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Treating Heart Disease

Published in Heart & Vascular, For the Health of It Author: Cardiologist Richard Backes, MD

Dr. Rick Backes, cardiologist with the CentraCare Heart & Vascular Center, spoke with WJONs Jay Caldwell about the symptoms of a heart attack and how to treat it. Read Dr. Backes’ blog post about preventing heart disease.

Jay Caldwell: What determines the next course of treatment when someone has a heart attack?

Dr. Rick Backes: First, let’s define what a heart attack is — a heart attack or myocardial infarction (MI) is a plugged pipe. It’s like a hairball in your sink where the water can’t drain. A heart attack simply means you have a complete blockage of an artery in your heart. The blood cannot get below that blockage, and the heart cells that it feeds start to die.

Several important points about a heart attack. Number one: those heart cells start to die within 30 minutes after the artery is plugged, and those heart cells will be dead within 12 to 24 hours after you plug up an artery. That’s important because when you get chest pain or if you’re concerned or wondering if you’re having a heart attack, there is a definite time window to get in. The longer the artery is plugged, the more heart cells will be damaged. Once a heart cell dies, even after inserting a stint or balloon, the heart cell will not be brought back to life. So, you end up with significant heart damage.

If you have a medical emergency, call 911 or have someone bring you to the emergency room. Prompt treatment saves lives.

The typical scenario or symptoms of a heart attack is chest pain or pressure or tightness or squeezing. Understand that about 70-80% of men will have typical symptoms. It’s only about 50% of women who have those typical symptoms. And as we age, we may have more shortness of breath or, in fact, no symptoms at all. If you suspect you’re having a heart attack, you need to get to the closest emergency room as quick as possible. What happens then is EKGs and blood tests are drawn to look at the cardiac enzymes. If there’s evidence you are in the throes of a heart attack, that means you’ve plugged that artery up completely and we know now, unequivocally, that the quicker we get that artery opened, the less heart damage there is going to be and the chance of survival will be much improved.

When I started back in 1980, in med school, we didn’t do any of this. We watched people have a heart attack. We put them in an ICU and let them complete the heart attack. And at that time, 15 percent of people died while we sat and watched them because we had no ability to balloon or stent the artery open. In today’s world, if we get you to the cath lab promptly, the mortality with a heart attack is down to 1%. Now what happens if you present to our ER here in St. Cloud, doctors will get an EKG and enzymes, and then they’ll call the cardiologists in and say “I have a patient with an MI” and we will call the cath lab team in. The cath lab is where we work to get the arteries open. We will open the artery up with a balloon and put a stent in it. All of that we hope we can do within an hour after the patient presents to the ER.

If you go into another ER, say in Staples or Wadena, and the doctors there see a heart attack, they will fly patients to us as soon as possible. We have developed this program at CentraCare where all of our surrounding communities know as soon as a patient comes in with chest pain to get an EKG, get the enzymes and if they’re in the throes of a heart attack, get them to us so we can get them to the cath lab as soon as we can. The saying in my world is “Minutes are myocardial.” So as long as we get the patient in, the artery open, we limit the damage. We take big heart attacks and turn them into small heart attacks. The first thing is to get the artery open.

The subsequent care after that depends upon how big the heart attack was. And we can check that by amount of damage in the heart by a test called an echo or an ultrasound of the heart. But the other treatment will depend upon how much damage was done. Every patient who gets a stent put in will be put on both aspirin and then another blood thinner that inhibits the platelets to keep clots from forming within that stent. We also will talk about the risk factors because the patient was lucky — he or she survived that heart attack. We talk about all those preventative issues and that’s why we get patients involved in cardiac rehab to try to educate them and get them to change their lifestyles.

Jay Caldwell: If you have a heart attack, will your heart be less equipped to handle another one?

Dr. Rick Backes: The answer to that is maybe. If the initial heart attack was large. What defines a large heart attack? Well our heart is a pump. That’s all it does, all day every day, is pump the blood through the rest of the body. A large heart attack, by definition, generally would damage literally half of that pump. A tiny heart attack means the pump may be totally normal. If you’re lucky enough to have had a tiny heart attack, you have lots of reserve left, so you could potentially survive a second or third. If you’ve had a large heart attack and damaged a significant amount of the heart, then your reserve, so to speak, to handle a second one is severely compromised.

Jay Caldwell: At what point is a pacemaker beneficial to someone with a heart condition?

Dr. Rick Backes: When I talk to patients, I tell them that heart doctors are plumbers and electricians. Those are really the two sides of things we do. A heart attack is a plumbing problem — it’s a plugged pipe. Now the electrical system of the heart is what makes the heart beat. There are some patients who will have heart rhythm problems where they get irregular heartbeats or something called atrial fibrillation.

If you watch television, you will see multiple ads about treatments of AFib. But what a pacemaker is for is quite simple. If your heart is beating too slow or if it forgets to beat for a period of time, you need a pacemaker. If our heart forgets to beat for about three or four seconds, you can have a dizzy spell, light-headed spell. If it forgets to beat for about six or seven seconds, you can pass out. And obviously if you’re driving a car, we don’t want that to happen. A pacemaker is indicated if your electrical system is not beating appropriately.

The flip side of things, on the fast side, you may have heard of or know people who’ve had what are called defibrillators. If a patient’s heart takes off and races and has a dangerous heart rhythm from the bottom chambers of the heart, that’s what a defibrillator is for.

Defibrillators help with fast heartbeats. A pacemaker helps with slow heartbeats, or if the heart forgets to beat. It does absolutely nothing for a heart attack.

A common scenario that I see — patients will feel what are called palpitations or heart takes off and flip flops, flutters or races. And the first emotion most patients has is either “I’m going to die” or “Oh my God, I’m going to have a heart attack.” The heart attack is plumbing, the plugged pipe. Flip flops, flutters, dizzy spells are electrical problems with the heart. Not a heart attack. If I have more than two cups of coffee in the morning, I feel some little fluttering — that’s electrical, that’s not plumbing.

Jay Caldwell: If you have one clogged artery, are you likely to get another one?

Dr. Rick Backes: The disease process called atherosclerosis doesn’t just occur in one spot in the blood vessel. It is a disease that occurs in every artery in the body. If you plug up in the neck, strokes are the problem. If you clog up the arteries to the legs, people can lose their limbs. And if it’s heart arteries, the coronary arteries, it’s heart attacks. But that process may occur in one spot more severely than others. But the disease process occurs in every blood vessel in the body. One heart attack, one stent, does not stop the disease process.

In 40 years in medicine, I’ve never cured anybody with a balloon, a stent or a bypass. We buy people time. The cure is in the lifestyle. Lifestyle changes, getting cholesterol down, controlling sugars, etc.

Jay Caldwell: If you do have something you think might be a heart attack and you need to go to the ER, what should you say or what should your loved one say to get you a care as soon as possible?

Dr. Rick Backes: The keywords are usually chest pain and that gets a whole sequence. And this is not just in the St. Cloud ER. Around the country, if you say those words, that will hopefully set off a sequence of events where a very quick EKG is done and then what are called the cardiac enzymes. The cardiac enzymes have evolved over the last 40 years where if there is a problem with the heart, those enzymes are very sensitive to picking up even the tiniest of heart attacks. If there are concerns, go in and tell the triage nurse that you’re concerned about it and that will set up a series of tests that will be done.

Jay Caldwell: How valuable is the heart care at CentraCare to the St. Cloud community?

Dr. Rick Backes: I was born at St. Cloud Hospital. I grew up in a small farm by Foley and have watched the hospital here go from a community hospital to a true tertiary care referral center. I have been fortunate to be a part of the Heart Center for going on 20 years. Most of the us who work in the Heart Center are Minnesota kids, who have wanted to raise our families in a relatively small town, but bring care to the area that is second to none. We fortunately have been recognized many times as either a Top 50 or Top 100 cardiac institution in the country. And obviously, we take great pride in that. Most of us have trained at the best institutions in the country, but we have chosen to either come back home to raise our family or to do it in a smaller town rather than a big city.