The heart of a sixty-three year old male patient with high grade stenosis

During a medical emergency like acute myocardial infarction—a heart attack—it’s reassuring to know that the gold standard in cardiac care is just moments away.

Washington County Hospital is now performing percutaneous cardiac intervention (PCI), a procedure in which the surgeon opens blocked arteries with a balloon and places stents to hold the artery open.

In the past, heart attack patients who were seen at Washington County Hospital were transferred by helicopter or ambulance to medical centers in Baltimore and Washington. While we are enormously proud of our cardiac team’s ability to diagnose and transfer patients rapidly, our patients’ access to timely treatment was vulnerable to delays caused by weather and traffic.

So, when the Maryland Health Care Commission granted Washington County Hospital permission to begin performing percutaneous cardiac intervention (PCI), we immediately launched a $1.7 million renovation of the cath lab. With the upgrades complete, we successfully performed our first coronary angioplasty in April.

The new cath lab is staffed by a team of cardiac nurses and interventional cardiologists from Hagerstown Heart, CardioCare, and Robinwood Heart, who are on call at all hours of the day and night. We expect to perform about seventy PCIs a year for patients who would have previously been transferred to another medical center for treatment. While the number may seem small, the implications for the well-being of our patients, their families, and our community are great.

The cardiologists at Washington County Hospital are proud to be able to offer this advanced treatment in our ongoing effort to serve our patients and community.

Before 99% proximal left anterior descending artery (LAD) stenosis		After Status post stent of proximal left anterior descending artery (LAD)

What is acute myocardial infarction?

During an acute myocardial infarction, or heart attack, the blood flow to the heart is interrupted. This deprives the heart of oxygen and damages or destroys part of the heart muscle. Heart attack is a leading cause of death for both men and women in the U.S.

The interruption in blood flow is usually caused by plaque, a substance primarily composed of cholesterol and fatty acids. The plaque builds up on the walls of the arteries, which can narrow the space through which blood passes. When part of the plaque breaks off, a blood clot forms and creates a sudden blockage.

Symptoms
The most common signs and symptoms of a heart attack include the following:
• Uncomfortable pressure, squeezing, fullness, or pain in the center of the chest. The discomfort or pain can be mild or strong; it will last more than a few minutes, or it may fade and then come back.
• Upper body discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath with or before chest discomfort
• Nausea (feeling sick to your stomach), vomiting, lightheadedness or fainting, or breaking out in a cold sweat. These symptoms are more common among women.

If you think you or someone you know may be having a heart attack, call 9-1-1 right away, or within five minutes of experiencing symptoms. It’s extremely important to seek medical assistance immediately. Even if your symptoms stop completely within five minutes, still call your doctor. Also, only take an ambulance to the hospital, because going in a private car can delay treatment. And finally, take a nitroglycerin pill if your doctor has prescribed this type of medicine for you.

Diagnosis
A patient who enters Washington County Hospital’s emergency department with chest pain will be fast-tracked in order to obtain vital signs and electrocardiogram (EKG) results within about ten minutes. The EKG shows electrical activity in the heart. If the EKG indicates the need for an angioplasty, the patient will go directly to our cath lab for treatment.

Treatment
When a heart attack occurs, the treatment is to open the artery to allow blood to pass through to the heart. A procedure called coronary angioplasty does just this, using a balloon and often a stent.

During an angioplasty, the cardiologist threads a wire with a balloon into the blocked part of the artery, then inflates it. This presses the plaque against the walls of the artery, opening a clear path for blood to move through. The cardiologist will often place a stent—a small tube of wire mesh—in the artery to help ensure that it remains open. During the procedure, the cardiologist can see your arteries, along with any areas of blockage, on a large screen.

Coronary Stent - a tiny wire mesh tube is inserted into the coronary arteries after a balloon has flattened the plaque against the artery. Stents are used to keep the artery open.

If the angioplasty procedure is unsuccessful at opening the arteries, or if there are multiple blockages, the patient will rapidly be transferred to another facility for heart bypass surgery.