What happens when you have a heart attack?

Consultant cardiologist at University Hospital Waterford (UHW) John O’Dea, explains what happens when you have a heart attack and how long you have to seek medical help.

“The thing that catches the public imagination is: ‘If I have a heart attack, what happens?’ The gold standard of care is a thing called a primary angioplasty.

“A primary angioplasty means coming to the cath lab (where heart examination and procedures are carried out) in a very urgent manner, having an urgent angiogram and having the blockage that’s causing our heart attack opened and potentially having a stent placed to maintain a patent artery [technique to see level of openness].

“So that’s what a primary angioplasty is and that offers the best outcome for the patient,” says Dr O’Dea, who is calling for 24/7 cardiac care in UHW, despite the Herity report which recommends the hospital cuts its existing service which caters for five counties.

“The report is flawed because, on one hand, it doesn’t take in our catchment area and that involves Wexford, Waterford, Kilkenny, and Carlow which is a four to five-county catchment area, coming into one cath lab. With the Herity report, he’s recommending that all such patients go to Cork, regardless of whether they’re nine-to-five or after-hours.”

He says travelling to Cork comes with considerable risk.

“The problem with going to Cork is the distance that has to be travelled. You have your heart attack and they’ll do a thing called a ‘drip and a ship’. A ‘drip and ship’ means they’ll give a very potent blood-thinning medication called thrombolysis, to try and chemically unblock the blocked artery and then they transfer them by ambulance to Cork.

Consultant cardiologists working in the South-East, from left: Dr Rob Landers, clinical director, South/South West Hospital Group; Dr Patrick Owens, consultant cardiologist and clinical lead for cardiology, University Hospital Waterford; Dr Aidan Buckley, consultant cardiologist, Wexford General Hospital; Dr John O’Dea, consultant cardiologist,University Hospital Waterford; and Dr Mark Doyle, consultant in emergency medicine and medical adviser to the Prehospital Emergency Care Council. Picture: Maxwellphotography.ie
Consultant cardiologists working in the South-East, from left: Dr Rob Landers, clinical director, South/South West Hospital Group; Dr Patrick Owens, consultant cardiologist and clinical lead for cardiology, University Hospital Waterford; Dr Aidan Buckley, consultant cardiologist, Wexford General Hospital; Dr John O’Dea, consultant cardiologist,University Hospital Waterford; and Dr Mark Doyle, consultant in emergency medicine and medical adviser to the Prehospital Emergency Care Council. Picture: Maxwellphotography.ie

“Now that’s called facilitated percutaneous intervention. The downside to that is that time is muscle and the longer you’re in transit, the more muscle is dying and the poorer your outcome and the higher the risk of you suffering heart failure or suffering, you know an adverse outcome, be it a full-blown cardiac arrest or death, let’s be honest,” says Dr O’Dea.

He says the worst possible scenario is dying in transit.

“The worst-case scenario is you identify these patients who are at risk, you commit them to a long journey and they die in transit.

“That’s the biggest risk that captures the public imagination. Nobody wants to travel in the back of an ambulance with severe chest pain for two hours while waiting to have the gold standard treatment,” he says.

He also cautions that the ‘drip’ element of the temporary ‘drip and ship’ intervention comes with a risk.

“The other problem with thrombolysis is it carries the risk of bleeding. So it’s a blood thinner that carries a 1% risk of you bleeding into your head.

“So not only do you run the risk of having a negative outcome from your heart attack when you’re transferred by ambulance emergently you only run the risk of a haemorrhage,” he says.

Timeline of events at UHW

  • A cath lab (where heart examination and procedures are carried out) opens in University Hospital Waterford (UHW) in 2008.
  • In April 2013, the lack of a second cath lab in UHW was noted by the HSE as being “a critical clinical risk on its risk register,” said consultant cardiologist at UHW, Dr Patrick Owens.
  • In March 2015, a brief document for a second cath lab for the hospital was submitted to the HSE ‘s national capital steering group.
  • In March 2016, the South/South-West Hospital Group approved the second lab “as a priority”, said Dr Owens, and this was signed off by the CEO. This was sent to the assistant director of estates (the HSE’s infrastructure and property office) and “it was and is queued for funding”, according to UHW’s consultant cardiologist.
  • In May 2016, Niall Herity MD, a director of clinical cardiology in Belfast was asked by the minister for health to undertake an independent clinical review of the provision of a second cardiac cath lab at UHW.
  • The Herity report was published last Thursday and did not recommend a second cath lab.


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