Delays a killer for heart patients

DUE to red tape and a dire lack of emergency transport services which delay referrals from general practitioners, heart attack patients outside of Port Elizabeth are not getting to hospital in time for cardiologists to help them, two of the city's prominent cardiologists said yesterday.

They said that in some areas of the Eastern Cape there was a severe lack of emergency vehicles.

Cardiologist Dr James Potts said he and Dr Jacques du Toit had just completed a trip around the western part of the Eastern Cape to talk to general practitioners and investigate the barriers between heart attack patients and the specialist teams at Life St George's Hospital who can help them.

The cardiologists at the hospital cover this region.

"We wanted to make sure that we and the GPs and local hospitals are all on the same page when it comes to the treatment of heart attack patients," he said.

Potts said he had found that one of the places with the fastest response times was Jeffreys Bay, unlike the much closer Uitenhage. "Uitenhage was very slow in getting patients to specialist teams. We can get a patient from Jeffreys Bay into the hospital for help faster than from Uitenhage," he said.

"We found that in areas like Cradock and Somerset East there is a dire lack of emergency vehicles. People get to their doctor fast enough because it is a small town ... but then, more often than not, an ambulance must be sent from elsewhere to take them to hospital.

"This takes too long. This is making it very difficult for us to get patients to the hospital in time. You cannot put an unstable patient with severe chest pains in the family car and take him to hospital," he said.

Between him and Du Toit, Potts said, there was always a cardiologist on duty. "We are very active in trying to get patients to the hospital early with heart attacks and chest pain.

"While we realise that not all chest pain is cardiac-related, we see many cases where patients sit at home [and] ignore symptoms, thinking they have indigestion – it isusually their wives whoprompt them to seek medical attention."

Ironically, Potts said, their best patients were those who had had heart attacks before.

"They get to us early as they know what a heart attack feels like."

If patients could get access to treatment within an hour or two, he said, their outcome was greatly improved.

"Fewer patients die. More live and there is less damage to the heart. Time is heart muscle saved.

"We have improved our speed of intervention by mobilising our teams to open arteries as fast as we can, but we need public awareness, education on a large scale, to improve the time from when the pain first occurs to when patients get to the hospital."

Potts said the maximum time in which to respond was six hours.

"I want to stress though that the earlier the better. The later the worse it is," he said.

"If a patient takes longer than six hours to get medical help, the damage can, in most cases, not be reversed."

Du Toit said they saw a high incidence of heart problems in the greater Port Elizabeth area.

"There are some hereditary cholesterol conditions but we also see a lot of lifestyle diseases causing heart problems," he said. "It also baffles me that so many people are still smoking even though they know this can cause heart problems."

Du Toit said that through catheter surgery they could open arteries very fast, often within 15 minutes, and remove blood clots or widen blocked arteries through a stent.

"It is a minimally invasive procedure done under local anaesthetic. "

In addition to stents and balloon (angioplasty) therapy they could also use rotational atherectomy to open calcified coronary lesions in the heart using a high speed rotating burr, he said. - Estelle Ellis