Saturday, 12 September 2009


The image above may look to the non-medically trained like a road map of the Himalayas. To the medically trained it'll look like something all together different. This is a sick heart. This is a myocardial infarction. Or in plain-speak: a heart attack.
Going to bed after a heavy meal is apparently no good for you, or so Pat claimed. That's why normally he'd have his main meal of the day at lunch time, and only a small dinner. Tonight was different. He'd gone out for a meal, and it would be an otherwise squandered opportunity if he didn't eat well whilst someone else did the cooking and clearing. As Pat and his partner were getting ready to leave, he felt a little discomfort. Indigestion. Must be. One.

They went home, watched some television, and got ready to go to bed. Pat decided that a glass of milk just before bedtime would ease the indigestion that had now been bugging him for the last two hours. Two.
His partner was starting to get a little nervous that the dull burning sensation was still there, so decided that maybe it'd be a good idea to call an ambulance.

Good plan.
Out of the kindness of my heart (as well as the weightlessness of my wallet), I'd decided to do an overtime shift on a real ambulance. Abandon my solo car for the night, and join Lou, the contender for my "Station Insomniac" crown. She's the sort of person who when you first meet seems a little matronly, but is actually just the sort of crewmate you need when it's all going wrong and all your patients turn out to be quite ill. It would be a night full of surprises. Pat was one of them.

When we arrive at his house, we're greeted by another paramedic on a FRU. Nice to be on the other side of the handover for a change. Pat looks well, is calm, not sweating, not feeling sick. He's a fit man in his early 60s, not seen a doctor for years, not on any medication, and the most serious illness he's had was a bad flu about five years back. And the fact that he's a smoker. Three.
His basic observations show a normal pulse, a normal blood sugar, excellent oxygen levels, and a very high blood pressure. Four.
He's still playing down the burning sensation as a bad case of heart burn, although he's a little concerned about the fact that his left arm feels heavy. Five.
Five warnings. Five danger signs.
Eventually he relents to an ECG (or EKG for our friends across the water). What printed out was the one at the top of this post. Lou and I step up a gear and a flurry of activity follows. We tell Pat what's happening. Drugs are administered, cannula inserted, bloods taken, repeat ECGs done, priority message placed to the hospital to make sure that they were all awake and ready to perform the angioplasty that would save Pat's heart from further and potentially fatal damage.
As we open the back of the ambulance at the hospital, before we've said a word to the staff who regularly greet us, I hand the ECG to Al, the cardiologist, and I could swear I see a glint in his eye. Even if it is 3am. This is one of the things they live for. Diagnosing heart attacks and delivering patients directly for emergency angioplasty is probably one of the best innovations in the ambulance service in recent years, and these cardiac experts are clearly a major and enthusiastic part of this innovation.
Al's first words to the patient are praise for us. "They got it right, sir. You're having a heart attack". Now I know that looking at the ECG it'd be hard for any trained medic worth their salt to get it wrong, but it's still nice to hear from another medical professional. Pat's wheeled in to the theatre, attached to the monitors, and prepared for the procedure. Whilst all that's happening the consultant walks in. He turns to Pat, takes one look at the ECG and says "These guys got it spot-on, they said that we need to fix your heart, and they're right". That's twice we've been complimented, which we like, but it had better not happen a third time, or our heads would be too big to fit back in the ambulance...
Pat successfully undergoes the procedure and should be out of hospital within a few days. With a little rest, a few life style changes and the right medications he should be able to get back to normality in a relatively short time. All in all, a good result.
And we got a pat on the back to boot.


Tazambo said...

I had a patient with an ECG very much like that about 2 months ago.

My pt arrested 4 times (3 with me) prior to getting stented. He had a proximal LAD occlusion (the widowmaker).

He made a full recovery.

Sean said...

Really enjoyed the blog. Great insights and observations

flobach said...

Good work, nice to see when a chain works smoothly.
I'm sure one day I will be working in a service that has 12 lead ECGs...