By Matt Roy
Twitter: @AzNewsmedia

The novel coronavirus has stoked fears around the globe and closer to home with more than 39,000 cases and 1,200 deaths confirmed in Arizona as of Tuesday, June 16, according to the Arizona Department of Health Services.

A healthy fear of infection may help motivate safe, preventative behaviors, including social distancing, wearing face masks and gloves, and frequent hand washing.

But that same fear may also promote less healthy choices, such as avoiding care for other serious and life-threatening conditions — such as heart attack.

Sandi Davis, a registered nurse and director of the emergency department at Banner Del E. Webb Medical Center in Sun City West, explained the risks of waiting to call for help during a heart attack.

“Everyone’s afraid to come in because they’re afraid to get COVID,” Ms. Davis said. “Don’t be afraid to come, please come in.”

She cited recent cases, where patients waited far too long to seek help and, unfortunately, paid the price with their lives.

“Since COVID has occurred, we’ve had a couple of patients that waited too long after having chest pain. One of them was three days and the other waited like 10 days,” Ms. Davis recounted. “One of them, as soon as she got here, she coded and she died. The other came in and we saved him, but he died later. It can cause so much damage to the heart that we can’t save it anymore.”

Catch the signs early

The American Heart Association echoed her concern, noting COVID-19 fears as a national problem preventing some from seeking help and explaining the urgency in a brief video posted at their website, heart.org.

“Heart attacks and strokes don’t stay home. So, don’t avoid the ER out of anxiety. Don’t die of doubt. If you have an emergency, call 9-1-1. When seconds count, the hospital is the safest place to be,” the video stated.

According to information published at the website, while some heart attacks are sudden and intense, many times the symptoms start more slowly, with mild pain and discomfort — even if mild, the symptoms should not be ignored.

While individual experiences of heart episodes may vary widely, some typical symptoms include:

• Chest discomfort: most patience experience discomfort in the middle of their chest that lasts longer than a few minutes and may come and go, including a sense of uncomfortable pressure, fullness, squeezing and pain. The pain and discomfort can appear in other areas, as well, including one or both arms, stomach, neck, jaw and back.
• Shortness of breath: This symptom may come alone or along with chest discomfort or pain.
• Other signs: Breaking out in a cold sweat, nausea or lightheadedness are also possible.

IMPORTANT: Anyone experiencing chest pain or shortness of breath should seek immediate medical attention.

Timely treatment needed

Tareq Khawaja, MD, director of Banner Del Webb’s cardiac catheter lab — or cath lab, as they call it — reiterated the need for prompt attention and treatment.

“We continue to put our focus on timeliness, in terms of how we get that patient through the emergency room and into the cath lab,” he said. “There’s a mantra that ‘time is muscle,’ when it comes to heart attacks. And the longer it takes, the more damage to the heart muscle there will be.”

The cath lab provides first-line treatment via a laparoscopic procedure, during which a catheter is inserted into the groin or wrist area, so doctors an clear clots in the blood vessels bringing blood to the heart muscle, Ms. Davis explained.

“They literally put a catheter in your groin or in your wrist and it goes into your artery and right to the heart itself and into the vessels on the outside of the heart,” she said. “There’s a balloon they use to open up the clogged vessel and restore blood flow to the area.”

She described the time it takes to get a patient entering the ER to completing the procedure as “door to balloon time,” which is crucial to prevent death or long-term damage to the heart.

“That’s why it’s so important to recognize a STEMI, get them in and get them up there as quickly as possible or they will die,” she added.

STEMI refers to patients who show certain symptoms on an EKG, which indicate that blood flow to the heart has been compromised. Without quick action to restore flow, patients can die or suffer permanent damage.

Because of that, everything first responders and hospital staffers are trained to do after a potential STEMI patient calls for help is designed coordinate and streamline the effort to get them to the catheter lab, Ms. Davis explained.

“This is where calling 9-1-1 is so helpful, because the ambulance crew, as soon as they get there, they immediately do a 12-lead EKG,” she said. “The 12-lead EKG is automatically transmitted to our hospital so our doctors can see it before the patient ever gets here.”

Being able to accurately diagnose the patient en route to the hospital helps staffers prepare, so the patient can get life-saving procedures that much faster. Once the patient arrives at the ER, they may get a second EKG and other assessments and moments later will be rushed into treatment.

“Literally, within minutes, we’ve done our assessments and anything else he needs and cath lab team comes down, takes him and he goes upstairs,” she explained.

By way of example, she shared once such case just last week, where a 46-year-old man came into the ER with STEMI symptoms and was in the lab getting the cardiac catheterization procedure in just 8 minutes, she said.

COVID concerns & prevention

Dr. Khawaja explained hospitals, in Arizona and nationally, have instituted protocols to keep patients safe from COVID-19 exposure, based on direction from the Centers for Disease Control and Prevention.

“The additional precautions that are now mandated by the CDC, we follow those,” Dr. Khawaja said. “So, when the patient first arrives, we are assuming that based on their assessment they have a certain risk of already either having been exposed to the virus, or not exposed, or being actively infected with the virus.” 

He said staffers are prepared to assess and separate every patient who comes to the hospital, regardless of what symptoms bring them in.

“If somebody shows up with a high-grade fever, for example, or cough, muscle aches, and they’re also, by the way, having a STEMI, it puts them in a different category from somebody younger, healthier with absolutely no symptoms otherwise to suspect a viral infection and they show up with a STEMI,” Dr. Khawaja said. “So, we have a way of identifying patients ahead of time.”

Ms. Davis said Banner Del Webb has created a virtual dual-track process, which keeps patients safely separated throughout intake, diagnosis and treatment.

“We’ve totally separated our processes — we have a COVID side and a non-COVID side,” she said.

As soon as a patient arrives, either by ambulance or by car, they are immediately and carefully screened to determine which side of the ER they are taken into, Ms. Davis explained.

“At our ER we’re fortunate enough to be able to separate out a section, so there are certain rooms where we only put COVID patients, they all have doors on them, and they’re all set up for special infection prevention purposes. And then we have other sections of our ER where we take everyone else,” she explained.

She said most ERs locally and nationally have instituted similar protocols to be able to treat the “usual” flow patients simultaneously with coronavirus patients, while preventing spread of the infection.

“We’re still able to do our processes and handle COVID patients safely, too” she added.

Learn more at heart.org and cdc.gov.