Chest pain? Call 9-1-1
David DePue stopped making breakfast and sat down on the couch to rub his right chest muscle, whose ache had kept him up most of the night. He was certain that a routine move on a weight machine at the gym had caused the muscle strain. Well, almost certain.
And it was the “almost” that nagged at him: Could it possibly be a heart attack? Running through the checklist of symptoms he’d read in the past, he made a self-assessment. No nausea, no dizziness, no shortness of breath, no history of heart disease. He went to the gym three times a week for spins on a stationary bicycle and to lift weights. He ate moderately well and took long bicycle rides through Fort Ord. And wasn’t heart-attack pain supposed to be on the left side?
His insurance also came to mind. What would it cover? If he got to the hospital and wasn’t admitted, he’d have quite a bill to pay. Besides, he’d be embarrassed if he called 9-1-1 to hail an ambulance, only to confirm it was just a muscle strain.
Then DePue got the trigger that something more than muscle pain was at play. When he leaned back on the couch, he could feel the pain in his chest. When he leaned forward, the pain went away. That scared him.
“I called 9-1-1,” says DePue, 62.
“I was able to get up, unlock the front door and sit back down, to wait. I leaned forward until the paramedics got there, no more than five minutes. I apologized in case it was just a muscle strain.”
It wasn’t. An emergency medical technician placed electrodes on DePue to check his heart’s electrical activity through an electrocardiogram (EKG). “Mr. DePue,” he said as he looked at the results, “you’re having a heart attack.”
“I actually was relieved because I knew what it was and because I knew the reputation of Community Hospital’s heart program,” DePue says. “I knew if I could get to the hospital, I would be in good hands.”
DePue made the right call: During a heart attack, 85 percent of heart damage occurs within the first two hours, so fast action increases chances of survival and of regaining a full life. Calling 9-1-1 is a key part of a chain of survival that includes early recognition and response, access to emergency care including cardiopulmonary resuscitation and defibrillation, and advanced care at a hospital with expert care and equipment, like Community Hospital.
At DePue’s home, EMTs gave him nitroglycerin, which dilates the arteries to improve blood flow, and sped to Community Hospital.
In the ambulance, DePue could feel himself passing out. “I thought I was dying,” he says, “I thought that was it.”
Dr. Reb Close, an Emergency department physician, waited in the ambulance bay, prepped for DePue’s arrival after reviewing a transmission of his EKG from the field. When the ambulance backed in, Close peered through its doors and saw DePue, ashen and eyes closed. When she called his name, he opened his eyes in recognition. As the EMTs moved him from the ambulance, they filled Close in and she accompanied him directly to the cardiac catheterization lab, bypassing the Emergency department.
“With no time to waste,” she says, “we made our assessment in the elevator.”
Staff members were prepped and waiting in the cath lab, which provides cardiovascular testing including angiograms, to explore for problems like clogged arteries, and interventions, like stenting, to open those blockages. At Close’s direction, DePue was given IV fluids and his pain decreased, his blood pressure improved, color returned to his face, and he was conscious.
“In the treatment room in the cath lab, I opened my eyes and saw everybody scrambling,” DePue says. “I wondered if there was anything I could do to help. I decided to lie there and breathe.”
Dr. Pir Shah, who specializes in interventional cardiology, assumed DePue’s care from Close. Shah performed an angiogram to determine what was blocking blood flow to DePue’s heart, causing his heart attack. He threaded a catheter through an artery in DePue’s groin and up into his heart. Dye injected into the catheter moved through the artery, highlighting blockages in blood flow. One artery was fully blocked with plaque and another was 75 percent clogged.
“It was a race against time,” says Shah. “It’s like grass in the backyard. If the sprinkler shuts down, you have to repair it before the roots die. We have what we call the ‘golden hour.’ If we are able to open the artery within one hour of chest pain, there will be little to no damage.”
“We inserted a hollow tube in to the coronary artery and, with a vacuum, extracted a clot,” Shah says. “Then we went in with a balloon to open the artery. Because it can recoil when the balloon is removed, we inserted a wire mesh, or stent, to keep it open.”
DePue received four stents in all. Two days later, he was discharged from the hospital, his heart functioning at 95 percent.
It was time to begin the rest of his life, starting with Community Hospital’s Cardiac Rehabilitation program. The medically supervised program is recommended for people who have had a heart attack, heart surgery or an intervention, like DePue’s. Registered nurses, exercise physiologists, and registered dietitians support participants in reducing cardiac risk factors, increasing health and fitness, learning to manage symptoms, and making lifestyle changes.
“The cardiac rehab program was great,” says DePue. “I love those guys. They want you working, rebuilding confidence. I took classes about heart disease and how to tweak my diet, and why exercise is important. I learned that I have a metabolism that can suck cholesterol out of a sesame seed, and I learned I can’t control heredity, but I can control my lifestyle.”
DePue, now 30 pounds lighter, has returned to his daily gym routine and his weekend bike rides and is doing the job he loves, supervising a crew of system operators responsible for all the seawater brought into the Monterey Bay Aquarium.
“If I didn’t go to the gym and know my body, I wouldn’t know what’s normal pain and what isn’t,” he says “and I wouldn’t have called 9-1-1. If you call the doctor every time there’s an ache or pain, you’re a hypochondriac. But I knew something was wrong.”
Anyone experiencing chest pain for more than 10 minutes should call 9-1-1, says Shah.
“With symptoms in the chest, the mind automatically triggers an alarm. But the mistake most people make is to blame it on age, arthritis, digestion, overuse injury,” he says. “Don’t ‘self doctor.’ If you have chest pain, never drive yourself to the hospital. If a heart attack happens while driving, you are in trouble. Call 9-1-1 and wait for paramedics who will help you — and will drive safely.”