Know the signs of a heart attack and don't ignore or dismiss them; quick action can be the difference between life and death

Many people who have a heart attack initially ignore the symptoms or dismiss them. For the best chance of survival and preserving heart function, you should not ignore these symptoms, and should get help quickly.

Heart disease is the leading cause of death in the U.S. and Kentucky. Nationwide, it causes about one in four deaths. The age-adjusted death rate from heart disease in Kentucky is 208.2 per 100,000 per year, according to the federal Centers for Disease Control and Prevention.

Below are some questions and answers about the symptoms and treatment of heart attacks and narrowed aortic valves, as reported by Gina Kolata for the New York Times.

How do you know if you are having a heart attack? Most people feel pain, pressure or squeezing in their chest and about one-third of people have symptoms in addition to or instead of chest pain that include abdominal pain, heavy sweating, back pain, neck and jaw pain, nausea and vomiting, Kolata reports. WebMD adds pain that radiates down one arm, indigestion or a choking feeling, extreme weakness, anxiety or shortness of breath, and rapid or irregular heartbeats to the list.

How can you decide if symptoms other than chest pain are actually from a heart attack? If your symptoms come on suddenly, or if they worsen over a period of hours or days, call 911 and get to an emergency room. "The best time to treat a heart attack is within one to two hours of the first onset of symptoms," says WebMD. "Waiting longer increases the damage to your heart and reduces your chances of survival."

Do women have different symptoms than men? "Probably not," Dr. Mary Norine Walsh, vice president of the American College of Cardiology, told Kolata. Walsh noted that women, however, are more likely to delay seeking treatment and doctors are more likely to dismiss their symptoms, especially if the woman is younger.

The American Heart Association says women often attribute signs of a heart attack to the flu, acid reflux or the normal aging process, even though it is the number one killer of women. It also noted that symptoms in women can be subtler, like shortness of breath, upper back pressure that feels like squeezing, lightheadedness or actually fainting.

What should you do if you are having heart attack symptoms? Call 911 for an ambulance to take you to the emergency room immediately. Do not drive yourself and do not have a friend or family member drive you unless you have no other choice. Kolata notes that paramedics are trained to treat heart attacks and are less likely to get stuck in traffic.

How can you find out if your local hospital is able to treat heart attacks quickly? Don't waste time fighting with your paramedic when you are having a heart attack, they will know the best place to take you, Kolata writes.

That being said, some hospitals are faster than others in treating heart attacks, but the time to research this information is before you are in the throws of a heart attack, Kolata writes. To find out this information, she suggest you ask each hospital what its "door to balloon time" is, which will tell you how long it takes the hospital to open a blocked coronary artery with a balloon after you arrive at the emergency room. If they don't have this information, ask if they take certain steps to speed up treatment. For example ask: Do paramedics transmit a patient's electrocardiogram to the hospital en route?; Does the ER doctor read the EKG and send out a single call to summon the cardiology team?; And are the team members on call required to be within 30 minutes of the hospital?

What are the symptoms of a severely narrowed aortic valve? There are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting, according to cardiologists. They also noted that these symptoms are often mistakenly attributed to the normal process of aging.

How can a doctor know if symptoms are caused by a narrowed aortic valve? The doctor will listen  for a heart murmur in the patient’s chest and can order an echocardiogram, which will reveal the narrowed artery and the extent of the damage.

Should everyone with a severely narrowed artery have it replaced? Not everyone should undergo treatment, Kolata reports, so ask your doctor if you are a good candidate. The latest treatment is a transcatheter aortic valve replacement, or TAVR, which allows doctors to replace valves without doing open-heart surgery. High risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement, but sometimes elderly patients whose health is compromised are not good candidates.

Heart attacks are leading cause of death while on the job in Kentucky; being struck by objects is No. 2, and falling is No. 3

Heart attacks are the number one killer of Kentuckians who die on the job, according to a study conducted by the state Labor Cabinet.

The study found that in the last three years, 87 Kentuckians had fatal heart attacks while on the job. Their average age was 52. Ten of them were truck drivers, seven were machine operators and six were maintenance workers.

The study found that 28 of the victims were struck by an object, 19 fell, 17 had transportation crashes, 13 were being caught in or between objects, seven were electrocuted, and one each suffered hyperthermia or suffocation. Eight deaths in the workplace were from natural causes, such as stroke, brain aneurysm and failure of the pancreas.

Kentucky ranks 48th in the nation in cardiovascular deaths, with more than 12,000 per year, a state press release said. “Employers should do everything they can to raise awareness about cardiovascular health, and everyone needs to keep an eye on their blood pressure and cholesterol levels while paying close attention to diet and exercise,” Labor Secretary Larry Roberts said.

The study includes workplaces under the jurisdiction of the Kentucky Occupational Safety and Health Program, and do not include those monitored under federal agencies, such as the Mine Safety and Health Administration or the Federal Railroad Administration.

New cardiovascular inpatient unit opens at UK

UK HealthCare's new 64-bed Cardiovascular Inpatient Unit, one of the largest intensive-care units in the country, accepted its first patients Monday, says a University of Kentucky news release.

"This new unit doubles our capacity to treat Kentucky's sickest heart patients and brings the best technology medicine has to offer right to a Kentucky heart patient's backyard," UK President Eli Capilouto said in the release.

The new unit, located on the 8th floor of the Albert B. Chandler Hospital's new Pavilion A, has 32 intensive care beds and 32 progressive care beds.

Dr. Susan Smyth, medical director of the Gill Heart Institute, told UKNow that the unit "represents an unequaled opportunity to help staff provide patients with the highest standard of care in a technologically advanced healing environment."

One of the unique features of the CV Unit is that it has its own Central Monitoring Service station embedded on the floor, says the release.

"Even though the nursing staff is situated immediately outside a patient's room, they are often away from one patient while helping ambulate another," Smyth said in the release. "Having trained staff monitoring patients in such close proximity provides an extra layer of care."

The unit also has its own imaging suite for echocardiography. This not only minimizes patient transfers for testing, but will open up existing imaging areas for other inpatient and outpatient use, thereby reducing wait times. The Gill Heart Institute performs approximately 25,000 imaging studies each year, says the release.

Additionally, the floor is the first in Pavilion A to use new barcode technology for patient medication administration, which will minimize medication errors. It also offers interactive TVs in every room, with programming available specific to the patient and their heart health needs.

"Patients will be able to access videos describing their condition, their treatment, and education about self-care and healthy lifestyles," Dr. Michael Sekela, surgical director of the Gill Heart Institute, told UKNow. "Once they are home, they will be able to access the same information from their home computer, which should help minimize post-discharge confusion and the readmissions that often result from that."

The unit will continue its longtime policy to ambulate every cardiac patient at least once a day, regardless of their diagnosis or treatment, says the release. This is accomplished by a group of physical therapy students and volunteers caled CATWalkers.

"This new unit brings the highest level of cardiac care available anywhere on one floor, in an environment that's efficient for our staff and conducive to healing for our patients."Dr. Michael Karpf, UK executive vice president for health affairs, said in the release."Combined with the Gill Affiliate Network partnerships, this means patients get the level of care they need as close to home as possible."

Paducah Baptist and Ashland hospitals 'above average' in Consumer Reports' ratings of hospitals for heart surgery

Baptist Health Paducah
(formerly Western Baptist Hospital)

By Melissa Landon
Kentucky Health News

Consumer Reports has reported ratings of hospitals for heart-valve and coronary artery bypass surgery based on hospitals' reports to the Society of Thoracic Surgeons. More than 400 hospitals in 45 states have been rated, based on "medical records showing whether patients survived the procedure and how they fared on other important measures, including complications," the magazine says.

Although more than 1,000 hospitals send data to STS, only 400 allowed it to be shared with Consumer Reports. Of those did, "20 percent (83) were above average, 75 percent (310) were average and 4 percent (18) were below average," the magazine reports. Robbin Cohen, a cardiothoracic surgery professor at the University of Southern California, said the STS has very high standards, so hospitals with average scores do a very good job.

King's Daughters Hospital, Ashland

King's Daughters Hospital in Ashland and Baptist Health Paducah (formerly Western Baptist Hospital) were the only Kentucky hospitals ranked above average for either type of procedure (and in their cases, only for bypasses). King's Daughters recently agreed to a huge settlement with the federal government for doing unnecessary heart procedures.

Four Kentucky hospitals were listed as below average for both procedures: Lourdes Hospital in Paducah and Jewish Hospital, Norton Hospital and Norton Audubon Hospital. Two were listed as below average for bypass and were not listed for valve: Baptist Health Lexington and Baptist Health Madisonville.

Several hospitals near Kentucky were on the list. Mercy Health-Anderson Hospital in Cincinnati was rated below average for bypass and was not listed for valve surgery. In Missouri, Poplar Bluff Regional Medical Center and Cape Girardeau's Saint Francis Medical Center were rated below average on both.

In Tennessee, Nashville's Tristar Centennial Medical Center and Saint Thomas Midtown Hospital were below average on both, but Saint Thomas West Hospital, was above average for bypass and below average on valves. In Knoxville, the Univerity of Tennessee Medical Center and its Fort Sanders Regional Medical Center were below average on both, and Parkwest Medical Center was above average on bypass and below average on valve. Wellmont Holston Valley Medical Center in Kingsport was below average on both, and Johnson City Medical Center was above average on bypass and below average on valves.

The top hospitals in the nation were Baystate Medical Center in Springfield, Mass., Borgess Medical Center in Kalamazoo, Mich., and Cleveland Clinic, which attracts some Kentuckians. To see the full list of ratings, click here.

Study indicates that vitamin D can help prevent early death from cardiovascular disease and cancer

Elderly people with a vitamin D deficiency are more at risk for death from cardiovascular disease and cancer, according to a large-scale study by the Mount Sinai health system of New York and a group of international collaborators, published in the June issue of BMJ, formerly British Medical Journal.

Paolo Boffetta of the Tisch Cancer Institute at Mount Sinai led a collection and analysis of data that showed a significant association between low vitamin D levels and risk of death not only from cardiovascular diseases and cancer in older people with a history of cancer, but death from all causes.

Other studies showed that vitamin D helps prevent issues like hypertension, diabetes and bone loss, but these new findings suggest it might be even more important than previously known. "Going into our study, the effect of vitamin D supplementation on risk of death was not clear," Boffetta said. "Our analysis confirms the protective nature of this substance, especially in elderly patients."

Sunlight, as well as food and supplements, provide vitamin D. Because elderly people generally get less sun, they're more likely to have a vitamin D deficiency. Though researchers don't yet know how much vitamin D is ideal, the study results do argue that people with a vitamin-D deficiency are more likely to die early than those who don't have such a deficiency, Boffetta said.

Researchers use data from eight different studies including 26,018 men and women between ages 70 and 79. During the study, 6,695 participants died—2,624 from cardiovascular diseases and 2,227 from cancer. Participants with the lowest levels of vitamin D had a risk ratio of 1.57, which was double the death risk of the people with high concentrations of the vitamin.

"Vitamin D's protective effect is clear," Boffetta said. "If our results are confirmed in additional studies, it could lead to recommendations for greater vitamin D supplementation in foods and to a better understanding of its role in cancer prognosis." (Read more)