Chest pain centers getting st... Health Article
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A new accreditation process could mean better care and fewer misdiagnosed heart attacks.
If you think the “big one” is at hand, where do you want to go? We aren’t talking metaphysics, religion, or earthquakes, but merely asking what hospital you would hope to be taken to if you find yourself having serious chest pain or other warning signs of a heart attack.
Here’s the ideal: a hospital close to you that has an emergency service staffed by clinicians who are experts at telling heart attack chest pain from other types of chest pain and that offers round-the-clock access to artery-opening angioplasty or bypass surgery.
The first part — getting the right diagnosis — doesn’t receive nearly as much attention as does getting the right treatment. Yet it is an equally vital step.
Each year, chest pain or other possible heart attack symptoms send nearly 6 million Americans to the emergency room. Only about 1 million are actually experiencing ischemia (iss-KEY-me-uh) — low (or no) blood flow to part of the heart due to a blood clot or other blockage. The rest have heartburn or other gastrointestinal problems, aches from muscles or bones in the chest, a blood clot in the lungs, pneumonia, anxiety, or one of a host of other problems.
No single test can definitively diagnose or rule out a heart attack. Doctors rely on a patient’s story, an electrocardiogram to pick up the telltale electrical signature of ischemia, and blood tests that can spot early damage to heart muscle.
Although this combination works most of the time, it misses up to 4 in 100 people, who are mistakenly sent home from the emergency room when they are actually in the midst of a heart attack or unstable angina. This is most likely to happen to those who don’t have chest pain or other “typical” heart attack symptoms.
Meeting new standards
Designated chest pain centers can help streamline treatment for people with ischemia and reduce the number of “missed” heart attacks. Such centers bring together emergency room doctors, cardiologists, nurses, paramedics, and emergency medical technicians for a more seamless approach to cardiac care.
The country’s first chest pain center was established in 1981 at St. Agnes Hospital in Baltimore. Since then, more than 3,000 others have sprung up around the country. In an effort to make sure these are true centers of excellence and not just marketing tools, the Society of Chest Pain Centers developed a set of standards and has started accrediting these centers.
To earn the society’s stamp of approval, a center must show that its emergency department and the local emergency medical system work well together; that it can quickly assess, diagnose, and treat people with ischemia; and that it also effectively treats people whose chest pain probably isn’t due to a heart attack or unstable angina. Accredited centers must also have community outreach programs that educate the public about early warning signs of a heart attack.
So far, more than 70 chest pain centers have completed the rigorous accreditation process, including the one at New York–Presbyterian Hospital where former President Bill Clinton was evaluated for chest pain last summer.
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Heart attack warning signs Chest pain and other warning signs of a heart attack can appear out of the blue. Almost as often, though, you get subtle, stuttering hints that there’s trouble brewing. These prodromal symptoms can include burning, aching, numbness, or pressure in the chest that comes and goes, nausea, shortness of breath, pain or tingling in the left arm, sweating, and a general sense of feeling ill, as if you are coming down with the flu. Don’t wait until you feel like an elephant is standing on your chest before calling your doctor or dialing 911. The sooner you check out problems like those listed below, the better your chances of avoiding permanent damage to your heart.
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Planning ahead
It pays to talk with your doctor about the specific steps you should take if you think you are having a heart attack. In that regard, it may also be worth checking to see if a hospital in your area has a designated chest pain center.
You can’t always choose where to go for diagnosis and treatment. Calling 911 is your best and safest bet, and the emergency responders usually follow clear rules about who goes where. In the years ahead, those rules may well include heading for the nearest accredited chest pain center.