Heart attack

One man's tale of survival

Dave Emberley's decision to call 911 as soon as he realized he was having a heart attack may have saved his life
Dave Emberley's decision to call 911 as soon as he realized he was having a heart attack may have saved his life.
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Heart attack information

Winnipeg Health Region
Wave, January / February 2016

Seven weeks ago, life was looking pretty good for Dave Emberley.

The 64-year-old Winnipeg man had been retired for about 8 1/2 years, following a 37-year career in aerospace with Boeing Canada.

Retirement meant that Emberley could spend more time with his wife, Heather. And it also gave him more time to pursue some of his other hobbies and interests.

For example, he instructed a variety of aerospace manufacturing classes at Red River College's Stevenson Aviation campus.

He also enjoyed racing and working on cars. He once helped rebuild a 1962 MG Midget racer, which he later drove at Gimli Motorsports Park, and he liked to crew for friends who vintage race at Road America in Wisconsin. He was also in the process of restoring a 1971 MGB sports car that he purchased in 2005.

Emberley also enjoyed serving as a coach at blind golf tournaments. He travelled throughout Canada and the United States with his visually impaired friend, acting as his eyes on the golf course.

And then there were the family trips. He and his wife had been planning a West Coast trip to visit their sons, one a California-based cancer specialist and father of their twin grandchildren, the other a hospital physiotherapist in British Columbia.

He also had plans to drive the Alaska Highway with his octogenarian father to retrieve vintage airplane parts as part of their volunteer work with the Royal Aviation Museum of Western Canada.

Life for Emberley was gratifying and full. And then things changed.

One day in late November, Emberley started to experience a bit of heartburn.

"I was instructing that day at Stevenson," he says. "I felt a burning in my chest. Thought it was heartburn. I took some Pepto Bismol. The feeling went away."

Five days later, as Emberley was putting up the Christmas lights on his house, the chest pain came back. He started to wonder: was he having a heart attack?

Emberley immediately dropped what he was doing and went online to check out the symptoms of a heart attack. It didn't take him long to ask Heather to call 911. And it is a good thing he did.

As it turns out, Emberley was having a STEMI heart attack, a potentially fatal condition that is triggered by a blockage in the arteries that cuts off the supply of blood to the heart.

Statistics show that in 2014/15, 687 people were treated for a STEMI heart attack at St. Boniface Hospital, which is the Winnipeg Health Region's centre for cardiac care. Of those, 24 died in hospital.

Fortunately, Emberley would not end up being one of those statistics. Instead, he joined a growing number of Winnipeggers who suffer a heart attack and survive.

That he did so can be largely attributed to two things: First, he was able to recognize the warning signs of a heart attack and call for help. Second, he benefitted from Code STEMI - a rapid treatment and transportation system for patients suffering from a heart attack. 

The STEMI acronym refers to an ST segment elevation myocardial infarction, the most common type of heart attack, according to Drs. Davinder Jassal and Ali Khadem, who are cardiologists with the Winnipeg Health Region's Cardiac Sciences program at St. Boniface Hospital.

They say that people suffering these types of heart attacks will often make the mistake of waiting too long before calling for help or trying to make it on their own to a hospital emergency department. The right thing to do, they say, is to call 911, which results in the immediate dispatch of trained paramedics who can begin the diagnosis and treatment process right on the scene.

In fact, Jassal and Khadem say Emberley's chances of surviving his heart attack improved dramatically as soon as his wife placed a call to 911, triggering the Code STEMI protocol.

Within a few minutes, paramedics were in Emberley's living room, hooking him up to an EKG, which took a reading of his heart. The results were sent via a secure server to Khadem, who was the cardiologist on call that night.

In Emberley's case, Khadem says there were a couple of scenarios that could have played out. The first would have seen him transported to a hospital emergency department if it was not clear on the EKG that he was having a heart attack. If the EKG did confirm that he was having a heart attack, he would have been given medication and transported to the Bergen Cardiac Care Centre.

In Emberley's case, the EKG reading showed that his heart was labouring. Khadem instructed the paramedics to administer heparin - a blood thinner - and transport the patient to the catheterization lab at the Bergen Cardiac Care Centre.

"In all cases, as soon as I hang up with the paramedics, I call internal paging here at St. Boniface," says Khadem. "I tell them to activate Code STEMI."

As Emberley arrived at St. Boniface on a Sunday evening, the medical team was paged to the cardiac catheterization lab. 

Once inside the lab, Dr. Malek Kass performed a dye test angiogram on Emberley. An angiogram is an X-Ray in which a dye is inserted into the coronary arteries by way of a catheter.

 By following the injected dye through Emberley's arteries, the interventional cardiologist was able to pinpoint the source of the blockage. A catheter was carefully inserted in Emberley's wrist, and advanced up an artery until it reached the blockage.

He then performed a balloon angioplasty, by inflating a small balloon in the tip of the catheter. Inflating the balloon expands the area around it and compresses the plaque buildup (or blockage). The inflated balloon also expands the artery wall. A metallic alloy tube, called a stent, was implanted to keep the artery wall expanded. The stent was initially inserted along with the balloon catheter, expanding when the balloon was inflated, and left behind in the expanded position as the balloon catheter was removed. 

About 95 per cent of patients undergoing balloon angioplasty will receive a stent in one coronary artery, and five per cent will receive more than one, says Jassal.

"Patients come to us, feeling like they have an elephant sitting on their chest," he says. "But once we get their artery open, and blood flowing again, they almost immediately feel much better."

The Code STEMI program has been very successful in saving lives. In 2006, the mortality rate for people treated for a STEMI heart attack within the Region was one in 10. By 2015, the rate had fallen to one in 30, according to Jassal.

The reason for the improvement can be attributed to the time saved in diagnosing and treating patients.

"Prior to this, patients would have been transported to the nearest hospital, be it the Grace, Victoria or Seven Oaks, where they would undergo an EKG in the emergency department, wait for the results, and then either have drugs administered if they were deemed to be having a heart attack or transferred emergently to St. Boniface Hospital," says Jassal, Medical Director of St. Boniface Hospital's Coronary Care Unit.

As he explains, the problem with this process was that it wasted valuable time. When the heart is deprived of blood flow, it starts to die for lack of oxygen.

"I tell everyone that time is muscle, when it comes to treatment. The sooner they receive treatment, the better."

Jassal uses the example of a 52-year-old male who suffers a heart attack while working out on a treadmill and is immediately transferred via ambulance to the Bergen Cardiac Care Centre and sent for an urgent angiogram.

"Once we get him, do the dye test, angioplasty and stent, only 32 minutes will have elapsed," he says. "He has done the right thing, and not delayed treatment."
Compare that to the same 52-year-old man who gets chest pain, pops some Tums and tries to ignore the pain.

"Three a.m. comes around, and he has crushing chest pain. This might be nine or ten hours after he first started experiencing the heart attack. That's nine hours during which his heart had reduced blood flow," he says. The second man's heart might only have 50 per cent of normal pumping capacity for the rest of his life, says Jassal. This patient would probably become short of breath during any exercise, and would have to be monitored for health complications such as fluid in the lungs and swelling of the legs.

As crucial as it was for Emberley to get to the hospital and have stents inserted into his arteries, the procedures marked just the beginning of his journey to recovery.

Following his cardiac procedure, Emberley was then moved to the cardiac care unit ward on the fifth floor of St. Boniface Hospital. There, nursing staff monitored his vital signs, a pharmacist introduced him to the medications he would be taking, and physiotherapists got him up and walking in order to maintain mobility. As well, a dietitian spoke to him about making changes in the food he eats.

In time, Emberley started to feel much better - well enough to joke about his condition. "I didn't get to see it," he says of the surgical work. "I missed the whole thing until they woke me up and told me I snored."

Emberley's light-hearted attitude toward his treatment and post-attack recovery comes from his belief that life is for living and enjoying.

"I like to think that I'm on an adventure, and now it's continuing, all thanks to the paramedics and the wonderful hospital staff. They're amazing," he says.

Still, he knows things will be different going forward. "My lifestyle has to change," says Emberley. "I can no longer wear the Superman cape with the big "S" on it. I am mortal."

Along with keeping up his sense of humour, Emberley was told to watch what he eats, watch his alcohol consumption and exercise more. "I've always been active, but I need to step it up a little more," he says, adding that he'll be on blood thinners and blood pressure pills for the rest of his life. "I used to bike, so maybe that's something I should take up again. But it's hard to walk, when you drive fast cars," he says, referring to his hobby of car racing.

Most patients, if they progress without complications, are discharged two to three days after their angioplasty, says Jassal.

Upon discharge, they are referred to their family physician, and given a summary of their treatment at the hospital, the results of their tests, new medications and a health-care plan.

"We also set up appointments for them to see us at regular intervals up to two years after their heart attack," says Jassal.

Patients are also referred to a cardiac rehabilitation program, either at the Wellness Institute at Seven Oaks Hospital or the Reh-Fit Centre. Cardiac rehabilitation is an education, coaching and supervised exercise program to help heart patients restore their heart health after a heart attack, surgery or other heart-related problems.

Although heart attacks can strike anyone, there are steps you can take to reduce your risk, says Jassal.

"Seventy-five per cent of our patients fit a certain profile," he says. "They fit into one of the five risk factor categories. These include a history of smoking, diabetes, high blood pressure, high cholesterol or a family history of heart attack."

The other twenty-five per cent don't have one of the risk factors, and Jassal says research is underway to find out why people who take care of their health are still facing heart attacks.

"For the majority of people, prevention is the key. What we do here doesn't cure heart disease. Angioplasty is like a band-aid after you get a cut," says Jassal. "It's up to people to do all the things needed for a healthy heart: exercise, eat a healthy diet, don't smoke, don't drink too much and keep your cholesterol and blood pressure levels low."

Susie Strachan is a communications specialist with the Winnipeg Health Region.

Wave: November / December 2015

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Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.

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