I've mentioned before about the superb care the people of London get in respect to heart attacks. They get diagnosed in the ambulance by a twelve-lead ECG, they will then get taken to a specialist centre for the gold standard treatment of an angioplasty. It is excellent and I love it, it improves the patient's outcome and gives us ambulance crews a warm fuzzy feeling to have done something other than pick up a drunkard.
I've had two such cases recently – both of them men in their early forties, both of them not recognising what was happening to them. Neither of them had any sort of medical history, it had just struck out of the blue. Both of them waited before they got treatment.
The first was an Eastern European chap who'd had pain in his chest since the morning, he'd gone to work and feeling unwell waited until his work was finished before walking to the hospital. It was only when the nurses there did the ECG that it became apparent that he was having a heart attack. We were called to 'blue light' transfer the patient to the angioplasty centre. He'd already been transferred to the CCU, so we also had a nurse coming with us. Like all CCU nurses she was excellent with the patient's care, all the paperwork was up to date, she kept explaining things to the patient to keep him informed and she treated us like professionals.
All throughout the patient didn't want to 'be a problem', he'd agree to anything, offered to help us (including walking to the ambulance!) and when he reached the angioplasty centre he told the doctor that they could 'do whatever they want with him'. He kept apologising that his English wasn't too good, but we muddled along fine.
The Consultant who performed the operation told us that once a patient had been through an angioplasty they normally gave up the smoking that nearly killed them. As this was the only risk factor the patient had, and as he was a really pleasant chap, I hoped he would find the strength to give up.
A really nice job.
The second job was picked up from the patient's place of work. Our FRU was already there and as soon as he saw us he shouted across that the patient would need a stretcher. As soon as you laid eyes on him it was obvious that the patient was having a big heart attack. He was sweating, he was clutching at his chest and he was scared that he was going to die. It was a perfect 'Hollywood heart attack'.
We wheeled him onto the ambulance where a very rapid ECG showed a big heart attack. My crewmate put the pedal to the floor while I tried to gather as much information as possible. The chest pain had started a few hours earlier, but the patient had ignored it and driven to work. He also had a phobia about needles, but the angioplasty centre managed to get the required needles into him through a combination of persuasion and brute force.
It's amazing to watch the screens as you see the blood flow return to the heart when the blockage is cleared. To know that the patient's chance of recovery is very good makes you feel that you have done a 'proper' job.
Both of these patients had a 'widowmaker' – a Left Anterior Descending Myocardial Infarction. These are the sorts of heart attack that can cause you to suddenly drop dead. Both were very lucky, despite their waiting to get treatment.
Both of these lives have been saved – but their outcome would probably be better if they had called an ambulance when they first got the symptoms.
Seriously – don't hang around with chest pain. If it's not obviously a pulled muscle (from lifting heavy objects or from coughing too much) then call an ambulance – the worst thing that can happen is that you get effective treatment quickly, the best thing is that you get a clean bill of health.
Oh – and quit smoking and/or taking cocaine.
As a public service announcement here is the British Heart Foundation description of the symptoms of a heart attack
“The most common symptoms of a heart attack tend to be pain in the centre of the chest which can spread to the neck, arm or jaw. It is often associated with nausea and shortness of breath.
“While women can experience the classic symptoms of a heart attack, they often present with more vague symptoms. These include a dull ache or heaviness in the chest, indigestion like pain, or feeling light headed with chest pain.”
You only have one heart, don't take it for granted.
I have the physical manuscript of the American version of Blood, Sweat and Tea – the one where they take out all the letter 'u's. Every page as a column of red copy-edit changes. I don't think that the copy-editor likes ellipsises much either…
What strikes me as amusing is that the American publishers sent me (by FedEx) the printed out manuscript and want me to send it back with my alterations on it. Wouldn't it have been much simpler, cheaper and kinder to the environment, to just email it to me? They want it back in nine days – for the next four 'days' I'm on night shifts. I'm tempted to just fire off an email saying that they can do whatever they want with it.