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44 °F Forecast | Road Cams Monday, January 19, 2004 Today's News | Classifieds | Autos | Homes | Jobs | Tempo | Health | Community | Home Delivery SECTIONS Home Page Local News Sports Business Obituaries Life Opinion - Politics AP News Weather Classified Archives Site Map EXTRA Newspaper in Education Personals Movie Times TV Times E The People CLASSIFIEDS Find a Car Find a Home Find a Job Find a Rental Place an ad eSouthernOregon Automotive Communities Entertainment Publications Recreation Calendar CUSTOMER SERVICE Frequent Questions Advertising Information Home Delivery Employment Contact Us Media Kit Network Affiliate Email Story to a Friend December 14, 2003 Carlos Quituqua of Medford and his wife, Colleen, recall his near-fatal heart-attack last July as they prepare to celebrate Christmas. Mail Tribune / Jim Craven A heartfelt idea Heart-attack patients will get the treatment they need more quickly, thanks to a cooperative agreement between local hospitals and emergency services agencies Stories by BILL KETTLER Mail Tribune Carlos Quituqua’s heart stopped twice on the long ambulance ride that saved his life. The Medford man fell ill during a National Guard meeting in Grants Pass last summer. His buddies took him to nearby Three Rivers Community Hospital, where doctors put him on a cardiac monitor, looked at his heart rhythms — and promptly put him in an ambulance bound for Rogue Valley Medical Center in Medford. The instruments confirmed what the doctors suspected — Quituqua (pronounced KIT-uh-kwah) was having a massive heart attack. "Somewhere between Grants Pass and Medford, I flat-lined twice," Quituqua said, recalling that day in July. "I don’t remember any of that." Not so long ago, he might never have left the Grants Pass hospital. Doctors probably would have treated his heart attack with anti-coagulant drugs, hoping to break up any life-threatening clots in his coronary arteries. The drugs usually helped dissolve the clot, but sometimes there were complications. Advertisement Quituqua went to Medford because the four hospitals in Jackson and Josephine counties recently had agreed to treat all heart-attack patients at RVMC, the only hospital in the region where doctors routinely perform a procedure known as angioplasty. Also known as balloon angioplasty, or heart artery dilation, it opens clogged arteries and increases patients’ chances of surviving a heart attack while also reducing the need for cardiac surgery. The procedure starts when doctors insert a hair-thin wire in a leg artery and guide it to the heart, using X-rays and dyes to see inside the circulatory system. The wire holds a tiny balloon that opens up the artery as well as a stent (a hollow stainless steel mesh) that keeps the artery open. The procedure isn’t new. Physicians have had the equipment to do angioplasties locally for 20 years. Only recently have scientific studies shown that angioplasty offers patients the best outcome after a heart attack. Angioplasty works best when it’s done quickly. The sooner a blockage is opened, the sooner life-sustaining blood flows to the heart muscle "downstream" of the blockage, says Dr. Brian Gross, a Medford cardiologist. Gross uses the example of a tourniquet to explain. "If you apply a tourniquet to your arm for 20 minutes, nothing much happens. If you leave it on overnight, your arm dies. "Time is muscle," Gross said. "The quicker you open the blockage, the more (heart) muscle you save." Saving heart muscle gives patients significantly better quality of life after a heart attack. Damaged hearts are fundamentally weaker and more susceptible to problems such as congestive heart failure. Cardiologists realized they could treat patients sooner by sending them directly to RVMC instead of the nearest emergency room. They gave Gross the task of selling the idea to hospitals, ambulance services and fire departments. Gross’s outgoing manner made him the obvious choice for the public-relations mission, says fellow cardiologist Dr. Rick Schaefer. "It’s really his forte. He’s an enthusiastic speaker. He’s effective and infectious." Gross had powerful data to back up the cardiologists’ proposal. Recent research showed heart-attack patients who went straight to angioplasty had dramatically lower death rates than those who were treated with anti-coagulant drugs. A Danish study was particularly compelling: Patients who were transported directly to a cardiac hospital for angioplasty had a death rate of 8 percent, while those who received anti-clotting drugs at the closest hospital died at the rate of 13.7 percent. "That’s a huge difference," Gross said. Hospital administrators realized the new approach could provide better care for heart-attack victims, even though it might cost them some patients — and income. "When we make these kinds of decisions, we try to keep the patient at the center," says Ginny Friesen, director of critical care at Providence Medford Medical Center. Providence has a heart catheterization lab, but RVMC was the obvious site to implement the new protocol because the American College of Cardiology recommends that angioplasty be performed where there is equipment to perform open heart surgery if problems develop. In Southern Oregon, only RVMC has that capability. "It was a very difficult decision," Friesen said. "It was not one we wanted to make. At the end, we kept the patient at the center." Gross said Providence, Ashland Community Hospital and Three Rivers deserve credit for putting patient welfare above economics at a time when hospitals are competing for business. "It’s a difficult time to see patients go away," he said. Ambulance services had to buy into the venture, too, to make it work. To achieve the best results, paramedics have to be able to evaluate patients’ heart rhythms on the road. Sophisticated "12-lead" heart monitor/defibrillators (named for the number of wires they carry) that analyze heart rhythms cost about $25,000 apiece. "We realized it was something we needed to do," said Ken Parsons, general manager of Mercy Flights, Jackson County’s largest ambulance company. "Since the cardiologists and the hospitals were all willing to work together, there was no reason to put it off. We could see that lives would be saved." Parsons noted that several ambulance companies bought equipment together when the manufacturer offered a 30 percent discount for a volume purchase. Even with the discount, Mercy Flights spent more than $250,000 to equip its ambulances with the monitors. Quituqua was one of the first beneficiaries of the new protocol. He’s returned to work at Bear Creek Corp., where he’s a computer systems analyst, and started the long road to regaining his strength and endurance. "It’s hard for his brain to acknowledge that his body can’t keep up," said his wife, Colleen. Since the program started late in June, 48 people have been transported directly to RVMC for angioplasty. As of midweek, none of them had died. "It’s been very gratifying," Gross said. "We can take people who are sicker than stink, in the throes of dramatic instability ... and return them to very active, productive lives." Gross said few Oregon communities have adopted rapid transport for angioplasty on the scale that it has taken hold in Jackson and Josephine counties. He wants Southern Oregon to become a model for other regions — and states — to emulate. "We’d like to try to make Oregon known for rapid treatment of heart attacks," he said. "I think we have an opportunity to do that. We’re a small enough state. We’d like to get every hospital saying, ‘This is the way togo.’ " Reach reporter Bill Kettler at 776-4492, or e-mail [email protected] Since the 1960s, techniques to treat heart attacks have improved greatly As recently as the 1960s, there wasn’t much a doctor could do for a heart attack. Physicians prescribed morphine for the pain and hoped for the best. "You either got better or you didn’t," said Medford cardiologist Dr. Brian Gross. Heart attacks still kill hundreds of thousands of Americans every year, but more people are surviving their initial heart attack these days. The American Heart Association estimates that about 540,000 Americans suffered heart attacks in 2000 (the most recent year for which there is data), and 240,000 people died from them. Another 250,000 people died from "sudden cardiac arrest," in which the heart stops abruptly for no apparent reason. Most of us tend to think of sudden cardiac arrest as a "heart attack" — someone falls over and dies when their heart suddenly stops. But physicians differentiate between heart attack (caused by blocked coronary arteries) and sudden cardiac arrest. Doctors can do little for sudden cardiac death because the heart dies in minutes without oxygen. But the blockages that cause heart attacks generally cut off blood to just a part of the heart. Doctors have time to open the blockage before too much heart muscle dies. Death rates from heart attacks have slowly declined as physicians learn more about how the heart functions. Some treatments that were once highly regarded have been abandoned as research gives physicians more information. "Old thinking gives way to new thinking," said Dr. Rick Schaefer, a Medford cardiologist. "We keep getting new data. As scientists we need to admit when we’ve made an error." During the 1970s, cardiologists realized they could control heart rhythms with drugs. They treated heart attacks with "beta blockers" — chemicals that blocked adrenaline from the heart. Around the same time, doctors began treating heart attacks with aspirin and other more powerful anti-coagulant drugs as well as medicines to stabilize heart rhythms. In the 1980s, research showed that most heart attacks were caused by blood clots in the coronary arteries. "That got physicians thinking about what we could do to get blood clots out of the heart," Schaefer said. That insight led to the broad use of blood-clot dissolving medicines such as streptokinase and other thrombolytic drugs as the standard treatment for heart attacks well into the 1990s. The thrombolytics weren’t without their disadvantages, however, because, in Schaefer’s words, "the medicine doesn’t know the difference between a good clot and a bad clot." Stroke victims and people who were recovering from major surgery or a head injury encountered problems if they used thrombolytics, along with people who had stomach ulcers or abnormal bleeding. "It was clear that the predominant effect of thrombolytics was positive," Schaefer said, "but there were still some very bad complications." Angioplasty (opening an arterial clot with a balloon deployed inside the damaged blood vessel) has become the preferred treatment for blocked coronary arteries because it’s more effective than the clot-busting drugs. Angioplasty has been in the cardiologists’ tool bag since the 1970s, but it took decades to accumulate the research that has made it the tool of choice. "In 1975 it would have been malpractice to take somebody (with a heart attack) into the cath lab (for an angioplasty)," Schaefer said. "Now it’s the preferred therapy." Gross said researchers are looking for ways to prevent clots from forming in the coronary arteries. Those discoveries could displace angioplasty and stents as the treatment of choice. "Stents are beautiful right now," he said. "We’ll look back on them 10 years from now and call them the dark ages." On the Web: www.the-heartclinic.com www.americanheart.org/ Mail Tribune Home Local News | Sports | Business | Obituaries | Life Opinion - Politics | AP News | Archives | Site Map E Southern Oregon | Classified Copyright © 1997-2004 Mail Tribune. All rights reserved. Privacy Policy | Terms & Conditions Website Feedback 3 WEEKS FREE! ADVERTISERS A D V E R T I S E R S RESOURCES Oregon Road Conditions & Cams SPECIAL SECTIONS Auto Finder Job Finder Home Finder Joy Magazine Homelife Magazine Tempo Readers' Choice Real Estate Showcase Since We Asked Food for Thought Wellness Connection Outdoor Journal Moving to Southern Oregon? Volunteer Opportunities Prime Times