chest pain who arrive by ambulance often go directly to the cath lab, he adds.

CONTINUAL IMPROVEMENT

At UPMC Passavant, data is collected from every STEMI case, which is then reviewed and analyzed by a STEMI Committee made up of representatives from the cath lab, ED, and local EMS. Time is only one measure that is reviewed. The committee also looks at outcomes and complications.

 “We review every step in the process and look for ways to improve it,” says Dr. Ahmed.

Some STEMI cases are obvious, but others can be more subtle and difficult to detect. That’s why false activation of the cath lab team by EMS is always possible, he says. “But that’s the cost of getting STEMI patients identified quickly. We’d rather err on the side of caution,” Dr. Ahmed says.

That’s precisely why the STEMI Committee reviews each case. “It’s a learning experience. We look at each step to determine where we can do better,” he says. In addition to representation on the committee, EMS workers also participate in education programs on EKG readings and the subtleties they may encounter.

“The EMS responders are an integral part of our team,” says Dr. Ahmed.

A COMMUNITY ASSET

As a tertiary care center, UPMC Passavant is fully equipped to handle emergency cardiac interventions and complex open heart surgeries, such as valve replacements and coronary bypasses. Its partnership with the UPMC Heart and Vascular Institute means patients have access to an entire system of internationally acclaimed experts, sophisticated life-saving treatments, and technology.

“People in the northern communities can feel confident knowing they have a hospital like Passavant in their back yard,” says Dr. Ahmed.

That’s exactly how Mike feels. The Ross Township resident says he feels lucky to have an “excellent hospital sitting right over the hill.”

“I grew up in the North Hills and I know we take Passavant for granted. But we are fortunate to have a hospital of that caliber here in our own community,” he says.

Mike, who spent a month in UPMC Passavant’s cardiothoracic intensive care unit and 10 days in inpatient rehabilitation, has had a slow but steady recovery. In September, the father of three returned to the Hampton School District as a special education teacher at Poff Elementary School.

“I’ve heard about people who dropped dead of a heart attack, but I never thought it would be me,” says Mike.

“They saved my life — that combination of first responders, emergency staff, the cath lab team, and follow up care. I really shouldn’t be here. The fact that I’m talking now says how amazing my care was.”

Surviving a Heart Attack

How do you survive a heart attack? By acting fast and calling 911, says Christopher Wentz, MD, an interventional cardiologist with the UPMC Heart and Vascular Institute at UPMC Passavant.

“When you’re having a heart attack, time is critical,” says Dr. Wentz. “Calling 911 is the fastest way to get emergency treatment. It can save your life and minimize damage.” 

In addition to relaying vital signs and EKG results to alert the hospital cath lab team, EMS responders can treat patients at the scene — or in the ambulance — with oxygen and defibrillators to restart the heart if it stops beating. 

While some heart attacks are sudden and intense, most start slowly with mild pain or discomfort. Often overlooked are the more subtle signs, including shortness of breath or a feeling of indigestion or upset stomach.

DON’T IGNORE THESE HEART ATTACK WARNING SIGNS:

• Chest pain or discomfort, including uncomfortable pressure, squeezing, or fullness
• Pain or discomfort in one or both arms, the back, neck, jaw, or stomach
• Shortness of breath, breaking out in a cold sweat, nausea, weakness, or lightheadedness