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‘Time is muscle’: Heart attack victim says fast response saved his life

UPDATED: Sat., Aug. 1, 2020

Ken Sylvester knows the reason he survived a “widowmaker” heart attack on June 27 goes directly to a speedy medical response.

After unbearable chest pain struck in the early morning, it took less than an hour from emergency responders’ arrival and then Life Flight leaving the Nine Mile Falls area to a coronary angioplasty procedure. It was critical to open Sylvester’s fully blocked left anterior descending artery and return blood flow in less than 90 minutes to prevent permanent heart damage, or death.

Sylvester requested the helicopter land at the MultiCare Pulse Heart Institute inside Deaconess Hospital.

“I’d gone to bed rather late and couldn’t sleep, so I rolled over and started playing a video game on my phone,” said Sylvester, 51, who didn’t have prior symptoms. “It came on like really bad heartburn. I rolled over to get up and take some Tums, and when I went to sit up, that’s when it hit me like a ton of bricks.

“It felt like a 400-pound person standing on my chest wearing a pair of stilettos, almost directly in one spot, with pressure and pain. I couldn’t breathe.”

He had to wake his wife, Carol, from a deep sleep. “She woke up and woke my son up, and they called 911.”

Sylvester now tells others about the need to get care in that “golden hour” after a heart attack. He said he’s grateful for the emergency responders arriving in about 15 minutes and to providers at the Pulse Heart Institute. The center recently doubled in size with a staff addition and now has more than 20 physicians.

“I wouldn’t be here without them,” Sylvester said. “I know it’s because of everybody’s quick response, and we’re in a rural part of Spokane.” Emergency responders who checked Sylvester with an EKG told him that an ambulance ride wouldn’t get him to the hospital in time, so Life Flight landed in a small pasture at his residence.

At Deaconess, interventional cardiologist Dr. Mohit Jain and a medical team were preparing for Sylvester’s arrival. All cardiology centers have a focus to act in a short window of time to open up an artery, Jain said.

The type of heart attack Sylvester had still carries its informal name of widowmaker, Jain added, as a term from the 1960s when more men smoked and often died from a 100% blockage in the LAD artery because it supplies a significant amount of blood flow to the larger, front part of the heart. Women can have the same type of attack but often with different symptoms, and quick response is crucial for anyone, Jain said.

“That golden hour number still stands,” Jain said. “The sooner we can open up the artery and provide oxygen-rich blood back to the heart muscle, the less the chances of going into lethal arrhythmia. That was studied extensively in the ’90s that determined what’s the best time cutoff that actually saves patients.”

Modern cardiology teams strive for a “door-to-balloon” time in less than 90 minutes, Jain said, from when a patient enters a hospital to having the angioplasty, which uses a tiny balloon catheter to reach a clot, and the balloon is then inflated with saline and contrast mixture to open the artery.

The balloon’s inflation restores blood flow, followed by the team putting in a permanent stent – a tiny wire mesh tube – at that same position.

In July, the Pulse Heart Institute was recognized for providing the fastest heart attack care in Eastern Washington and tied in the state for 2019 with an average of 44 minutes for door-to-balloon time. It’s important because “time is muscle,” Jain said.

“The heart is a muscle that pumps blood to the rest of the body, so the moment the heart attack starts, that means the heart muscle is not getting enough blood and oxygen,” he said. If that goes too long, heart muscle dies, “and you can’t restore a dead muscle.”

Sylvester had to have three stents because his LAD artery was blocked 100% in two places, and another blockage was in a diagonal artery. His procedure was done via the radial artery in his wrist instead of the femoral artery in the groin. Jain said the radial artery approach emerged about 10 years ago, and Pulse cardiologists use it as a preferred technique that has fewer bleeding complications.

Physicians use a guidewire that is 0.014-inch in diameter for leading the balloon to the blockage, and the left descending artery is between about 2.5 millimeters and 4 millimeters in size, “so we’re talking pretty tiny stuff,” Jain said. “When we put in the balloon, we size it according to the artery.”

The wire serves as “a rail on which we pass the balloon over, and once we get it to where we need to go, we inflate the balloon,” a process which helps restore blood flow and compresses a clot against the vessel wall. The team then deflates the balloon that’s taken out, followed shortly by putting in a stent that’s also mounted onto a balloon, he said.

“Once we get to that place where we had the balloon before, we inflate this stent balloon, and then the stent expands fully, and it captures that clot between the stent and blood vessel.”

For women, Jain said heart attacks might bring pain in the back or down the right arm. Others might have nausea, shortness of breath and intense fatigue.

“Women might not experience any symptoms, but they just know something isn’t right, so recognition is key.”

After his procedure, Sylvester and his medical team decided to wait for his recovery before tackling a problem in his right coronary artery, which had about a 90% blockage. However, about a week later, he returned to the hospital after feeling pain on the right side of his chest and arm.

“I wasn’t sure it was a heart attack; there was some pain and pressure,” Sylvester said. His wife started driving him to the hospital, but he started feeling worse, so they met an ambulance at a fire station. A different Deaconess cardiologist did that angioplasty procedure.

Recovering at home, Sylvester encourages people to call 911 if they think they’re having a heart attack, even if unsure.

“Get help right away,” he said. “The sooner you can make a call to 911 and get the professionals there, the better it will be.”

His family practitioner told him he was surprised Sylvester walked into the practice because of the type of heart attack on June 27.

“Another 5 minutes, I probably wouldn’t have made it,” Sylvester said. “I was lucky my family was here. I was lucky I hadn’t fallen asleep. You never know what day will be your last, so every day I hug my wife, my kids and my grandkids.”

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